Abnormal Liver Function

Tests

What are Liver Function

Tests ?
Liver Function tests are panel of
blood markers used to
Asses and monitor several diseases

Indications of LFTs
History and examination suggesting
liver disease.
Poisoning ( paracetamol )
Alcohol abuse.
Family history of autoimmune
disease.
Jaundice.
Ascites

Indications for Liver

Function Tests

Screening

High risk groups

Hepatitis.
Illicit drug use.
Transfusions

Non liver Diseases.

Malignancy
Hypoxia.
Monitoring hepatotoxic drugs like
valproate , methotrxate

What to tell the patient

before test
A blood test is required.
No special preparation like fasting.
Results will be available in 24 hrs
( usually)
Attracts medicare benefits

What are included in LFTs

Gamma Glut amyl Tranferase GGT

Alkaline Phosphatase. ALP.
Alanine Transaminase ALT
Aspartate transaminase AST.
Total protein.
Albumin.
Bilurubin

What does the result mean.

Overall result is used to differentiate
between cholestasis and
hepatocellular damage

Cholestais
damage
CHOLESTASIS
Interruption of bile
flow from hepatocyte
to gut.
Alkaline Phosphatase
> 200 IU/Lit
Or alkaline
phosphatase ALP
>3times Alanine
transaminase ALT

Hepatocellular
Hepatocellular
damage
Insult to hepatocyte
Alanine transaminase
>200IU/lir
Or Alananine
transaminase >3
times alkaline
phosphatase

Conditions
cholestasis

Biliary obstruction like

gall stones.
Pregnancy
Drugs.
malignancy

Hepatocellular
damage

Infections
Alcohol
Fatty liver
Metal over load
Hypoxia.
Autoimmune diseases

Individual results.
Raised transaminases
Usually seen in hepatocellular
damage.
10 times the upper limit seen in
acute or severe insult
1.Drugs
2.Viral hepatitis.
3.Hypoxia

Raised Transaminases

5 times the upper limit seen in

1. Infections.
2.Alcohol.
3.Fatty liver.
4. Medication.
However transaminases do not directly
correlate to extent of liver damage .
In cirrhosis they are in normal range

Raised GGT and ALP

1. Cholestasis.
2.Medication.
3.Alcohol.
4.Isolated GGT is seen in 70% alcohol use.
Takes 2-3 weeks to return to normal.
5.Isolated ALP seen in
1.Bone disease.
2.pagets disease

Isolated ALP
3. Vitamin D deficiency.
4.Metastasis.
ALP also produced by bone,
intestines and placenta.
Specific ALP cane be requested

Raised Bilurubin.
Seen both cholestasis and
hepatocullular damage.
1.Fasting.
2. Acute illness
Adults usually conjugated.
Only in Gilbert syndrome unconjugated
bilurubin is seen.
Gilbert syndrome is where there is
impairement of bilurubin conjugation

Albumin
Low levels
1.Physiological conditions like
pregnancy
2.Inflamation.
3.Malnutrition.
4.protein losing states.
5.Severe liver disease

Total protein
Estimate globulin fraction
Increased in Inflammation.
Cirrhosis low albumin and increased
bilurubin indicate low survival rates.

What is next step ?

Repeat blood tests
Minor abnormalities return to normal
in 1 week.
Existing liver disease}
repeat 4
weeks time
Hepatotoxic medication}
Acute insult/ toxic insult ; done daily.
But cane be done 2 weeks once

Further investigations.

Follow up investigations like

1. hepatitis serology.
2. Ferritin levels.
3. auto immune disease.
4 .copper overload.
Cholestasis : ultrasound

Thank you for your Patience and

time