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Complete LFT

The document classifies liver function tests (LFT) into five categories: excretory function, serum enzymes, metabolic capacity, synthetic function, and detoxification. It details various tests and their significance, including bilirubin levels, jaundice types, serum enzyme levels, and specific tests like the Bromosulphthalein test and Galactose tolerance test. Additionally, it discusses normal values for serum proteins and the clinical implications of abnormal results.

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6 views11 pages

Complete LFT

The document classifies liver function tests (LFT) into five categories: excretory function, serum enzymes, metabolic capacity, synthetic function, and detoxification. It details various tests and their significance, including bilirubin levels, jaundice types, serum enzyme levels, and specific tests like the Bromosulphthalein test and Galactose tolerance test. Additionally, it discusses normal values for serum proteins and the clinical implications of abnormal results.

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

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• Crude and outdated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

Feature Hemolytic Obstructive Hepatic

Serum bilirubin Unconjugated ↑ Conjugated ↑ Both ↑

Urine bilirubin Absent Present Present

Urobilinogen Increased Absent Increased

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

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