LIVER FUNCTION(II)

DR.PARWEEN

Liver enzymes

Liver enzymes
1.Transaminases ALT( Alanine amino transferase) AST(Aspartate amino transferase) 2. Alkaline phosphatase 3.GGT(Gamma glutamyl transpeptidase) 4. 5nucleotidase

Transaminases
Function of transaminases---- carry out transamination reaction
Transamination-The transfer of amino(-NH2) group from an amino acid to a keto acid is known as transamination. And is catalyzed by a group of enzymes called transaminases recently called aminotransferases. All transaminases require pyridoxal phosphate (PLP) A coenzyme derived from vitamin B6 ExampleALT(Alanine Amino Transferase) and AST(Aspartate Amino Transferase)

Example of transamination

AST

ALT

catalyze transfer amino groups to form pyruvate

cytosol (20%) and mitochondria (80%) T1/2 17 hr. (cytosol) 87 hr. (mitochondria) liver, cardiac muscle, skeletal muscle, kidneys, brain, pancreas, lungs, leucocytes, and RBC

catalyze transfer amino groups to form oxaloacetate

cytosol T1/2 47 hr. Mainly present in liver low concentration in other tissues

Alkaline Phosphatase
is a hydrolase enzyme responsible for removing phosphate groups from many types of molecules. Alkaline phosphatase (ALP) is an enzyme in the cells lining the biliary ducts of the liver. ALP levels in plasma will rise with large bile duct obstruction, intrahepatic cholestasis. ALP is also present in bone and placental tissue, so it is higher in growing children (as their bones are being remodelled) and elderly patients with Paget's disease Normal range- 30 to 120 IU/L

It is present in kidney,pancreas,liver,bile duct,spleen. Normal value for men is 15-85 IU/L, whereas for women it is 5-55 IU/L. Elevated serum GGT activity can be found in diseases of the liver, biliary system, and pancreas GGT is elevated by large quantities of alcohol ingestion. .Its is used to diagnosed alcoholic liver diseases.

Gamma Glutamyl Transpeptidase(GGT)

5' Nucleotidase (5'NTD)

5' Nucleotidase is another test specific for cholestasis or damage to the intra or extrahepatic biliary system, and in some laboratories, is used as a substitute for GGT for ascertaining whether an elevated ALP is of .biliary or extra-biliary origin

Prothrombin time
Prothrombin time (PT) is a blood test that measures how long it takes blood to clot . A prothrombin time test can be used to check for bleeding problems A PT test may also be called an INR test. INR (international normalized ratio) stands for a way of standardizing the results of prothrombin time tests, no matter the testing method

Prothrombin time
Prothrombin, or factor II, is one of the clotting factors made by the liver. Vitamin K is needed to make prothrombin and other clotting factors. Prothrombin time is an important test because it checks to see if five different blood clotting factors (factors I, II, V, VII, and X) are present.

Prothrombin time
Prolonged prothrombin time : Vitamin K deficiency (malnutrition, malabsorption, antibiotics) Massive transfusion ,Congenital disease Liver disease

Prothrombin time

in vit K deficiency, vit K 10 mg SC decrease prolong PT >30% within 24 hrs.

Other Hepatic Analytes

Glucose---Liver is concerned with storage of
carbohyderate as glycogen and its release by glycogenolysis as glucose In hepatic diseases due to poor glycogen storage in the liver ,there is fasting hypoglycemia. In liver Glactose is converted to glucose In liver diseases conversion does not occurgalactose is excreted

Other Hepatic Analytes

LipidsEster/free cholesterol ratio
Liver is concerned with synthesis ,esterification and excretion of cholesterol Normal cholesterol level is 150-250mg/dl About two thrid(66%)is in the esterified form and one third is in the free form. In obstructive jaundice there is increase in the total cholesterol content In hepatic jaundice there is decreased in ester/free cholesterol ratio and total cholesterol may be normal or decreased.

Other Hepatic Analytes

PROTEINS---A decrease in plasma albumin and a rise in the globulins occur in liver diseases. Serum Iron-In hepatitis,the level of serum iron in the plasma reaches high level

Since no single test gives complete or conclusive evidence of liver damage,it is customary to do several tests and correlate the findings.

Cholestasis?
Cholestasis is a condition where bile can not flow from the liver to the duodenum Obstructive type of cholestasis- there is a mechanical blockage in the duct system such as can occur from a gallstone or malignancy Metabolic types of cholestasis- which are disturbances in bile formation that can occur because of genetic defects or acquired as a side effect of many medications

Diseases Of Liver
2.Cirrhosis- Consequences of chronic liver disease. What is cirrhosis? Formation of fibrous tissue in the liver from replacing dead liver cells. The death of the liver cells can be caused by viral hepatitis, alcoholism or contact with other liver-toxic chemicals. Diagnosis is done by checking levels of alanine transaminase(ALT) and aspartate transaminase (AST) Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis

Thank you