lft-140225102345-phpapp02 (1).pptx
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BY
PAYAL PATEL
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Metabolic
function
Excretory
function
Synthetic
function
Detoxification
function
Storage
function
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Tests based on metabolic function
Tests based on excretory function
Tests based on synthetic function
Tests based on detoxification
function Determination of serum enzymes
I
II
III
IV
V
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1.Serum bilirubin
2.Urine bilirubin
3.Urine and faecal urobilinogen
4.Urine bile salts
5.Dye excretion tests BSP Test
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Plasma proteins
Prothrombintime
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Tests related toCARBOHYDRATEmetabolism
Tests related toLIPIDmetabolism
Tests related toPROTEINmetabolism
Galactose tolerancetest Serum cholesterolSerum proteinsAminoaciduria
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Hippuric acid
test
Determinationof blood
ammonia
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Serum
transaminases
ALT
AST
Serum alkalinephosphatase
ALP
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Total, conjugated and unconjugated
Serum-Bilirubin
Bile pigments, bile salts and
urobilinogen
urine
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1.Serum bilirubin
Conjugated
0.0 0.2mg/dl Unconjugated
0.2 0.6mg/dlTotal
0.2 0.8mg/dl
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Serum bilirubin estimation is based on van denBergh reaction.
Diazo reagent consists of diazotized sulfanic acid
Normal serum does not give postive van den
bergh reaction
When a bilirubin in serum is allowed to
react with a freshly prepared solution of
diazo reagent, there will be formation
of purple compound azo-bilirubin
Principle
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Conjugated bilirubin- Direct positive
Unconjugated bilirubin- Indirect positive
Both conjugated & unconjugated bilirubin-iphasic
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Yellow color of conjunctivae, mucous membrane and skin
due to increased bilirubin level More than 2.0 mg/dl
Heamolytic
jaundice
haemoglobin
opathies
Hepatocellular
jaundice
hepatitis
Obstructive
jaundice
Gall stone
Tumor of
bile duct
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URINE BILIRUBIN
In all cases of jaundice, urine should be examinedfor the presence of bile pigments (bilirubin), bile
salts and urobilinogen
Fouchetstest
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URINE UROBILINOGEN
Urobilinogen absent in obstruction to bile
flow
Ehrlichs test
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URINE BILE SALTS
Obstruction in the biliary passages
Hays test
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S Bilirubin
U
Urobilinogen
U
Bilirubin
F
UrobilinogenConjugated Unconjugated
Normal
0.1-
0.2mg/dl
0.2-0.6mg/dl 0.4mg/day Absent 40-
280mg/day
PrehepaticNormal Increased Increased Absent Increased
HepaticIncreased Increased N/Decreased Present Decreased
Posthepatic
Increased Normal Absent Present Trace to
absent
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Dyeexcretion
test
Bromosulphthalein [BSP] test
Nontoxic, almost exclusively excreted by the
liver
5mg/kg body weight I.V
Serum level at 45min and 2hours
Less than 5% dye retained at the end of 45min
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Liver is the main source of synthesis of Plasma proteins
- Albumin
- Globulin(except ) Blood clotting factors
- Prothrombin and
factors V, VII and X.
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Total serum protein
= 6-8gm/dl
Serum
albumin
= 3.5-
5.5gm/dl
Serum
globulin
=2-3.5gm/dl
Albumin/globuliratio= 1.2:1 to2.5:1
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Prothrombin time depends upon
the presence of prothrombin and
factors V, VII and X & vit-K.
Deficiency causes prolonged
time.
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Hippuric acid test 6gm of sodium benzoate dissolved in 250ml water
Collect urine for next 4 hour
Determination of blood ammonia Liver detoxicates ammonia to form urea
Normal 40-70g/100ml
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In liver cell injury, damage to the membraneof cells and organelles allows intracellularenzymes to leak into the blood.
Where their elevated concentrations can bemeasured
Serum transaminases
Serum alkaline phosphatase
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Serumtransaminases
AST or SGOT=
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Enzyme Prehepatic
Jaundice
Hepatic
Jaundice
Obstructive
Jaundice
ALT or AST Usually normal Markedincrease500-1500IU/L
Increased100-300IU/L
ALP Normal Increasedslightly< 30KA/dl
Markedincrease>30KA/dl
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Normal range: 10-47IU/L increased in
chronic alcoholism
Serum -Glutamyl Transferase
Normal range: 2-17IU/L incre3ased in
hepatobilary disease
Serum 5-Nucleotidase
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Thank you
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