Some time we go to doctor and they say for some liver test.
Here we will discuss liver function test which is important to know what is wrong with our liver and disease related liver.
When we do liver function test below things we should see in test results.
See the Video
(1) Serum Bilirubin
Normal value : 0.3-1.3 mg/dl
There is 2 types of bilirubin.
A. Unconjugated bilirubin
B. Conjugated bilirubin
When we see result of test.
👉 If there is bilirubin level more than 1.3mg/dl and below 6mg/dl. It is Unconjugated hyperbilirubinemia.
Cause : Hemolytic anemia
Ineffective erythropoiesis
Gliberts Disease
👉If bilirubin lever higher than 6mg/dl then it is conjugated hyperbilirubinemia.
Cause : Parenchymal liver disease
Biliary tract obstruction
° Tea or Cola colored urin may indicate the presence of bilirubinuria and this conjugated hyperbilirubinemia.
(2) SERUM ENZYMES
By knowing level of serum enzyme we can know demage to hepatocytes which is cells of liver.
There is 2 types of enzymes.
A. Aspartate aminotransferase (AST/SGOT)
It is increase in hepatic necrosis, myocardial infraction, muscle injury, congestive cardiac failure.
B. Alanine aminotransferase (ALT/SGOT)
It is increase in liver injury.
👉AST:ALT ration is more than 1 then it is because of chronic viral hepatitis and non-alcoholic fatty liver disease (NAFLD)
If AST:ALT ratio is more than 2/3 it is suggestive of alcoholic liver disease.
(3) Alkaline phosphatase (ALP)
Normal serum level of ALP is 80-240 IU/L.
👉Low level of ALP :
Wilson disease,with fulminant hepatitis and hemolysis
👉Raise level of ALP :
<2.5 times - Hepatocellular carcinoma
>4 times - Obstructive jaundice
Infiltrative liver diseases e.g. cancer, metastases and amyloidosis
Bone lesions with rapid bone turnover e.g. Paget's disease
Primary biliary cirrhosis
(4) Gamma glutamyl transpeptidase (GGT)
Screening test for alcoholism - if ALP is normal , raised serum Gamma glutamyl transpeptidase is a good guide to alcohol ingake of more than 60g/day.
👉 Raised GGT levels ;
Biliary obstruction
Alcoholism
Liver parenchymal damage
Non-alcoholic fatty liver
Other cause : chronic obstructive lung disease, diabetes mellitus, hyperthyroidism, obesity and renal failure
(5) 5-nucleotidass
Increase in hepatobiliary disease
(6) Lactate dehydrogenase (LDH) :
Not useful for liver disease diagnosis
Moderately raised in ischemic hepatitis and hepatic metastasis.
(7) Plasma Proteins
👉Serum albumin
Normal level - 4-5.5 g/100ml
Low level : chronic liver disease like cirrhosis and chronic hepatitis,sever liver demage, decrease albumin synthesis.
👉Serum globulin
Normal level - 1.5-3.5/100ml
Increased in chronic liver disease
Increased in IgG - Chronic hepatitis, autoimmune hepatitis
Increased in IgA - Alcoholic liver disease
Increased in IgM - primary biliary cholangitis
(8) Coagulation factors :
Liver produces all coagulation factor except VIII
It is important for diagnosis and assesing the prognosis of acute parenchymal liver disease.
Prothrombin time is important for measure coagulation factor.
👉Cause of prolonged prothrombin time :
Sever liver demage - acute hepatitis, cirrhosis
Deficiency of vitamin k
Disseminated intravascular coagulation
Drugs and toxin like warfarin,apixaban, anticoagulant rodenticide etc.
(9) Ceruloplasmin :
Normal plasma level - 20-60 mg/dl
👉Cause of elevated levels : infection,liver disease, obstructive jaundice, rheumatic arthritis,pregnancy
👉Cause of decreased level :
Wilson disease, neonates,kwashiokor, marasmus, copper deficiency, protein losing enteropathy.
(10) Cholesterol
Synthesis in liver
Low cholesterol is seen in advanced liver disease.
Raised cholesterol seen in primary biliary cholangitis (PBC)
(11) Urin Tests
👉Bilirubin in urine :
Normal not detected in urin
In unconjugated hyperbilirubinemia,urine does not contain bilirubin this absence of bilirubin in urin in jaundice patient suggest unconjugated hyperbilirubinemia.
In conjugated hyperbilirubinemia,urine contain bilirubin. Thus bilirubinuria in a jaundice patient points to conjugated hyperbilirubinemia.
Fouchet's test done to detect urinary bilirubin.
👉Urine urobilinogen :
Normal seen in urine in trace amounts (1-2 mg/dl).
Increased in hemolytic anemia and liver disease like preicteric phase of infective hepatitis,drugs or toxic hepatitis, cirrhosis.
Ehrlich's aldehyde test done for detection.
👉 Alpha Fetoprotein (AFP)
Produced by fetal liver cells and falls level to low level after birth.
Cause of elevated level :
-Hepatocellular carcinoma. (HCC)
-Carcinoma of stomach, pancreas, gallbladder,bile ducts and lungs
-Teratomas
NOTE : All test result is for knowledge. pls consult doctor after test.
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