LIVER FUNCTION TEST Flashcards
Markers of Liver Cell Damage
ALT
AST
Markers of CHOLESTASIS
ALP
GGT
5’ nucleotidase
Lucine aminopeptidase
Markers of SYNTHESIS (SYNTHETIC Markers)
- Albumin
- PT/INR
- Cholinesterase
1st SIGN of LIVER FAILURE
⬆️ PT/INR
Liver Failure 🌸 TYPES
Normal Value of ALT & AST
5-45 IU/L
Which is SGOT & SGPT
🧠⚡ L-PG⚡
🧠💡GO-ST💡
ALT: SGPT
Alanine transaminase
Serum Glutamate Pyruvate Transaminase
AST: SGOT
Aspartate transaminase
Serum Glutamate Oxalate Transaminase
Normally ALT or AST which is HIGHER?
ALT
⭐ ALT/SGPT is specific for
⭐ AST/SGOT is specific for
🧠⚡I ASKED(AST) why Little Men Hate Everybody ⚡
🧠⚡aLt ⚡
⭐ LIVER
⭐ Liver, Muscle Heart, Erythrocytes
Which Liver Cell Damage marker is Mitochondrial
🧠⚡ IMAGINE IMAGE OF MITOCHONDRIA ITS A CIRCLE= O MEANS sgOt⚡
SGOT/AST is Mitochondrial 80%
20% CYTOSOLIC
SGPT is 100% CYTOSOLIC
AST ⬆️ > 3 times NORMAL
➕
ALT ⬆️ > 3 times NORMAL
💡🪔CLINICAL POINTER🪔
Hepatocellular Injury
AST ⬆️ < 3 times NORMAL
➕
ALT ⬆️ < 3 times NORMAL
💡🪔CLINICAL POINTER🪔
CHOLESTASIS
(Cholestasis can also lead to Liver call damage)
AST ⬆️
➕
ALT NORMAL
💡🪔CLINICAL POINTER🪔
NO HEPATOCELLULAR CELL INJURY
⭐ HEMOLYSIS
⭐ RHABDOMYOLYSIS
⭐ ACUTE MI
AST ⬆️
➕
ALT NORMAL
➕
LDH/AST = ≥ 30
➕
LDH2 > LDH1
💡🪔CLINICAL POINTER🪔
Hemolysis
LDH Flip seen in
MI
AST ⬆️
➕
ALT NORMAL
➕
LDH1 > LDH2
💡🪔CLINICAL POINTER🪔
Acute MI
HEPATOCELLULAR INJURY
Classified by
AST/ALT ratio
De Ritis Ratio seen in
Alcoholic Hepatitis
AST/ALT ≥ 2
AST/ALT >1
Seen in
- Alcoholic Hepatitis
- Fulminant Liver Failure/Cirrhosis
- HCC / METASTASIS
ALKALINE PHOSPHATASE
NORMAL Value
44-144 IU/L
CAUSES: ⬆️ ALP
🧠⚡ Plates of Kidney & Liver Can Be Soaked ⚡
Pregnancy (3rd TRIMESTER)
Kidney Disease
Liver Disease
Choriocarcinoma
Seminoma
ALP in BILIARY Pathology
ALP in HEPATOCELLULAR Pathology
ALP in BILIARY Pathology
🎯 > 2 TIMES Upper Limit of NORMAL
ALP in HEPATOCELLULAR Pathology
🎯 < 2 TIMES Upper Limit of NORMAL
ALP ⬆️ is significant only if
> 4 times NORMAL
Reduced ALP
Causes
- Wilson’s disease
- Hypothyroidism
- Zinc deficiency
- Pernicious anemia
- Hypophosphatemia
differentiate between Alkaline phosphatase coming from Liver & Bone
🧠⚡Bone Burns ⚡
🧠⚡Liver Lasts ⚡
liver (heat stable)
bone (heat labile).
GGT
NORMAL Value
10-60
⬆️ GGT
- Biliary pathology: Cholestasis
- Alcohol abuse
- Phenytoin
- Diabetes
- CKD
Isolated GGT Elevation
Alcohol ABUSE
Membrane bound enzyme in Biliary tract
GGT
T½ of Albumin
21 days
NORMAL Albumin
Low Albumin
3.5-5.5 mg/dl
PT vs aPTT
🧠⚡ Play Tennis⚡
🧠⚡ Play Table Tennis ⚡
Elevated PT/INR
- Liver Disease
- Vitamin K deficiency
✨ Malnutrition
✨ Malabsorption
✨ Broad Spectrum Antibiotics
✨ Hemorrhagic Disease of Newborn - WARFARIN Therapy
- DIC
BILIRUBIN HANDLING
Hepatic Cell: BILIRUBIN METABOLISM
Transporter which transports UNCONJUGATED BILIRUBIN-ALBUMIN into Hepatocyte
LIGANDIN
Transporter which transports CONJUGATED BILIRUBIN into BILE DUCT
MRP2/CMOAT
Enzyme causing CONJUGATION of BILIRUBIN
UGT1A1
Difference BETWEEN JAUNDICE & ICTERUS
Elevation of Serum BILIRUBIN > 3mg/dl: Jaundice
ICTERUS: Clinical sign of Jaundice; Yellowish discolouration of Sclera
Serum BILIRUBIN that causes DISCOLOURATION of MUCOUS MEMBRANE
Serum BILIRUBIN > 4-5mg/dl
NORMAL Serum BILIRUBIN
0.2-1.2 mg/dl
Approach to JAUNDICE
Approach to ACUTE HEPATITIS
Approach to CHRONIC HEPATITIS
Approach to CHOLESTASIS
Sequale of LIVER DISEASE
Acute HEPATITIS
⬇️
Chronic Hepatitis
⬇️
Cirrhosis ➡️ HCC
⬇️
DECOMPENSATION: Portal Hypertension
Cause of Acute HEPATITIS.
🧠⚡Always Go in ORDER ⚡
🧠⚡IDIA Wins ⚡
- Infective HEPATITIS
⚡⚡ MOST COMMON in ADULTS: Hepatitis E
⚡⚡ MOST COMMON in CHILDREN: Hepatitis A - DRUGS/TOXIN
- ISCHEMIA
- AUTOIMMUNE
- WILSON’S Disease