Liver Function

Measures of hepatocyte integrity....enzymes within hepatocytes themselves...Aspartate aminotransferase, Alanine aminotransferase, alkaline phosphatase.....collectively known as LFTs....not true tests of liver function though...

Liver makes bilirubin water soluble for excretion into the urine....get total bilirubin from complete CFP...

often used with elevated alkaline phosphatase to clarify

Removal of RBCs (along with spleen)....production of clotting factors, bile secretion, metabolic processing, lipoprotein production....waste elimination, plasma porteins....Endocrine (insulin-like growth factor, vitamin D activation (made in skin but two step activation....liver and kidney).....thrombopoetin (more platelets) and erythropoetin (left over from embryonic life...more red blood cells)....

CMP (chem 14) or liver function tests (LFTs)

ALT and AST (liver enzymes....alanine aminotransferase and aspartate aminotransferase

GGT and ALP (alkaline phosphatase....mostly in biliary cells but some in hepatocytes)...

albumin and prothrombin time...

bilirubin (indirect vs. direct) and ammonia ....might just be overwhelmed from a hemolytic anemia....why getting a fractionated bilirubin is good....

less than 2 fold elevation of ALT and AST....no signs of chronic liver disease

ALT, AST, albumin, total bilirubin, Alk phos (ALP)....markers of hepatocytes, synthetic function, and some excretion information

Found in highly metabolic tissues (liver, brain, pancreas, kidneys, heart)....not very specific.....maker of hepatocyte (or other organ) damage...needs to be part of a picture

chronic injury (persistent elevation).....chronic disease (mild elevations)....don't forget medication effects!....elevation from acute injury should decrease in 3-7 days post-injury

Acute hepatitis, acute pancreatitis, acute hepatocellular disruption....

chronic hepatitis, alcoholic hepatitis, Biliary tract obstruction, cardiac arrhythmias, muscular dystrophy

cirrhosis from viral hepatitis, fatty liver, delirium tremens, cholestatic liver disease

Pregnancy, severe chronic liver disease, uremia, diabetic ketoacidosis.....not clinically significant

MORE LIVER SPECIFIC.....MOST SENSITIVE FOR HEPATIC DAMAGE...but found a bit in heart, pancreas, muscle.....isolated ALT will spell liver whereas AST may not....

levels will come down pretty quickly from acute issues as the hepatocytes repair themselves....ALT usually higher in pathologies due to its specificity.....AST usually higher in alcoholic though (self...you did it to yourself)...

significant...hepatitis, hepatic necrosis, hepatic ischemia, shock liver.....moderate elevation: cirrhosis, obstruction....mild: pancreatitis, mono, shock, drugs

alcoholic cirrhosis, liver congestion, metastatic tumor of liver...SOMETHING you do to your SELF

acute hepatitis, viral hepatitis....ALT generally more due to DIRECT DAMAGE TO LIVER

acute hypoperfusion injury to liver....AST and ALT altered....restore perfusion and the hepatocytes can heal themselves

Enzyme found in liver, bones, cells lining biliary tract.....may see it elevated in pregnancy (normal from building a skeleton).....more indicative of something biliary.......bone diseases as well...

Less liver specific than others....obstructions, hepatitis.... Paget's disease, osteosarcoma, bone metastasis, pregnancy.....

Liver-ALP1....Bone-ALP2....

hepatocellular

predominantly cholestatic....bile duct obstruction

probably bone related

Confirms findings of increase in ALP to the effect of cholestasis.....probably think bone if the GGTP comes back normal and they aren't pregnant

MOST SENSITIVE for biliary obstruction and cholestasis

pre-hepatic...water insoluble...rise says liver is overwhelmed or not working....MAJORITY NORMALLY....

post-hepatic...usually a duct obstruction...is water-soluble....if >50% look for obstructive issue....if <15%, think hemolysis....or hepatitis....

Ordered by CMP...fractionated must be ordered separately

Brain damage due to sustained elevations of bilirubin...no exact number on it....combination of factors...trauma due to birth (pre-hepatic) and immature liver (hepatic)

Could be liver issues or could be failure to thrive (not providing with building blocks)....

chronic liver issue (cirrhosis or cancer)...

Due to the inflammation....not liver issues....acute inflammation can cause albumin to fall....

amylase and lipase....majority is exocrine with tiny endocrine pockets....also secretes an alkaline solution of bicarbonate into duodenum....

quite acute....might miss it if they have suffered from pancreatitis for a couple of days....starch cleavage....elevations include pancreatitis, alcoholism, cholelithiasis....

more readily discernable from amylase....available longer....MORE PANCREAS SPECIFIC....