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Dr Yasir M Khayyat,MBcHB,FRCPC,FACP. Approach to Liver Function Test. Before you order LFT ask. 600 ريال. Hepatocellular Necrosis Markers. Markers of synthetic function. INR. Markers of Cholestasis. Liver cell. Liver cell. AST ALT. ALT: Specific from the liver ,Cytosolic Enzyme

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Approach to Liver Function Test

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dr yasir m khayyat mbchb frcpc facp
Khayyat Y

Dr Yasir M Khayyat,MBcHB,FRCPC,FACP

Approach to Liver Function Test

Khayyat Y

Hepatocellular Necrosis Markers

Markers of synthetic function


Markers of Cholestasis



  • Specific from the liver ,Cytosolic Enzyme


  • 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 > 2
  • Its elevation does not correlate with hepatic necrosis.

Khayyat Y


In Alcoholic liver disease

AST  Alcohol increase release of mitochondrial AST

ALT in alcohol there is pyridoxal 5 deficiency with decrease in ALT > AST activity

In NAFLD,chronic liver disease:

AST ( early low ,then with progressive disease and cirrhosis increase) , advanced cirrhosis  decrease hepatic clearance of AST.


Khayyat Y


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

Khayyat Y



  • 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.

Khayyat Y


Albumin :

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

Khayyat Y