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LABORATORY IN HEPATOBILIARY DISEASES. Dr. Sebati ÖZDEMİR Division of Gastroenterology. L I VER CHEM I STRY TESTS. Liver chemistry tests fall into three main categories : T ests that reflect hepatobiliary injury. (Hepatocellular injury and cholestatic injury).

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laboratory in hepatobiliary diseases

LABORATORYIN HEPATOBILIARY DISEASES

Dr. Sebati ÖZDEMİR

Division of Gastroenterology

l i ver chem i stry tests
LIVER CHEMISTRY TESTS

Liver chemistry tests fall into three

main categories:

  • Tests that reflect hepatobiliary injury.(Hepatocellular injury and cholestatic injury).
  • Tests that evaluate the functional status of the liver.
  • Tests that define the etiology of liver disease.
liver chem i stry tests
LIVER CHEMISTRY TESTS
  • Aminotransferase (ALT and AST)
    • The reflection of hepatocellular damage
  • Alkaline Phosphatase and γ-glutamyltransferase (GGT)
    • The reflection of cholestasis and/or hepatic infiltrates
  • Bilirubins
    • The presence and severity of jaundice
  • Albumin and prothrombin time
    • The reflection of hepatic synthetic function
common serum liver chemistry tests
Common Serum Liver Chemistry Tests

Liver chemistry test Clinical implication of abnormality

Alanine aminotransferase …(ALT)......Hepatocellular damage

Aspartate aminotransferase..(AST)….Hepatocellular damage

Prothrombin time…………(PT)……….Synthetic function

Albumin……………………..…...….…..Synthetic function

Bilirubin: Cholestasis, impaired conjugation,or biliary obstruction, or isolated-familial hyperbilirubinemia (discussed in the lecture of JAUNDICE)

Alkaline phosphatase…....(AP)………Cholestasis or biliary obstruction

or infiltrative disease

γ-glutamyltransferase……(GGT)…....Cholestasis or biliary obstruction

Bile acids……………………………….Cholestasis or biliary obstruction

5'-Nucleotidase……………………..…Cholestasis or biliary obstruction

Lactat dehydrogenase……(LDH).......Hepatocellular damage; not specific for

hepatic disease

hepatocellular injury
Hepatocellular Injury

Alanine aminotransferase (ALT) formerly (SGPT)

  • It is found primarily in the liver.

Aspartate aminotransferase (AST) formerly (SGOT)

  • It is found in the liver, cardiac muscle, skeletal muscle, kidneys, brain, pancreas, lungs, leukocytes, and erythrocytes. (in decreasing order of concentration)
etiology of mild alt or ast elevations less than 5 times normal
Etiology of mild ALT or AST elevationsLess than 5 times normal

Hepatic: ALT-predominant

  • Chronic hepatitis B
  • Chronic hepatitis C (*)
  • Acute viral hepatitis (A–E, EBV, CMV)
  • Steatosis/steatohepatitis
  • Hemochromatosis
  • Medications/toxins
  • Autoimmune hepatitis
  • Alpha1-antitrypsin deficiency
  • Wilson's disease
  • Celiac disease
etiology of mild alt or ast elevations less than 5 times normal1
Etiology of mild ALT or AST elevationsLess than 5 times normal

Hepatic: AST-predominant

  • Alcohol-related liver injury
  • Steatosis/steatohepatitis
  • Cirrhosis

Nonhepatic

  • Hemolysis
  • Myopathy
  • Thyroid disease
  • Strenuous exercise
etiology of severe alt and ast elevations greater than 15 times normal
Etiology of severe ALT and AST elevationsGreater than 15 times normal
  • Acute viral hepatitis (A-E viruses, herpes)
  • Medications/toxins
  • Ischemic hepatitis
  • Autoimmune hepatitis
  • Wilson's disease
  • Acute Budd-Chiari syndrome
  • Hepatic artery ligation
cholestatic injury
Cholestatic Injury
  • Alkaline phosphatase
    • It is found in the liver, bone (the both more than 80% of total AP), placenta, intestine, kidneys, and leukocytes.
  • Gamma-glutamyltransferase (GGT)
    • It is found in the cell membranes of several tissues (BUT NOT IN BONE!.. )(Therefore GGT is a valuable test whether an alkaline phosphatase elevation is “LIVER OR BONE” origin)
    • It is a very sensitive indicator of the presence or absence of hepatobiliary disease.
  • 5'-Nucleotidase
causes of elevated serum alkaline phosphatase
Causes of Elevated Serum Alkaline Phosphatase

HEPATOBILIARY

  • Bile duct obstruction
  • Cholestatic liver disease (primary biliary cirrhosis, primary sclerosing cholangitis)
  • Medications
  • Hepatocellular carcinoma (HCC)
  • Hepatic metastasis
  • Infiltrating diseases of the liver
  • Hepatitis
  • Cirrhosis
causes of elevated serum alkaline phosphatase1
Causes of Elevated Serum Alkaline Phosphatase

NONHEPATIC

  • Bone disease
  • Pregnancy
  • Childhood growth
  • Lymphoma and other malignancies
  • Infection/Inflammation
functional status
Functional Status
  • Albumin
    • Hypoalbuminemia is due to a decreased hepatic synthesis (liver disease), or increased renal losing (nephrotic syndrome)
  • Prothrombin Time (PT)
    • The liver synthesizes coagulation factors I, II, V, VII, IX, XII and XIII.
    • PT depends on tha activity of factors I, II, V, VII and X.
    • (K vit. II, VII, IX and X).