Liver Function Tests

Dr. CHHAY Sokpanhana, PharmD

 Objectives
After the end of this lecture, the student should be able to:
• Describe the anatomy of liver, blood supply and the function of
liver.
• Outline the component of liver function test (LFT) and its clinical
use.
• Describe the liver diseases
 Plans
1. Anatomy
2. Liver Functions
3. Classification of Liver Function Test
4. Liver diseases
 Anatomy
• Largest solid organ in body.
• Adult: weighs 1-1.5 kg
(proportion to body weight).
• Only represents 2–3 % of the body’s mass, it accounts for 25–30 % of
oxygen consumption.
• Consists of 2 lobes: large right and small left lobe.
• Locate in upper right quadrant of abdomen under lower edge of
diaphragm.
• Only organ has capability to regenerate completely after damage or
 Anatomy
• All blood flow from intestine and pancreas reaches liver via
portal venous system.
• Liver is a multifunctional organ that is involved in diverse body
functions.
 Anatomy
• Liver cell type:
– Parenchymal cell or Hepatocytes: 80% cell in liver and perform
main metabolic function (metabolism and detoxification).
– Non parenchymal cell: Endothelial Cells, Kupffer Cells, Ito cells
(hepatic stellate cell) and Pit Cells (liver specific natural killer).
 Liver Functions
• Metabolic Functions
 Liver actively participates in carbohydrate metabolism,
lipid, protein, mineral and vitamin metabolisms
• Storage Function
 Glycogen, Iron, all fat-soluble vitamins (A, D, E, K) and some
water-soluble vitamins (B12)
• Protective functions & detoxification
 Kupffer cells of liver perform phagocytosis to eliminate
foreign compounds.
 Eg. ammonia is detoxified to urea and metabolism of
xenobiotics (detoxification).
• Clearance of hormones such as insulin, parathyroid hormone,
oestrogen, cortisol
 Liver Functions
• Hematological and synthetic functions
– Liver participates in formation of blood (particularly in
embryo)
 Synthesis of plasma proteins (albumin and
prothrombin), hormones e.g angiotensinogen, insulin-
like growth factor and triiodothyronine.
 Destruction of erythrocytes (Bilirubin)
• Excretory Functions
– Bile pigments, bile salts and cholesterol are excreted in
bile into intestine.
Classification of Liver Function Test
Tests based
on excretory
function
Tests based Tests based
on synthetic on metabolic
function function

Tests based Testson

based
on serum detoxificatio
enzymes n function
 Classification of Liver Function Test
• Tests based on excretory function
– Serum bilirubin: total, conjugated and unconjugated
– Urine: bile pigments, bile salts and urobilinogen.
• Tests based on serum enzymes derived from liver
– Determination of transaminases, alkaline phosphatase, 5'-
nucleotidase, γ – glutamyltranspeptidase and LDH.
• Tests based on metabolic capacity
– Galactose tolerance, Serum cholesterol, urea.
• Tests based on synthetic functions
– Prothrombin time, serum protein.
• Tests based on detoxification
– Hippuric acid synthesis and Determination of blood ammonia
 Advantages
• Different tests will show abnormalities in response to
– liver inflammation
– liver injury due to drugs, alcohol, toxins, viruses
– Liver malfunction due to blockage of the flow of bile
– Liver cancers
 Bilirubin
Metabolism
 Tests based on excretory function
• Bilirubin
– diffuses into tissues → yellowish discoloration of sclera,
conjunctiva, skin & mucous membrane resulting in jaundice (or
icterus).
• Urine Bilirubin (bile pigments)
– Normally bile pigments are absent in the normal urine
– Presence of bilirubinuria is liver disease
• Urine Urobilonogen
– Increase in urine is sensitive indicator of hepatocellular disease
– It is markedly increased in hemolysis
• Bile Salts
– Normally bile salts are negative in the urine.
– Bile salts lower the surface tension allowing the sulphur
powder to sink.
– Bile salts is present in urine in obstructive jaundice.
 Tests based on serum enzymes
• Determination of
– Transaminases (ALAT, ASAT), alkaline phosphatase,
– 5'-nucleotidase, ϒ– glutamyltranspeptidase (GGT) and LDH

Tests based on detoxification

• Determination of blood ammonia
– Raised serum: cirrhosis and portocaval anastamosis
 Tests based on metabolic capacity
• Galactose tolerance:
– The normal liver is able to convert galactose into glucose;
but this function is impaired in intrahepatic disease and the
amount of blood galactose and urine galactose is excessive.
– markedly elevated in hepatocellular damage (infective
hepatitis, cirrhosis).
• Cholesterol:
– one lipid compound interest
– Cholestasis: total cholesterol ↗
– large hepatocellular insufficiency: total cholesterol ↘
• Urea
– decrease in terminal liver failure
 Tests based on synthetic function
• Albumin
– A plasma albumin concentration below the lower reference
limit may imply hepatic disease chronicity.
• Prothrombin time (PT)
– PT is a measure of the activities of certain coagulation
factors made by the liver,
– an indicator of hepatic synthetic function.
– PT may be prolonged by cholestasis.
• Plasma protein electrophoresis and immunoglobulin
assay may help in the diagnosis of:
– cirrhosis – high plasma IgG and IgA
– A low plasma albumin concentration (hypoalbuminaemia)
in the face of abnormal liver function tests can be seen in
cirrhosis implying chronicity.
 α-Fetoprotein
• One of the major plasma proteins in fetal life disappear after
2 weeks of birth.
• Reference value:
– up to 1 year of age < 30 ng/ml
– adults (Male and non pregnant Female < 15 ng/ml)
• Tumor marker
– Mild increase: chronic hepatitis or cirrhosis
– Drastic increase: Hepatocellular carcinoma, germ cell
tumour
 Liver Diseases
• Cholestasis
• Acute hepatitis
• Chronic hepatitis
• Cirrhosis
• Hepatocellular failure