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Functions of Liver

The document outlines the functions of the liver, including metabolic, excretory, protective, hematological, and storage functions. It details various liver function tests (LFTs) used to assess liver health, such as serum bilirubin, AST, ALT, and prothrombin time, along with their classifications and significance. Additionally, it discusses bilirubin types, jaundice patterns, and specific tests like the Bromosulphthalein test and Galactose tolerance test.

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3 views6 pages

Functions of Liver

The document outlines the functions of the liver, including metabolic, excretory, protective, hematological, and storage functions. It details various liver function tests (LFTs) used to assess liver health, such as serum bilirubin, AST, ALT, and prothrombin time, along with their classifications and significance. Additionally, it discusses bilirubin types, jaundice patterns, and specific tests like the Bromosulphthalein test and Galactose tolerance test.

Uploaded by

20vishusharma
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

LFT

Functions of Liver
1. Metabolic Functions

 Carbohydrate metabolism
 Lipid metabolism
 Protein metabolism
 Vitamin and mineral metabolism

2. Excretory Functions

 Excretion of bilirubin, bile salts and cholesterol through bile

3. Protective and Detoxification Functions

 Kupffer cells perform phagocytosis


 Ammonia converted to urea
 Detoxification of xenobiotics and drugs

4. Hematological Functions

 Blood formation in embryo


 Synthesis of plasma proteins and clotting factors
 Destruction of RBCs

5. Storage Functions

 Glycogen
 Vitamins A, D, B₁₂
 Iron

Liver Function Tests


 Serum bilirubin
 Bromosulphthalein (BSP) test
 AST (SGOT)
 ALT (SGPT)
 Alkaline phosphatase (ALP)
 Gamma-glutamyl transpeptidase (GGT)
 5’-Nucleotidase
 Galactose tolerance test
 Serum albumin
 Prothrombin time
 Hippuric acid synthesis

Classification of LFT
1. Excretory Function

 Bilirubin
 Bile salts
 BSP test

2. Serum Enzymes

 AST, ALT
 ALP
 GGT
 5’-Nucleotidase

3. Metabolic Capacity

 Galactose tolerance test


 Antipyrine clearance

4. Synthetic Function

 Serum albumin
 Prothrombin time

5. Detoxification

 Hippuric acid synthesis

Bilirubin
 Bile pigment
 End product of heme degradation
 Conjugated in liver and excreted in bile

Normal Serum Bilirubin

 Total: 0.2–1 mg/dL

Types of Jaundice

 Hemolytic: ↑ Unconjugated bilirubin


 Obstructive: ↑ Conjugated bilirubin
 Hepatic: ↑ Both

Icterus Index
 Measures yellow colour of serum
 Crude and outdated
 Useful in neonatal jaundice

Van den Bergh Reaction


 Based on reaction of diazotised sulfanilic acid with bilirubin
 Forms purple azobilirubin
 Measured at 540 nm

Reaction Types

 Direct positive: Conjugated bilirubin → Obstructive jaundice


 Indirect positive: Unconjugated bilirubin → Hemolytic jaundice
 Biphasic: Both → Hepatic jaundice

Bilirubin in Urine
 Conjugated bilirubin: Present
 Unconjugated bilirubin: Absent

Tests

 Fouchet’s test (Important)


 Gmelin’s test

Target MLT – Jaundice Pattern


Obstructiv
Feature Hemolytic Hepatic
e

Serum Unconjugated Conjugated


Both ↑
bilirubin ↑ ↑
Obstructiv
Feature Hemolytic Hepatic
e

Urine
Absent Present Present
bilirubin

Increase
Urobilinogen Increased Absent
d

ALP Normal Very high Mild ↑

AST / ALT Normal Mild ↑ High ↑

Bromosulphthalein (BSP) Test


 Tests excretory function
 Dose: 5 mg/kg IV
 Normal: <5% retention at 45 minutes
 Increased retention indicates liver dysfunction

Serum Enzymes
ALT (SGPT)

 More liver specific


 Normal: 5–40 IU/L

AST (SGOT)

 Present in liver and heart


 Normal: 5–45 IU/L

AST/ALT Ratio (De Ritis Ratio)

 Normal: ~0.8
 >2: Alcoholic liver disease / MI
 <0.8: Acute hepatitis

Serum Proteins
Normal Values

 Total proteins: 6–8 g/dL


 Albumin: 3.5–5 g/dL
 Globulin: 2.5–3.5 g/dL
 A/G ratio: 1.2–1.5 : 1

Clinical Significance

 Low albumin: Liver disease, malnutrition, nephrotic syndrome


 High globulin: Chronic infection, multiple myeloma

Estimation of Serum Proteins


Biuret Method

 For total proteins


 Violet colour
 530 nm

BCG Method

 For albumin
 Blue-green colour
 628 nm

Alkaline Phosphatase (ALP)


 Source: Liver and bone
 Normal: 3–13 KA units/dL
 Increased in obstructive jaundice, rickets, cirrhosis, liver
tumors
 Isoenzymes separated by electrophoresis

Gamma-Glutamyl Transpeptidase (GGT)


 More specific for liver
 Increased in alcoholic liver disease
 Helps differentiate liver vs bone ALP

-Nucleotidase
 Increased in obstructive jaundice
 Confirms hepatic origin of ALP

Prothrombin Time
 Indicates synthetic function
 Depends on vitamin K–dependent clotting factors
 Prolonged in severe liver disease

Galactose Tolerance Test


 Galactose metabolized only by liver
 Dose: 300 mg/kg IV
 Normal half-life: 10–15 minutes
 Increased in hepatitis and cirrhosis

Hippuric Acid Synthesis


 Test for detoxification
 Benzoic acid + glycine → hippuric acid
 Reduced excretion (<3 g) indicates liver damage

Serum Ammonia
 Normally converted to urea
 Increased in liver failure
 Causes hepatic encephalopathy

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