Liver Function Tests:- Part 1 – Liver function tests and Jaundice Classification
Liver Function Tests
Sample for Liver Function Tests
- The venous blood is needed to prepare the serum.
For the complete evaluation of liver functions, the following tests are recommended.
-
- Total Bilirubin.
- Direct bilirubin.
- Indirect bilirubin.
- SGPT.
- SGOT.
- Alkaline phosphatase.
- Gamma-glutamyltransferase (γ-GT).
- Total protein.
- Albumin
- A / G ratio.
- Prothrombin time (PT).
- Ultrasound of the abdomen to evaluate the liver or any other mass in the abdomen.
- Viral markers.
- Total Bilirubin.
Normal Values of liver function tests:
| Test | Normal value |
| Total bilirubin | o.3 to 1.0 mg/dL |
| Conjugated bilirubin | 0.1 to 0.3 mg/dL |
| Unconjugated bilirubin | 0.1 to 0.8 mg/dL |
| Newborn total bilirubin | 1.0 to 12.0 mg/dL. |
| Alkaline phosphatase |
Adult = 30 to 120 units/L Child <2 years = 85 to 235 units/L 2 to 8 years = 65 to 210 units/L 9 to 15 years = 60 to 300 units/L 16 to 21 years = 30 to 200 units/L |
| SGOT (AST) |
Adult = 0 to 35 units Elderly = values slightly higher than adult Newborn and infants = 15 to 60 units/L |
| SGPT (ALT) |
Adult and child = 4 to 40 units/L Infants may be twice high as the adult value |
| Albumin |
Adult = 3.5 to 5 g/dL Premature infants = 3 to 4.2 g/dL Newborn = 3.5 to 5.5 g/dL Infant = 4.4 to 5.4 g/dL Child = 4 to 5.9 g/dL |
| Total protein | 6.4 to 8.3 g/dL |
| A/G ratio | 0.8 to 2.0 |
| Gamma-glutamyltransferase (γ-GT). |
>45 years = 8 to 38 units/L Female <45 years = 5 to 27 units/L Childlike adult level Newborn = 5 times higher than the adult level |
| Prothrombin time (PT) |
11 to 12.5 seconds Anticoagulant therapy = 1.5 to 2 times control |
| Ultrasound | No organomegaly |
| Viral markers | Negative |
Phases of the Jaundice:
- Preicteric phase.
- Icteric phase.
- Nonicteric phase.
Preicteric phase:
- In this phase, urine, bilirubin is usually positive 1 to 6 days before the onset of clinical jaundice.
- Urinary urobilinogen is usually increased.
- The BSP test is usually the first test to become positive in this phase.
- Thymol flocculation, turbidity tests, and cephalin flocculation tests are positive in the late phase of jaundice.
Icteric phase:
- Direct bilirubin is increased.
- Urinary urobilinogen is increased, and bile is present in the urine.
- Alkaline phosphatase may or may not be elevated.
- Thymol turbidity and flocculation test and cephalin-flocculation test are positive.
- The Bromsulphalein test is not helpful.
Nonicteric phase:
- Urinary urobilinogen is increased.
- Thymol-flocculation and turbidity and cephalin flocculation tests are usually positive.
- The Albumin-globulin ratio shows high globulin and low serum albumin.
- Alkaline phosphatase and cholesterol ester may or may not be helpful.
Liver Function Tests: Jaundice and its phases
Classification of jaundice:
The major causes of jaundice are:
- Pre-hepatic jaundice where there is hemolysis.
- Hepatic jaundice where there is intrahepatic biliary tract obstruction.
- Post hepatic jaundice where there is extrahepatic biliary tract obstruction.
Liver Function Tests: Classification of the jaundice
- Please see more details in the LFT part.
Questions and answers:
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