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    1 : LIVER FUNCTION TESTS Dr.Hariharan.V
    2 : Functions of liver Providing fuel for other organs Almost all metabolic pathways Blood glucose regulation Synthesis -glycogen, triacylglycerol, plasma ptns, VLDL, cholesterol Detoxification Bile and bilirubin metabolism
    3 : Liver function tests Tests used in diagnosing and monitoring liver diseases
    4 : Classification of LFT Markers of hepatic dysfunction Tests based on synthetic functions of liver Based on enzymes Tests based on metabolic capacity of liver Other tests
    5 : Measurement of bilirubin:van den bergh Serum Bilirubin- 0.2 to 0.8 mg/dl Unconjugated- 0.2 to 0.6-INDIRECT POSITIVE Conjugated- 0 to 0.2mg/dl-DIRECT POSITIVE Hemolytic(prehepatic) jaundice- unconjugated bilirubin Obstructive jaundice- conjugated Hepatocellular jaundice-both I. Markers of hepatic dysfunction
    6 : Blood vessel Spleen, liver& bone marrow Liver Small intestine UBG bilirubin RBC RBC breakdown bilirubin bilirubin Bilirubin- conjugation
    7 : 2. Urinary Bilirubin- Fouchet’s test Only conjugated Bilirubin excreted in urine Prehepatic jaundice- nil Obstructive jaundice- regurgitation of bilirubin 3. Urinary Urobilinogen-Ehrlich’s test Hemolytic-increased Obstruction- nil or reduced Hepatocellular- initially elevated 4. Bile salts- Hay’s test Obsteuctive- +ve
    8 :
    9 : II. Tests based on synthetic functions of Liver Causes of Jaundice Hepatitis A virus- feco oral route Hepatitis B virus- parentral-dr.blumberg-1976 HCV, HDV, HEV, HGV Serum Albumin- Normal- 3.5gm/dl to 5gm/dl Prothrombin Time- synthesised by liver Prolonged in liver disease Also in vit K def
    10 : III. Tests based on Serum Enzymes Hepatocellular Damage: Transaminases ALT AST moderate inc in- alcoholic hepatitis, autoimmune hepatitis, Wilson’s disease, chronic hepatitis Minor elevation- Chronic HCV, fatty liver, NASH AST>ALT in alcoholic liver disease
    11 : 2. Obstructive liver disease: Alkaline Phosphatase(ALP)-cholestasis, hepatocellular carcinoma- bile duct obstn- synthesised by biliary epithelial cells Also inc in bone diseases Gamma Glutamyl Transferase(GGT) Alcoholism, pancreatic disease, MI, renal failure c. 5’ Nucleotidase- Hepatobiliary disease d. AFP-alpha feto protein- Ca liver
    12 : Why enzymes elevated disease inflamation Cell damage Cell wall rupture Release of cell contents
    13 : IV. Tests based on metabolic capacity of liver Blood Ammonia: Index of urea synthesis by liver Hepatic encephalopathy V. Other tests: Galactose tolerance test BSP excretion test Ceruloplasmin Ferritin Alpha 1 AT
    14 : Thank you

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