Dr Yasir M Khayyat,MBcHB,FRCPC,FACP 1 Khayyat Y

LFT WhyHowWhenWHO 600 ريال 2 Khayyat Y

LFT AST AlbuminBilirubin AlkPh GGT ALT Hepatocellular Necrosis Markers INR Markers of Cholestasis Markers of synthetic function 3 Khayyat Y

4

AST ALT 5 Khayyat Y

ALT:  Specific from the liver,Cytosolic Enzyme AST:  Muscle(skeletal, Cardiac),Brain,Kidney,Pancreas, cytoslic 20% and mitochondrial 80%.  Levels are normal in advanced cirrhosis AST/ALT ratio :  Acute liver injury ≤ 1, Alcoholic hepatitis > 2  Its elevation does not correlate with hepatic necrosis. 6 Khayyat Y

In Alcoholic liver disease AST  Alcohol increase release of mitochondrial AST ALT  in alcohol there is pyridoxal 5 deficiency with decrease in ALT > AST activity In NAFLD,chronic liver disease: AST ( early low,then with progressive disease and cirrhosis increase), advanced cirrhosis  decrease hepatic clearance of AST. ALT Khayyat Y 7

Alkaline phosphatase:  From Liver,Bone,Kidney,placenta,leukocytes,various neoplasms.  From the apical membrane of the hepatocyte and luminal domain of the bile duct.  Predominantly in infiltrative hepatic disorders, biliary obstruction,extrahepatic biliary tree obstruction.  Due to increased de novo synthesis rather than release of the stored enzyme or impaired clearance GGT ( Gamma Glutamyl Transpeptidase)  From kidney,spleen,pancreas,heart,lung,brain 8 Khayyat Y

Bilirubin  Conjugated Bilirubin  Unconjugated Bilirubin Markers of Hepatic Synthesis:  INR or PT :  The liver is factory for all coagulation factors except 8.  INR if dependant on Vit K ( 2,7,9,10)  Increased in: vitamin K deficiency( malnutrition-malabsorption-antibiotic use)warfarin use, consumptive coagulpathy. 9 Khayyat Y

Albumin :  Synthesize 10g by the liver daily. It is not only reflect liver status but it reflects nutritional and volume status, vascular integrity,catabolism,hormonal factors, loss in the urine or stool. 10 Khayyat Y

Albumin: - Protein losing enteropathy - Nephrotic syndrome -Malnutrition -Congestive heart failure Alkaline Phosphatase: - Bone Diseases - Pregnancy -Malignancy AST: - Muscle disorders - Myocardial Infarction Bilirubin: - Hemolysis - Sepsis - Ineffective erythopoiesis Shunt hyperbilirubinemia PT /INR: - Antibiotics use - Anticoagulant use - Steatorrhea - Dietary Vit K deficiency Khayyat Y 11

Mild persistent Elevation < 250 ≤ 5 folds Moderate Elevations folds Marked Elevations > 2000 > 15 folds NAFLDAnyDrug induced Alcohol useAutoimmune hepatitisToxin induced Chronic hepatitis C Infection Alpha one alpha antitrypsin deficiency Ischemic liver injury ( shock) CirrhosisWilson diseaseAutoimmune hepatitis NeoplasmsDrug induced Acute viral hepatitis Hemochromatosis 12 Khayyat Y

ALP >>> Bilirubin: 1- Partial Biliary obstruction: CBD stone/stricture,recur rent cholangitis,PSC,mali ganat obstruction of Left or right systems, early biliary Cirrhosis 2- Hepatic Infiltration:Primary, metastatic cancer,amyloid,myco bacteria,granulomat ous disorders. Bilirubin >>> ALP 1- Conjugated B > ALP,variety of causes of Liver disease.( non specific) 2- Unconjugated B >>> ALP :inherited or acquired defects in hepatic uptake or conjugation (e.g., Gilbert's syndrome) or hemolysis GGT : isolated with normal LFT ( drugs or alcohol) ↑ ALP with normal GGT : rapid bone growth (e.g., in children), bone disease (e.g., Paget's disease), or pregnancy. 13 Khayyat Y

14 Khayyat Y

MiscellaneousHepatobiliaryInfectious BerylliosisPBCTB SarcoidosisAtypical Mycobacteria DrugsBrucellosis Candidasis Syphilis 15 Khayyat Y

Acquired Neoplastic - Primary - Secondary Non Neoplastic Infectious,Inflammtory,Metabolic, Vascular,Infiltrative,Toxic Congential 16 Khayyat Y