LIVER FUNCTION TESTS (LFT)
Liver function test (LFT) is the biochemical tests to assess the capacity of the liver to carry out
any of the function it performs. LFT will help to detect the abnormalities and the extent of liver
damage.
The major liver function test are;
I) Test for bile pigments- serum Bilirubin
1.) Van den Bergh reaction
This is a specific reaction to identify the increase in serum bilirubin.
Principal – Diazotized sulfanilic acid reacts with bilirubin to form a purple colored azobilirubin.
• Direct positive – Van den Bergh reagent reacts with conjugated Bilirubin and gives a
purple colour immediately within 30 seconds, this is referred to as a direct positive reaction.
Indicator - obstructive jaundice
• Indirect positive - Unconjugated Bilirubin gives purple colour only when Van den Bergh
reagent and methanol are added (normally within 30 minutes), this is referred to as indirect
positive.
Indicate – Hemolytic jaundice
• Biphasic – If the serum contains both unconjugated and conjugated bilirubin in high
concentration, the purple colour is produced immediately (direct positive), which is further
intensified by the addition of methanol (indirect positive). This type of reaction is known
as biphasic.
Indicator – Hepatic jaundice
• Normal serum shows negative Van den Bergh reaction. (Include this reaction in
Jaundice)
2.) Bromosulphthalein (BSP) test-
Bromosulphthalein is a dye used to assess the excretory function of liver. It is a non-toxic
compound and almost exclusively excreted by the liver (through bile).
● BSP is administered intravenously (5 mg/kg body weight) and its serum concentration is
measured at 45 min and at 2 hrs.
● In normal individuals, less than 5% of the dye is retained at the end of 45 min.
● Any impairment in liver function causes an increased retention of the dye.
II)Tests based on synthetic functions:
a) Serum albumin:
Albumin is solely synthesized by the liver. It has a half-life of about 20-25 [Link] is a good
marker to assess chronic liver damage. Low serum albumin is commonly observed in patients
with severe liver damage.
Functional impairment of the liver is frequently associated with increased synthesis of
globulins. Cirrhosis of the liver causes a reversal of albumin/globulin ratio (A/G ratio).
b) Prothrombin time:
The liver synthesizes all the factors concerned with blood clotting. A decrease in the
concentration of plasma clotting factors is found in the impairment of liver function. This can
be assessed by measuring prothrombin time which is prolonged in patients with liver damage.
III. Test based on metabolic capacity:
a) Galactose tolerance: Galactose is metabolized by the liver. The liver function can be assessed
by measuring the utilization of galactose.
Procedure
● Intravenous administration of galactose (about 300 mg/kg body weight).
● Blood is drawn at 10 minutes intervals for the next 2 hours and galactose estimated.
● In normal individuals, the half-life of galactose is about 10-15 minutes.
• This is markedly elevated in hepatocellular damage (infective hepatitis, cirrhosis).
IV.) Serum enzymes in assessment of liver function
Measurement of selected enzymes in serum is often used to assess the liver function.
a) Alanine Transaminase (ALT / SGPT)
SGPT – Serum glutamate pyruvate transaminase
• ALT is a cytoplasmic enzyme predominantly found in liver, with lesser quantities found
in the kidneys, heart and skeletal muscle.
• As a result ALT is a more specific indicator of liver damage than AST.
• Normal serum level – 10-50 IU/L
• Serum ALT is elevated in acute hepatitis, Jaundice and cirrhosis of liver.
• In viral hepatitis and other forms of liver disease associated with hepatic necrosis,
serum AST and ALT levels are elevated 100 times. The normal peak value occurs
between 7th and 12th day and decreases gradually by 3rd to 5th week.
b) Aspartate Transaminase (AST / SGOT)
SGOT – Serum glutamate oxaloacetate transaminase.
• AST is found in both cytoplasm and mitochondria. AST found in liver, heart, skeletal
muscle, kidney, brain etc.
• Normal serum level – 8-40 IU/L
• AST activity in serum is increased in myocardial infarction and also in liver diseases.
c) Alkaline phosphatase (ALP)
• ALP is mainly delivered from bone and liver.
• Normal – 3-13 KAU /dl
• A rise in ALP, usually associated with obstructive jaundice and bone diseases like
rickets.
d) γ -Glutamyl transferase (GGT)
• It is a microsomal enzyme widely distributed in body tissues including liver.
• Normal – 10-48 IU/L
• GGT is highly elevated in obstructive jaundice and alcoholic liver diseases.
e) 5’- Nucleotidase
• Normal – 2-15 IU/L
• Serum activity of 5’- nucleotidase is elevated in extrahepatic or intrahepatic or bile duct
obstructions.
f) LDH-5
• LDH-5 is mainly found in liver and skeletal muscle.
• Serum LDH-5 is elevated in liver diseases.
V. Test based on detoxification-
Hippuric acid synthesis: Liver is the major site for detoxification. Hippuric acid is produced in
the liver when benzoic acid combines with glycine.
Procedure
• 6g sodium benzoate dissolved in 250 ml water is given orally.
• Two hours after light breakfast and after emptying bladder.
• Urine is collected for next four hours.
• Amount of hippuric acid excreted is measured.
Interpretation
Normal - > 4.5g hippuric acid
Abnormal - <3 g hippuric acid – indicate hepatic dysfunction.