1. Blood Studies Liver function test (LFT) Group of biochemical tests Group of biochemical tests Uses of liver function test (LFTs) Differential diagnosis & prognosis of jaundice Differential diagnosis & prognosis of jaundice To assess the extend of liver damage To assess the extend of liver damage To follow the progress of liver damage To follow the progress of liver damage

2. Liver function test (LFT) Serum Bilirubin Serum Bilirubin Hepatic enzymes – AST, ALT, Alkaline Phosphatase Hepatic enzymes – AST, ALT, Alkaline Phosphatase Prothrombin time Prothrombin time Serum proteins (with albumin & globulin ratio A/G ratio) Serum proteins (with albumin & globulin ratio A/G ratio)

3. 1. Serum Bilirubin 2. Serum Enzymes Serum Aminotransferase - AST (SGOT), ALT (SGPT) Serum Aminotransferase - AST (SGOT), ALT (SGPT) Elevated levels usually indicate cellular damage to the liver ALT – alanine amonitransferase Cytosol enzyme Cytosol enzyme It is more specific than AST for the liver It is more specific than AST for the liver AST – asparate amninotransferaase Mitochondrial enzyme Mitochondrial enzyme Also present in heart, brain, kidney & musles Also present in heart, brain, kidney & musles High levels are seen in hepatic necrosis, myocardial infarction, muscle injury High levels are seen in hepatic necrosis, myocardial infarction, muscle injury

4. Alkaline phosphatase Present in canalicular membranes of hepatocyte Present in canalicular membranes of hepatocyte Secreted in bile, Blockage of Alkaline Phosphatase excretion (via bile) will induce more synthesis, leading to high blood levels. Secreted in bile, Blockage of Alkaline Phosphatase excretion (via bile) will induce more synthesis, leading to high blood levels. Raised in cholestatic jaundice (4-6 times normal) Raised in cholestatic jaundice (4-6 times normal) Also raised in Metastatis & cirrhosis Also raised in Metastatis & cirrhosis Present in liver, bone, intestine & plasma Present in liver, bone, intestine & plasma Gamma glutamyl transferase (γGT) Raised value is good guide to alcohol intake Raised value is good guide to alcohol intake

5. Prothrombin Time (PT) Time required for a firm fibrin clot to form Time required for a firm fibrin clot to form It is a sensitive indicator of both acute & chronic liver disease It is a sensitive indicator of both acute & chronic liver disease Prolonged PT occurs due to Vit K deficiency, which is excluded by giving 10mg of Vit K IV Prolonged PT occurs due to Vit K deficiency, which is excluded by giving 10mg of Vit K IV In liver dysfunction, increase clotting time with increased risk of bleeding In liver dysfunction, increase clotting time with increased risk of bleeding

6. Protein Studies Serum albumin Serum albumin Low levels indicates severity of chronic liver disease Low levels indicates severity of chronic liver disease Falling serum albumin is a bad prognostic sign liver disease Falling serum albumin is a bad prognostic sign liver disease Serum globulin Serum globulin Hyperglobulinaemia occurs in chronic liver disease due to immunological mechanisms Hyperglobulinaemia occurs in chronic liver disease due to immunological mechanisms High globulin & low albumin is a characteristic feature of CLD

7. Ammonia Liver converts ammonia to urea. Ammonia rises in liver failure Liver converts ammonia to urea. Ammonia rises in liver failure Tumor Marker Alpha-fetoprotein (AFP) Alpha-fetoprotein (AFP) Increased levels are seen with hepatic carcinoma Increased levels are seen with hepatic carcinoma Liver Biopsy Used to obtain a specimen of liver tissue Used to obtain a specimen of liver tissue Done under local anesthesia Done under local anesthesia

8. Imaging USG of Liver USG of Liver

9. Imaging CT of Liver CT of Liver MRI of Liver MRI of Liver

10. Cholangiography X-ray examination of the biliary system, using a radiopaque dye given intravenously or orally, as contrast medium Types Oralcholecystography /OCG Oralcholecystography /OCG Intravenous cholangio graphy/ICG Intravenous cholangio graphy/ICG Endoscopic Retrograde Cholangio – Pancreatography /ERCP Endoscopic Retrograde Cholangio – Pancreatography /ERCP Percutaneous transhepatic cholangiography /PTC Percutaneous transhepatic cholangiography /PTC Operative cholangiography Operative cholangiography Operative T tube cholangiography Operative T tube cholangiography 10 Dr S Chakradhar

11. Magnetic Resonance cholangio-pancreatography/MRCP 11 Dr S Chakradhar