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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