Transcript Chapter 5 Liver function tests

Chapter 5


Liver function tests
Liver function tests include the tests of protein
metabolism, the tests of bilirubin metabolism,
the tests of dye intake and excretion, the tests
of serum enzymes and the tests of viral
hepatitis.
In general , the tests currently available can
be divided into two categories: the tests of
hepatic function or capacity and the screening tests that suggest the presence and /or
type of liver disease. Specific diagnostic tests
such as serologic tests for hepatitis infection
are also covered in this chapter.
Tests of protein metabolism
•Serum total protein (TP),albumin (A)
and globulin (G)
The normal range of TP, A and G is
60-80g/L, 40-55g/L and 20-30 g/L .
The normal ratio of A to G (A/G) is
1.5-2.5 : 1
Increased G and decreased A
(reversed A/G) can be seen in chronic
hepatitis, cirrhosis, hepatic neoplasm .
•Serum protein eletrophoresis
A 0.61-0.71 , a1 0.03-0.04 , a2 0.06-0.1 , B
0.07-0.11 , r 0.09-0.18
cirrhosis and hepatic neoplasms: A , a1, a2, B
decrease , r increase
hepatitis: in acute hepatitis : normal level,
in chronic hepatitis : A decrease, r
increase
• hepatic
neoplasm markers:
alpha fetoprotein (AFP): < 25ug/ L , >
500 ug /L : primary hepatocellular
carcinoma
carcinoembryonic antigen (CEA): 0-5 ug
/L , increased CEA: liver metastatic
carcinoma or other carcinomas of the
gastrointestinal system
abnormal prothrombin (APT): < 20 ug/L,
increased APT : primary hepatocellular
carcinoma
Tests of bilirubin metabolism
•serum total bilirubin(STB), serum direct
bilirubin
(SDB) and
serum indirect
bilirubin(SIB)
STB : 1.7-17.1 umol/L (normal), 17-34
umol/L (latent jaundice), hyperbilirubinemia
SDB: 0-6.8 umol/L (normal), SIB: 1.7-10.2
umol/L (normal), SDB/STB 20% (normal),
•urea bilirubin : normal: (-), when SDB > 34
umol/L (+)
•urobilinogen: normal : (- ~ +)
Clinical significance of tests in bilirubin metabolism(umol/L)
STB
normal
SDB
SIB
1.7~17.1.7 ~10.2 0~6.8
hemolysis <85
mild
significant
SDB/STB
20%
URO
UBI
-~+
-
<20%
++~+++
-
hepatitis 17~200 medium medium
>35%
+~++
+
biliary
>60%
-
++
200~500 significant mild
obstruction
Dye intake and excretion
•Indocyanine
green
retention
(ICGR): 15 mim: < 10%
chronic hapatitis: 15~20%
cirrhosis : 35%
rate
Serum enzyme tests



aspartate ( AST, SGOT) and alanine ( ALT,
SGPT) . The serum transaminase are
sensitive tests of liver damage. And the height
of the activity reflects the severity of hepatic
necrosis.
ALT: < 35U/L,
AST: <40U/L
elevated ALT,AST : acute hepatitis (viral or
toxic ), chronic hepatitis and cirrhosis,biliary
obstruction




Alkaline phosphatase `(ALP):
Serum levels are elevated in association with
cholestasis, partial or complete bile duct
obstruction, bone regeneration, and also with
neoplastic , infiltrative, and granulomatous
liver disease. An isolated elevated ALP level
may be the only clue to partial obstruction of
the common bile duct.
ALP : 30-130 U/L ( 36-92 U/L)
elevated ALP: bile duct obstruction, primary
hepatocellular carcinoma, hepatitis
• r-glutamyl transferase (r-GT):
3~17U/L(M), 2~13 U/L(F)
elevated r-GT: hepatic neoplasm
obstructive jaundice
hepatitis
Tests of viral hepatitis
• Viral hepatitis is caused by five main viruses:
hepatitis viruses A, B, C, D and E. In present,
hepatitis A , hepatitis B and hepatitis C are
more common. The ability to detect the
presence of viral components in hepatitis B
and C and antibodies to components of
hepatitis A,B, C and D has enabled
considerable progress to be made in the study
of the epidemiology of viral hepatitis. These
so-called viral markers can be diagnostic of
the cause of acute viral hepatitis.
serologic markers of viral hepatitis
agent
markers
definition
HAV
anti-HAV
antibody to HAV
IgM type
significance
current or recent infection
or convalescence
IgG type
current or previous infection
, confers immunity
HBV
HBsAG
HBV surface antigen
positive in acute
or chronic infection
HBeAG
e antigen, a component
of the HBV core
transiently positive
in acute Hepitis B ,may
reflects presence of viral
replication and infectivity
anti-HBe
antibody to e antigen transiently positive in convalescence,
may be persistently present in chronic
cases, reflects low infectivity
anti-HBc
antibody to core antigen
IgG type
positive in all acute and chronic cases,
reliable marker of infection ,past or
current
IgM type
reflects active viral replication ,
not protective
anti-HBs
antibody to surface antigen positive in late convalescence,
confers immunity, after injection of
Hepitis B vaccine
HCV
anti-HCV
antibody to HCV
positive after clinical onset(15 week),
not protective, persists in chronic
infection
Automatic biochemistry analyzer:
Using the analyzer, we can detect 14
items of liver and renal function tests
easily.
ALT, AST, CHO, ALP, GGT, TBIL,
DBIL, TP, ALB, GLB and BUN, CRE,
GLU, UA
Case analysis

History and physical examination: This 48year-old man had complained of abdominal
pain and intermittent fever for 3 months. The
pain was usually felt in the right upper
quadrant. His appetite was not good and lost
his body weight apparently. He once suffered
from hepatitis ten years ago. Physical
examination revealed the patient who
appeared chronically ill with icteric selera.
The liver was enlarged to 2 cm below the
costal margin with tenderness, and the
spleen was enlarged to 3 cm below costal
margin .
Laboratory data: Hb 90g /L, WBC 8.0×109/L,
PC 90×109/L, ALT 120U/L, AST 200U/L,ALP
255U/L, TP 55g/L, A 25g/L, Y 40%, TBI
55umol/L, DBI 38umol/L, URO (++), UBI (+),AFP
600ug/L, HBsAg (+), HBeAg (+), anti-HBc IgM
(+)
Question:
• What is your diagnosis for this patient?
•Which kind of jaundice this patient has?
•How to evaluate this patients liver function?
•What is
hepatitis?
etiological
classification
for
his