LFTs

Markers of hepatocellular damage Cholestasis Liver synthetic function

Test Total bilirubin

Normal range 3-17 mmol/L 0.2-1.0 mg/dl

Role Diagnosis of jaundice, severity of liver disease. Diagnosis of hepatocellular damage. Follow progression of disease. Diagnosis of cholestasis, biliary obstruction Severity of chronic liver disease Assess severity of hepatic synthetic function Correlates well with alkaline phosphatase, can exclude bone disease Highly specific for cholestasis Higher sensitivity & specificity for liver injury

Aminotransferase: Alanine Aspartate Alkaline phosphatase Serum albumin Prothrombin time Serum glutamyltrans peptidase Serum 5 nucleotidase Serum bile acids

4-36 IU/L 8-33 IU/L 20-90 U/L 35-50 g/L 3.5-5.0 g/dL 12-15 s 5-40 U/L

1-11 U/L 3-30 mg/L

Markers of Hepatocellular damage (Transaminases)

AST- liver, heart skeletal muscle, kidneys,

brain, RBCs Clearance performed by sinusoidal cells, half-life 17hrs

ALT more specific to liver, v.low

concentrations in kidney and skeletal muscles. Half-life 47hrs

 Gamma-GT hepatocytes and biliary

epithelial cells, pancreas, renal tubules and intestine Very sensitive but Non-specific Raised in ANY liver discease hepatocellular or cholestatic Alcohol

Markers of Cholestasis
ALP liver and bone (placenta, kidneys, intestine

and WBC) Hepatic ALP present on surface of bile duct epithelia and accumulating bile salts increase its release from cell surface. Takes time for induction of enzyme levels so may not be first enzyme to rise half-life is 1 week. ALP isoenzymes: 5-NT or gamma GT may be necessary to evaluate the origin of ALP

Bilirubin, Albumin and Prothrombin time (INR)

Useful indicators of liver synthetic function Thrombocytopaenia is a sensitive indicator of liver fibrosis

Albumin
300-500 g in body fluids Synthesize 15 g/d Half life: 20 days 4% degraded daily

Prothrombin time
I, II, V, VII, IX, X, XII, XIII Half life < 24h Congenital, consumption, warfarin, Vitamin K deficiency, parenchymal liver disease Not sensitive but highly prognostic
Alcoholic steatonecrosis, hepatocellular disease, acetaminophen overdose

Approach to a patient with Jaundice

Summery