LIVER FUNCTION

TEST
BY
KRISHNAKUMAR M S
INTRODUCTION:

▪ Each organ of the body has to perform its biochemical

functions to keep the body, as a whole, in a healthy state.
▪ This is possible only when the cells of the organ are intact
in structure and function. Any abnormality in the tissue,
caused by exogenous or endogenous factors, will
seriously impair the organ function which, in turn,
influences the health of the organism.
▪ Liver performs several diversified functions. It is the
central organ of body’s metabolism.
MAJOR FUNCTION OF LIVER:

▪ Metabolic functions : Liver actively participates in

carbohydrate, lipid, protein, mineral and vitamin
metabolisms.
▪ Excretory functions : Bile pigments, bile salts and
cholesterol are excreted in the bile into intestine.
▪ Storage functions : Glycogen, vitamins A, D and B12
and trace element iron are stored in liver
▪ Protective functions and detoxification : Kupffer
cells of liver perform phagocytosis to eliminate foreign
compounds. Ammonia is detoxified to urea. Liver is
responsible for the metabolism of xenobiotics
(detoxification).
▪ Hematological functions : Liver participates in the
formation of blood (particularly in the embryo),
synthesis of plasma proteins (including blood clotting
factors) and destruction of erythrocytes.
CAUSES OF LIVER DAMAGE:

Hepatocellular damage may occur due to viruses

(hepatitis A virus, hepatitis B virus), toxins (carbon
tetrachloride, aflatoxin), alcohol, hepatocellular
carcinoma, autoimmune hepatitis etc
SYMPTOMS:

▪ Abdominal (stomach) pain.

▪ Dark urine (pee).
▪ Fatigue (feeling tired).
▪ Itching.
▪ Jaundice (yellowing of your skin or eyes).
▪ Light-colored stools (poop).
▪ Loss of appetite.
▪ Nausea and vomiting
LIVER FUNCTION TEST’S(LFT):

The major liver function tests may be classified as

follows,
1. Tests based on excretory function :
Serum bilirubin, Urine bilirubin, Urine bile salts,
bromosulphthalein (BSP) dye tests.
2. Tests based on Detoxification function:
Blood ammonia, Hippuric acid test.
3. Tests based on synthetic function:
Plasma proteins, albumins, globulins, and prothrombin.

4. Tests based on metabolic function:

Galactose tolerance, antipyrine clearance

5. Tests based on serum enzymes :

Determination of transaminases, alkaline phosphatase, 5’-
nucleotidase, J-glutamyltranspeptidase
 TEST BASED ON EXCRETORY FUNCTION:

BILIRUBIN:
 Bilirubin is a bile pigment, and is the excretory end product
of heme degradation.
 It is conjugated in the liver to form bilirubin diglucuronide,
and excreted.
 Bilirubin is insoluble in water but bilirubin diglucuronide is
soluble in water
▪ Bilirubin exist in two forms they are.
▪ Conjugated or Direct Bilirubin which is water
soluble
▪ Un conjugated or Indirect Bilirubin which is water
insoluble
The normal concentration is,
▪ Total serum bilirubin - 0.2-1.0 mg/dl.
▪ Conjugated serum bilirubin - 0.1-0.4 mg/dl
▪ Unconjugated serum bilirubin - 0.2-0.7 mg/dl
Icterus index

▪ This is a simple test to measure the yellow colour of

serum due to bilirubin. It is rather crude and almost
outdated. However, it is often useful for a rapid
assessment of neonatal jaundice
SERUM BILIRUBIN ESTIMATION BY VAN DEN
BERGH REACTION:

▪ This is a specific reaction to identify the increase in

serum bilirubin (above the reference level). Normal
serum gives a negative van den Bergh reaction
▪ In this reaction when serum bilirubin is allowed to
react with van den bergh diazo reagent ( sulfanilic
acid and sodium nitrate in HCL) a purple coloured
azobilirubin is formed
▪ Conjugated bilirubin being water soluble can react
directly with aqueous solution of diazo reagent and
so called direct bilirubin
▪ Unconjugated bilirubin is water insouble and does
not react in aqueous solution. It requires addition of
methyl alcohol to react with diazo reagent in the
determination method and called indirect bilirubin.
▪ If the serum contains both unconjugated and
conjugated bilirubin in high concentration, the purple
colour is produced immediately (direct positive) which
is further intensified by the addition of alcohol (indirect
positive). This type of reaction is known as biphasic
 Clinical interpreation:

▪ This reaction is highly useful in understanding the nature of

jaundice.

▪ This is due to the fact that the type of jaundice is

characterized by increased serum concentration of
unconjugated bilirubin (hemolytic), conjugated bilirubin
(obstructive) or both of them (hepatic).
Therefore, the response of van den Bergh reaction can
differentiate the jaundice as follows,
Hemolytic jaundice (Prehepatic) : Indirect positive
Obstructive jaundice : Direct positive
Hepatic jaundice : Biphasic
URINE BILIRUBIN:

▪ In normal individulas, bilirubin is not excreted in

the urine, when it present in the urine it indicates
some disease of the liver
▪ Only conjugated bilirubin is soluble in water and is
excreted in urine but not the uncojugated which is
water soluble
▪ In urine conjugated bilirubin can be detected by
Fouchet’s test.
Clinical Interpretation:

▪ Conjugated bilirubin appears in urine of patients in

obstructive hepatic jaundice.
UROBILINOGEN IN URINE:

 The amount of urobilinogen present in the urine

depends on the amount of bilirubin entering the
intestine.
 Urine urobilinogen is estimated by ehlrich’s
aldehyde test.
Clinical Interpretation:

▪ Normally trace amounts of urobilinogen are present in urine.

▪ An increase in urobilinogen in urine is found in hemolytic
jaundice due to excess production of bilirubin
▪ In hepatits the urobinogen in urine may be normal or
decreased
▪ In obstructive jaundice due to the complete or almost
complete biliary obstruction no urobilinogen is found in
urine because bilirubin is unable to enter the intestine
TEST BASED ON DETOXIFICATION
FUNCTION:

DETERMINATION OF BLOOD AMMONIA:

 Liver detoxicates ammonia to form urea
 In a liver disease the ability to remove ammonia
may be impaired
 The normal level of blood ammonia is 40-70
mg/100ml of blood.
Clinical interpretation:

▪ High blood levels of ammonia are found in acute

hepatis and cirrhosis.
Measurement of Hippuric Acid:
Measurement of Hippuric acid synthesis is an ideal
test for assessing the detoxification function of liver
Hippuric acid produced in liver when benzoic acid
combines with glycine.
Clinial Interpretaiton:

▪ About 6g of sodium benzoate is orally given to the

subject after a light breakfast
▪ Urine collection are made for the next 4 hours and
the amount of hippuric acid excreted is estimated
▪ A reduction in hippuric acid excretion less than 3mg
indicates hipatic damage.
THANK YOU!!!