Liver function test

Although measuring liver enzyme levels is important in

the assessment of a patients liver disease, these test
results can be nonspecific.
Thus, evaluation of patients with suspected liver
disease should always involve careful interpretation of
abnormalities in these liver test results in the context of
a thorough history and physical examination.
The approach to evaluating abnormal laboratory values
also can be simplified by categorizing the type of
abnormality that predominates (hepatocellular damage,
abnormal synthetic function, or cholestasis).

Test

Aspect of Liver Function Assessed

Major Utility

Serum bilirubin levels (total and

conjugated)

Indicator of the ability of the liver to Aids in the differential diagnosis of

take up, conjugate and excrete
jaundice (seeTable 313).
bilirubin (conjugation and excretory
function).

Total serum protein and albumin

Measure of the biosynthetic function Indicator of chronic liver disease.

of the liver, as the liver is the
primary site of synthesis of most
plasma proteins.

Prothrombin time

Measure of the biosynthetic function Indicator of severity of acute and

of the liver, as several coagulation
chronic liver disease.
factors are synthesized in the liver.

Serum enzymes:
Aspartate transaminase (AST)

Serves as marker of injury to

hepatocytes that contain AST in
abundance.

Activities of serum AST and ALT are

early indicators of liver damage.
They also help in monitoring
response to treatment.

Alanine transaminase (ALT)

Serves as marker of injury to

hepatocytes that contain ALT in
abundance.

Alkaline phosphatase (ALP)

Serves as marker of biliary

obstruction.

Blood ammonia

Indicator of the ability of the liver to Levels are elevated in cirrhosis of

detoxify ammonia.
liver with portal hypertension and in
disorders of the urea cycle.

Aids in diagnosis of obstruction of the

biliary tract.

Serum Bilirubin
1. Jaundice is usually clinically obvious when total bilirubin exceeds 3
mg/dL.
2. Hyperbilirubinemia that is primarily unconjugated may be seen with
hemolysis
3. Unconjugated bilirubin is neurotoxic, and high levels may produce
encephalopathy.
4. predominantly conjugated hyperbilirubinemia (>50%) is associated
with increased urinary urobilinogen and may reflect
hepatocellular dysfunction,
acquired intrahepatic cholestasis
extrahepatic biliary obstruction

Serum Alkaline Phosphatase

1. Alkaline phosphatase is produced by the liver, bone,
small bowel, kidneys, and placenta and is excreted
into bile.
2. In the liver, ALP is expressed by the bile duct
epithelium.
3. children and adolescents have much higher levels,
reflecting active growth. Most of the
circulatingenzyme is normally derived from bone
4. However, with biliary obstruction, more hepatic
alkaline phosphatase is synthesized and released into

GGT
1. enzyme found in hepatocytes and released from the
bile duct epithelium.
2. Elevation of GGT is an early marker and also a
sensitive test for hepatobiliary disease. However, it is
nonspecific and can be produced by a variety of
disorders in the absence of liver disease.
3. Increased levels of GGT can be induced by certain
medications,alcoholabuse, pancreatic disease,
myocardial infarction, renal failure, and obstructive
pulmonary disease.

AST& ALT

1. AST is found in liver, cardiac muscle, skeletal muscle, kidney, brain, pancreas, lungs, and red
blood cells and thus is less specific for disorders of the liver.
2. ALT is predominately found in the liver and thus is more specific for liver disease.
3. Hepatocellular injury is the trigger for release of these enzymes into the circulation. Common
causes of elevated aminotransferase levels include viral hepatitis,alcoholabuse, medications,
genetic disorders (Wilsons disease, hemochromatosis, 1-antitrypsin deficiency), and
autoimmune diseases.
4. However, the levels of the enzymes in these tests correlate poorly with the severity of
hepatocellular necrosis, because they may not be significantly elevated in conditions of
hepatic fibrosis or cirrhosis.
5. In alcoholic liver disease, an AST:ALT ratio of >2:1 is common.
6. Mild elevations of transaminase levels can be found in nonalcoholic fatty liver disease,
chronic viral infection, or medication-induced injury.
7. Moderate increases in the levels of these enzymes are common in acute viral hepatitis.
8. In conditions of ischemic insults, toxin ingestions (i.e.,acetaminophen), and fulminant
hepatitis, AST and ALT levels can be elevated to the thousands.

Serum Albumin
1. Albuminvalues less than 2.5 g/dL are generally
indicative of chronic liver disease, acute stress, or
severe malnutrition.
2. Increased losses ofalbuminin the urine (nephrotic
syndrome) or the gastrointestinal tract (protein-losing
enteropathy) can also produce hypoalbuminemia.

Blood Ammonia
1. Significant elevations of blood ammonia levels usually
reflect disruption of hepatic urea synthesis.
2. Marked elevations usually reflect severe
hepatocellular damage and may cause
encephalopathy.

Prothrombin Time
1. Measurements of the prothrombin time (PT) and international normalized ratio
(INR) are some of the best tests of hepatic synthetic function.
2. PT measures the rate of conversion of prothrombin to thrombin.
3. The PT, which normally ranges between 11-14 sec, depending on the control
value, measures the activity of fibrinogen, prothrombin, and factors V, VII, and X.
To standardize the reporting of PT and avoid interlaboratory variability, the INR
was developed.
4. The relatively short half-life of factor VII (4-6 h) makes the PT useful in evaluating
hepatic synthetic function of patients with acute or chronic liver disease.
5. Because only 20% to 30% of normal factor activity is required for normal
coagulation, prolongation of the PT usually reflects either severe liver disease
orvitamin K deficiency.
6. The INR is the ratio of the patients PT to the mean control PT.