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Comprehensive Hepatic Function Assessment for Liver Disorders

This CMS-approved Hepatic Function Panel includes tests for total protein, albumin, AST, ALT, ALP, total bilirubin, direct bilirubin, and indicators of necrosis, cholestasis, protein synthesis, and reaction to injury. Learn about hepatic diseases, evaluation criteria, and references for interpreting test results for liver disorders.

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Comprehensive Hepatic Function Assessment for Liver Disorders

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  1. Hepatic Function Tests

  2. CMS approved Hepatic Function Panel • Total protein • Albumin • AST • ALT • ALP • Total Bilirubin • Direct bilirubin

  3. Hepatic Disease • NECROSIS - Acute - viral, toxic, hypoxic - Chronic - carrier state, chronic activity • CHOLESTASIS - Intrahepatic - Diffuse: drug-induced, PBC - Focal: tumor, granuloma, stone - Extrahepatic: stone, tumor

  4. Indicators of Necrosis • normal ALT and inc AST: nonhepatic • AST:ALT > 2: acute alcoholic hepatitis > 1: in chronic disease: alcoholic < 1: in acute viral hepatitis • in acute alcoholic hepatitis: - AST & ALT < 250 U/L • Abrupt increases to > 10,000 U/L occur in hypoxia, acetominophen, herpes simplex • predominance of ALT/AST over ALP/GGT favors necrosis over cholestatsis

  5. Indicators of Cholestasis • increases in ALP and GGT: Hepatic • increases in ALP and normal GGT: Bone • increases in ALP and normal bilirubin: mean focal intrahepatic cholestasis • blood group O and B secretors may increase intestinal ALP postprandially • predominance of ALP/GGT over ALT/AST favor cholestasis over necrosis • Isolated slight increases in GGT - alcohol, anticonvulsants, diabetes, hyperthyroidism weeks after acute MI

  6. Bilirubin • Increased T. Bilirubin < 5.0 mg/dL with D. Bilirubin < 20% of total indicates hemolysis or Gilbert syndrome • In extra-hepatic obstruction T. Bilirubin rarely exceeds 25 mg/dL

  7. Indicators of Protein Synthesis • decreased albumin in a non-acutely ill patient means a chronic illness • Albumin may decrease quickly in an acutely ill patient in negative nitrogen balance • PT is a more sensitive index of synthesis than albumin • both albumin and PT are better indices of severity and prognosis of liver disease

  8. Indicators of Reaction to Injury • autoimmune hepatic disease indicated by: - immunoglobulins > 3.0 g/dL; ANA > 1:160, homogeneous; positive smooth muscle antibody, Type I L-K microsomal antibody • PBC: Increased IgM & antimitochondrial antibody in >90% • in chronic hepatic disease, increase in globulin indicates activity

  9. Hepatic Function: References • Kamath, PS: Clinical approach to the patient with abnormal liver test results. Mayo Clin Prroc 1996;71:1089-95 • Herlong, HF: Aproach to the patient with abnormal liver enzymes. Hospital Practice 1994, November, pp 32-38 • Burke, MD: Liver function:test selection & interpretation of results. Clin Lab Med 2002; 22:377-90

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