Liver Profile 1 PDF

LIVER PROFILE 1 Lakmini Walpola LEARNING OUTCOMES Students should be able to comprehend the basic functions of the liver, including its role in detoxification, metabolism, synthesis of proteins, and storage of nutrients. Students should be able to interpret the abnormal levels of liver...

LIVER PROFILE 1 Lakmini Walpola LEARNING OUTCOMES Students should be able to comprehend the basic functions of the liver, including its role in detoxification, metabolism, synthesis of proteins, and storage of nutrients. Students should be able to interpret the abnormal levels of liver enzymes such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma- glutamyl transferase (GGT). Students should be able to recognize common liver disorders such as hepatitis (viral and non-viral), fatty liver disease, cirrhosis, and cholestasis. Students should understand the biochemical and clinical markers associated with each disorder and be able to differentiate between acute and chronic liver conditions. 2 3 LIVER FUNCTION AND INTEGRITY TESTS ARE USEFUL IN Detecting Diagnose Monitoring therapy Assessing the prognosis of liver disease and dysfunction As a routine precaution after starting certain medicines to check that they are not causing liver damage as a side-effect 4 REQUEST FORM Chemical pathology test request form Patient Name - Mr. Upul Senerath Age - 45 years BHT no - 1659 Ward - 02 Specimen - Blood Collection date - 03/07/2022 Test requested - Liver profile History - ………………………………… Medical officer 5 Liver has to perform different kinds of biochemical, synthetic and excretory functions, so no single biochemical test can detect the global functions of liver. All laboratories usually employ a battery of tests for initial detection and management of liver diseases and these tests are frequently termed “Liver function tests” 6  BIOCHEMISTRY TESTS. LIVER FUNCTIO N TESTS IMAGING STUDIES HISTOLOGICAL STUDIES 7  BLOOD TEST Liver enzymes Albumin Prothrombin BIOCHEMIST time Viral RY TEST markers Bilirubin Urine test Bilirubin Urobilinoge n Bile salts 8 9 BLOOD TEST 10 Bilirubin (mg/dl) - Diagnosing jaundice (0.2 – 1.0 mg/dl) Bilirubin fraction - Diagnosing disorders of metabolism and disorders of the newborn Direct bilirubin (Conjugated) (0.0 -0.4 mg/dl) Indirect bilirubin (Unconjugated) (0.0 – 0.2 mg/dl) ALP (Alkaline phosphatase) - Diagnosis cholestasis and space occupying lesions 35 – 123 IU/L AST (Aspartate aminotransferase) / SGOT - Sensitive test of hepatocellular disease 2 – 36 U/L ALT (Alanine transaminase) / SGPT - Sensitive and more specific test of hepatocellular disease 2 – 35 U/L Total Protein 6.2 – 8.2 g/dl Albumin - Indicator of chronicity and severity 3.5 - 5.3 g/dl GGT (Gamma glutamyl transferase) 9- 48 U/L Prothrombin time - Indicator of severity, early indicator of cirrhosis in chronic hepatitis 11 1. Markers of hepatocellular damage Liver enzymes 2. Markers of functions of liver Serum total protein/ albumin Prothrombin time Serum bilirubin 12  LIVER ENZYMES 1. Aspartate aminotransferase (AST/ SGOT) 2. Alanine aminotransferase (ALT/ SGPT) 3. Alkaline phosphatase (ALP) 4. Gama Glutamyltransferase (ɤ GT/ GGT) 13  LIVER ENZYMES Markers of hepatocellular damage 1.ALT 2.AST Markers of biliary tract obstruction 1.ALP 2.GGT 14  AMINOTRAN SFERASES Aminotransferases constitute a group of enzymes that catalyze the interconversion of amino acids to 2-oxo-acids by transfer of amino groups. Aspartate aminotransferase (AST) Alanine aminotransferase (ALT) 15  AST and ALT Can found in other tissues as well AST – heart, liver, skeletal muscle, kidney ALT – Liver and kidney 16  AST and ALT  Reflects the hepatocellular damage  Release into the blood in cellular damage  ALT – Cytosolic  AST – Cytosolic and mitochondrial 17  AST and ALT Liver ALT >> disease AST  Exceptions  Alcoholic hepatitis  Hepatic cirrhosis  Liver neoplasia Acute hepatic necrosis – serum AST, ALT elevated before clinical signs and symptoms 18  AST and ALT AST/ALT < 1 – Acute liver cell injury AST/ALT > 1 - Chronic liver cell injury 19 20  AST and ALT – METHODS Continuous monitoring methods areOF usedANALYSIS commonly Measure the amino transaminase activity by coupling amino transaminase reactions to specific dehydrogenase reactions. The oxo-acids formed in the amino transaminase reaction are measured indirectly by enzymatic reduction To corresponding hydroxyl acids, and the accompanying change in N A D H concentration is monitored spectrophotometrically. 21 AST 22 ALT 23 AST – Formed oxaloacetate reduced to malate (malate dehydrogenase) ALT – formed pyruvate reduced to lactate (lactate dehydrogenase) N A D H ---------NAD + Disappearance of N A D H is followed by measurement of the decrease in absorbance at 340 nm. 24 Stability AST ------ 48 hours at 4oC / frozen longer ALT -------- Same day Haemolyzed specimen should not be used, large amount of this enzyme present in red blood cells 25 Marked elevations in ALT/AST >5 (Patient likely to be symptomatic) Viral hepatitis Ischemic hepatitis Autoimmune hepatitis Drugs/toxins 26 Mild or Moderate elevations in ALT/AST