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Approach to Liver Function Test

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Khayyat Y Dr Yasir M Khayyat,MBcHB,FRCPC,FACP * 600 * Khayyat Y Hepatocellular Necrosis Markers INR Markers of Cholestasis ... – PowerPoint PPT presentation

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Title: Approach to Liver Function Test


1
Approach to Liver Function Test
  • Dr Yasir M Khayyat,MBcHB,FRCPC,FACP

2
Before you order LFT ask
600 ????
3
Hepatocellular Necrosis Markers
Markers of synthetic function
INR
Markers of Cholestasis

4
Liver cell
5
Liver cell
AST ALT
6
  • ALT
  • Specific from the liver ,Cytosolic Enzyme
  • AST
  • Muscle(skeletal , Cardiac),Brain,Kidney,Pancreas,
    cytoslic 20 and mitochondrial 80.
  • Levels are normal in advanced cirrhosis
  • AST/ALT ratio
  • Acute liver injury 1 , Alcoholic hepatitis gt 2
  • Its elevation does not correlate with hepatic
    necrosis.

7
  • In Alcoholic liver disease
  • AST ? Alcohol increase release of mitochondrial
    AST
  • ALT ? in alcohol there is pyridoxal 5 deficiency
    with decrease in ALT gt AST activity
  • In NAFLD,chronic liver disease
  • AST ( early low ,then with progressive disease
    and cirrhosis increase) , advanced cirrhosis ?
    decrease hepatic clearance of AST.
  • ALT

8
  • Alkaline phosphatase
  • From Liver,Bone,Kidney,placenta,leukocytes,various
    neoplasms.
  • From the apical membrane of the hepatocyte and
    luminal domain of the bile duct.
  • Predominantly in infiltrative hepatic
    disorders, biliary obstruction ,extrahepatic
    biliary tree obstruction.
  • Due to increased de novo synthesis rather than
    release of the stored enzyme or impaired
    clearance
  • GGT ( Gamma Glutamyl Transpeptidase)
  • From kidney,spleen,pancreas,heart,lung,brain

9
  • Bilirubin
  • Conjugated Bilirubin
  • Unconjugated Bilirubin
  • Markers of Hepatic Synthesis
  • INR or PT
  • The liver is factory for all coagulation factors
    except 8.
  • INR if dependant on Vit K ( 2,7,9,10)
  • Increased in vitamin K deficiency(
    malnutrition-malabsorption-antibiotic
    use)warfarin use, consumptive coagulpathy.

10
  • Albumin
  • Synthesize 10g by the liver daily. It is not only
    reflect liver status but it reflects nutritional
    and volume status, vascular integrity,catabolism,h
    ormonal factors, loss in the urine or stool.

11
Non Hepatic causes of abnormal lft
12
Hepatocellular necrosis
13
Cholestasis
14
(No Transcript)
15
Hepatic granulomas
16
Think about the causes of liver disesase
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