1. INTERPRETATION OF LIVER
FUNCTION TESTS
PROF.(DR)G.SUNDARAMURTHY
M2 UNIT
SECOND YEAR JUNIOR
RESIDENT
DR.DILIP HARINDRAN

2. INTRODUCTION
Better term is liver biochemical tests.
Lab tests are an effective and sensitive method
for screening for
 The presence and pattern of hepatic dysfunction
 Directing further diagnostic evaluation of
identified abnormalities
 Assessing the severity of disease and follow
course
 Response to treatment
Liver performs various important functions in our
body like metabolism of drugs and toxins, protein
lipid and carbohydrate metabolism, synthesis of
clotting factors.

3. INTRODUCTION(CONTD.)
LIVER FUNCTION TESTS
CAPACITY DETECTION OF INJURY CHRONIC INFLAM
OF LIVER MATION
TO TRANS- NECROSIS CHOLESTASIS BIOSYNTHETIC -HYALUR
PORT ANI- -AST -ALP FUNCTION ONAN
ONS AND -ALT -GGT -ALBUMIN -IMMUNO
METABOLISE -LDH -5’NT -PT GLOBULIN
DRUGS -GDH -FIBROTEST
-SERUM BILIRUBIN -CERULOPLASMIN -TRANSIENT
-URINARY BILIRUBIN -FERRITIN ELASTOGRA
-BSP,ICG,SERUM BILE ACIDS, -ALPHA1 ANTITRYPSIN PHY
BREATH TESTS AND METABOLITE -LIPOPROTEINS
TESTS

4. CASE 1:A 22 YEAR MALE CAME WITH
COMPLAINTS OF JAUNDICE FOR 6 MONTHS,
FATIGUABLITY AND MUSCLE PAIN FOR 2 YEARS.
TEST PATIENT VALUE LAB VALUE
SERUM BILIRUBIN (T) 5.84 0-1mg/dl
SERUM BILIRUBIN(D) 2.24 0-0.25mg/dl
AST(SGOT) 146 UPTO 40 IU
ALT(SGPT) 57 UPTO 37 IU
ALP 250 80-290 U/L
GGT 45 MALE-7-32 U/L
TOTAL PROTEIN 7.2 6.4-8.3 G/DL
ALBUMIN 2.9 3.8-4.4 G/DL
PROTHROMBIN TIME TEST-44 CONTROL-26 14-16 SEC
INR 1.8

5. CASE 1:A 22 YEAR MALE CAME WITH
COMPLAINTS OF JAUNDICE FOR 6
MONTHS,FATIGUABLITY AND MUSCLE PAIN FOR 2
YEARS.
TEST PATIENT VALUE LAB VALUE
SERUM BILIRUBIN (T) 5.84 0-1mg/dl
SERUM BILIRUBIN(D) 2.24 0-0.25mg/dl
AST(SGOT) 146 UPTO 40 IU
ALT(SGPT) 57 UPTO 37 IU
ALP 250 80-290 U/L
GGT 45 MALE-7-32 U/L
TOTAL PROTEIN 7.2 6.4-8.3 G/DL
ALBUMIN 2.9 3.8-4.4 G/DL
PROTHROMBIN TIME TEST-44 CONTROL-26 14-16 SEC
INR 1.8

6. INTERPRETATION
A CASE OF INDIRECT HYPERBILIRUBENEMIA
(DIRECT<50% OF TOTAL BILIRUBIN) WITH 3
TIMES ELEVATION OF AST, REDUCED
ALBUMIN(AG REVERSAL) AND RAISED PT AND
INR SUGGESTIVE OF A CHRONIC LIVER
DISEASE.

7. CASE 2:A 19 YEAR OLD FEMALE WITH
HISTORY OF CHICKEN POX 8 MONTHS BACK
DEVELOPED JAUNDICE, PALE STOOL AND
PRURITUS GRADUALLY.
TEST PATIENT VALUE LAB VALUE
SERUM BILIRUBIN (T) 32.7 0-1mg/dl
SERUM BILIRUBIN(D) 27.5 0-0.25mg/dl
AST(SGOT) 181 UPTO 40 IU
ALT(SGPT) 65 UPTO 37 IU
ALP 914 80-290 U/L
GGT 34 FEMALE-6-29 U/L
TOTAL PROTEIN 5.7 6.4-8.3 G/DL
ALBUMIN 2.2 3.8-4.4 G/DL

8. INTERPRETATION
A CASE OF DIRECT HYPERBILIRUBINEMIA
WITH RAISED AST(6 TIMES) AND ALT(MILD)
AND MARKEDLY RAISED ALP SUGGESTIVE
OF A CHOLESTATIC PICTURE WITH
ONGOING ACTIVITY. ALBUMIN ALSO IS
LOW SUGGESTIVE OF LIVER DISEASE.

9. CASE 3:A 32 year old male a chronic alcoholic
and known case of DCLD, with history of alcohol
intake 3 days before admission.
TEST PATIENT VALUE LAB VALUE
SERUM BILIRUBIN (T) 38.63 0-1mg/dl
SERUM BILIRUBIN(D) 31.4 0-0.25mg/dl
AST(SGOT) 54 UPTO 40 IU
ALT(SGPT) 19 UPTO 37 IU
ALP 211 80-290 U/L
GGT 78 MALE-7-32 U/L
TOTAL PROTEIN 7.8 6.4-8.3 G/DL
ALBUMIN 2.5 3.8-4.4 G/DL
PROTHOMBIN TIME TEST-34 SEC CONTROL-
22SEC
14-16SEC

10. INTERPRETATION
A CASE OF DIRECT HYPERBLIRUBENIMIA WITH
MILD ELEVATED AST AND AST/ALT~ 3:1 AND
GGT RAISED SUGGESTIVE OF ALCHOLIC LIVER
DISEASE WITH ONGOING ACTIVITY. AG
REVERSAL SUGGESTIVE OF CHRONIC LIVER
DISEASE. THE LIVER ENZYMES ARE NOT
ELEVATED MUCH AS THE LIVER HAS ALREADY
UNDERGONE CIRRHOSIS.

11. CASE 4:A 40 year old male asymptomatic
came, after routine master health check up.
TEST PATIENT VALUE LAB VALUE
SERUM BILIRUBIN (T) 0.8 0-1mg/dl
SERUM BILIRUBIN(D) 0.15 0-0.25mg/dl
AST(SGOT) 125 UPTO 40 IU
ALT(SGPT) 80 UPTO 37 IU
ALP 190 80-290 U/L
GGT 30 MALE-7-32 U/L
TOTAL PROTEIN 8.0 6.4-8.3 G/DL
ALBUMIN 4.0 3.8-4.4 G/DL

12. INTERPRETATION
A CASE OF MILDLY ELEVATED
TRANSAMINASES WITH NO OTHER
ABNORMALITY.HAS TO BE WORKED UP
FURTHER FOR ANY OCCULT LIVER
PROBLEM.

13. EVALUATION OF ELEVATED
TRANSMINASE LEVELS

14. CHOLESTASIS
INTRA
HEPATI
C
EXTR
A
HEPA
TIC

15. Causes of Elevated Serum
Aminotransferase Levels
ALT > AST
AST > ALT
HEPATIC CAUSES
α1-antitrypsin deficiency
Autoimmune hepatitis
Chronic viral hepatitis (B, C,
and D)
Hemochromatosis
Steatosis and steatohepatitis
Wilson disease
medication and toxins
NON HEPATIC CAUSES
Celiac disease
Hyperthyroidism
(Chronic, Mild < 5 fold)( Acute severe>20 fold )
Acute bile duct
obstruction
Acute Budd-Chiari
syndrome
Acute viral hepatitis
Autoimmune
hepatitis
Ischemic hepatitis
Medications/toxins
Wilson disease
( Acute severe>20 fold )( Chronic, Mild < 5 fold )
Hepatic Causes
Alcohol-related liver injury
Cirrhosis.
Nonhepatic Causes
Hypothyroidism
Myopathy
Strenuous exercise
Hepatic Cause
Medications or toxins in a
patient with underlying
alcoholic liver injury
Nonhepatic Cause
Acute rhabdomyolysis

16. EVALUATION OF RAISED
ALKALINE PHOSPHATASE

17. KEY CONCEPTS
• Elevations in serum levels of ALT and AST are
nonspecific indicators of hepatocellular damage
except that AST/ALT ratio(de riti’s ratio)greater than
2 suggests alcoholic liver disease.
• Elevation of serum level of ALP in liver injury is
caused by regurgitation of alkaline phosphatase
from damaged hepatocytes into the serum.
• The rate-limiting step in hepatic bilirubin production
is excretion of conjugated bilirubin into canalicular
bile-explains why patients having hepatocellular
dysfunction have a predominantly conjugated
fraction in hyperbilirubinemia.
• Prolongation of PT that is unresponsive to vitamin K
infusions-poor prognosis.