In jaundiced patients with hepatobiliary disease

Part of direct-reacting bilirubin fraction includes conjugated

ALT (SGPT) – found in cytochrome

Alkaline Phosphatase

AST-

injury severe enough to produce jaundice

Typically aminotransferases > 500 U/L

ALT > AST

Jaundice from cirrhosis

Normal or only slight elevations of aminotransferases

Remember in cirrhosis you have already fibrotic liver so the population of liver cells is
diminished thus few enzymes will be released.

AIDS cholangiopathy

Patients usually present with greatly elevated serum alkaline phosphatase levels,
mean of 800 IU/L, but bilirubin often is near normal

Albumin and Prothrombin time

Perform in all jaundiced patients to assess liver function

Low albumin

Suggests chronic process such as cirrhosis or cancer

Normal albumin Hepatocellular process

Generally disproportionate rise in aminotranferases compared with alkaline

phosphatase

Cholestatic process

Disproportionate rise in alkaline phosphatase compared with aminotransferases

Degree of aminotransferase elevation

Occasionally helpful in differentiating between hepatocellular and cholestatic process

ALT and AST values < 8 times normal may be seen in either hepatocellular or
cholestatic liver disease

Values ≥ 25 times normal seen primarily in acute hepatocellular diseases

Alcoholic hepatitis

AST:ALT ratio typically at least 2:1

AST rarely exceeds 300 U/L

Suggests more acute process such as viral hepatitis or choledocholithiasis

Elevated prothrombin time indicates either

Vitamin K deficiency due to prolonged jaundice and malabsorption of Vitamin K or

Significant hepatocellular dysfunction

Failure of prothrombin time to correct with parenteral administration of vitamin K

indicates severe hepatocellular injury.

Most important is albumin

It denotes a chronic illness

Half-life is 120 days, note that if it goes down, it indicates that the liver is not producing
enough