Hepatic Function Tests

Liver function tests

Groups of laboratory blood assays designed

to give information about the state of a
patient's liver
 1) Synthetic function
A) Plasma proteins:
 Total protein = 6.5 – 8.5 g/dl
 Serum albumin = 3.5 - 5.5 g/dl
 Globulins = 2-3 gm/dl
 A/G ratio = 1.5-2 : 1
Valid in chronic not acute illness.
 Synthetic function
 Coagulation factors:
Vitamin K dependant (2,7,9,10)
Tested by prothrombin time and concentration
(PT 10-13 sec, INR=1)
Valid in both acute & chronic illness.
Prolonged in vit k def.
 2) Transaminases
 Alanine transaminase (ALT) = Serum
glutamic pyruvic transaminase (SGPT):

 Normal value = 5-30 IU/L.

 It is an enzyme present in hepatocytes (cytosol).
 It leaks this enzyme into the blood, when the cell
is damaged.
 Transaminases
 Aspartate transaminase (AST) = Serum
glutamic Oxalacetic transaminase
(SGOT):

 Normal value = 8-40 IU/L.

 Less specific and less sensitive than ALT.
 Transaminases
 Value of ALT & AST:

 Highly sensitive in acute damage.

 In chronic liver disease, cholestasis.
 Prognostic value.
 ALT level is more specific and more sensitive
than AST level.
 Transaminases
 Alkaline phosphatase (ALP):
 Normal value = 40-180 IU/L.
 It is an enzyme in the cells lining the biliary ducts
of the liver in addition to bone and intestine .
 Rise markedly with large bile duct obstruction,
intrahepatic cholestasis, infiltrative diseases and
space occupying lesions of the liver .
 It show moderate elevation with acute or chronic
hepatocellular affection
 Transaminases
Gamma glutamyl transpeptidase (GGT):

 Normal value = 10-50 IU/L.

 Although reasonably specific to the liver and a
more sensitive marker for cholestatic damage
than ALP, they may be elevated with even
minor, sub-clinical levels of liver dysfunction .
 3) Evaluation of biliary tract
 Serum bilirubin:
 Total serum bilirubin 0.2-1 mg/dl.
 Direct bilirubin normally <0.2 mg/dl.
 Direct vs indirect hyper-bilirubinemia.
 Bilirubin in urine:
 Normally it is absent.
 It is present in cases of cholestasis and
hepatocellular affection.
 Evaluation of biliary tract
 Urobilinogen in urine:
 Normally 0.5-2.5 mg/day.
 Increases in hemolysis and hepatocellular and
decreases in cholestasis.
 Strechobilinogen in stool:
 Normally 50-250 mg/day.
 Increases in hemolysis and decreases in
hepatocellular and cholestasis.
 4- tests depending on fat
metabolism
 Serum cholesterol:

 Normally 150-200 mg %.
 ↑↑↑with cholestasis and ↓ in acute liver disease.