INVESTIGATIONS FOR LIVER DISEASES

Dr. Mahmoud Ahmed Mahmoud Alexandria University of medicine

BIOCHEMICAL TESTS

Indication:
Estimation of synthetic and excretory functions:
o Bilirubin (total and fractionated).

Bilirubin Metabolism:

Bilirubin:
Increased total bilirubin (0.2-1.2 mg):
o Pre-hepatic:
hemolytic anemias & internal hge.

o Hepatic:
liver injury e.g. hepatitis & cirrhosis. reduced hepatocyte uptake. impaired conjugation of bilirubin.

o Post-hepatic:
Obstruction of the bile ducts: Intrahepatic. Extrahepatic.

Bilirubin:
If indirect is elevated (0.1-0.4 mg/dL):
o Hemolysis, viral hepatitis or cirrhosis can be suspected.

If direct bilirubin is elevated:

o Bile duct obstruction by gallstones or cancer should be suspected.

Bilirubin:
Urine Test:
o Bilirubinuria:
hepatobiliary disease.

o Urobilinogen:
hemolysis or hepatic dysfunction.

Performed By dipstick test.

Indication:
Estimation of synthetic and excretory functions:
o Bilirubin (total and fractionated). o PT or INR. o Albumin.

Synthetic Function:
Albumin: 3.5-5.3 g/dL. Made specifically by the liver. Coagulation Tests: *PT: 10-14 sec *INR: 0.8-1.2 Liver disease:
o vit. K-dependent coagulation factors. o INR & PT.

Chronic liver disease:

o Albumin.

Indication:
Estimation of synthetic and excretory functions:
o Bilirubin (total and fractionated). o PT or INR. o Albumin.

Detection of Hepatocellular Damage:

o Serum Aminotransferase (ALT & AST).

Aminotransferases:
ALT:
o 7-56 IU/L. o Only liver.

AST:
o 5-47 IU/L. o liver + other organs.

In acute hepatocellular injury:

o AST & ALT.

In acute hepatitis:
o ALT & AST.

In chronic liver disease :

o AST & ALT.

Indication:
Estimation of synthetic and excretory functions:
o Bilirubin (total and fractionated). o PT or INR. o Albumin.

Detection of Hepatocellular Damage:

o Serum Aminotransferase (ALT & AST).

Detection of biliary Disease:

o o o o Bilirubin (total and fractionated) & Bile acids. Alkaline Phosphatase (AP). 5 nucleotidase (5NT). -glutamyl transpeptidase (GGT).

Cholestasis:
Alkaline phosphatase: 30-120 IU/L. Non-specific:
o in growing children (bone).

5 nucleotidase: -glutamyl transpeptidase: 0-42 IU/L. More specific:

o in cholestasis.

Cholesterol:

<200 mg/dL.
in cholestasis. in severe hepatitis.

Indication: (cont.)
Detection of certain diseases:
o Autoimmune hepatitis:
Gamma-globulin levels. Anti-smooth muscle, antinuclear & anti-liver-kidney-microsome antibodies.

Hepatoma / Hepatoblastoma:
-fetoprotein levels.

o Viral Markers:
Hepatitis A,B,C,D&E. Ag. Ig.

IMAGING PROCEDURES

Ultrasonography (US):
Liver:
o Size. o Composition.

Gallbladder:
o Size. o Stones. o Choledochal cyst in neonates.

Doppler US:
o Assess amount of ascites. o Determining vascular patency after liver transplantation.

Computerized Tomography (CT) Magnetic Resonance Imaging (MRI):

The best method to define:
o Anatomic extent (Size). o Nature (solid/cystic). o Vascularity.

More accurate than US for focal lesions:

o Tumors. o Cysts. o Abscesses.

Angiographic Studies:
Used to visualize:
o Hepatic circulation. o Portal circulation.

Define the blood supply of tumors before surgery. IN portal hypertension, evaluate:
o Patency of the portal system. o Extent of collateral circulation. o Caliber of vessels for a shunting procedure.

Cholangiography:
Used to evaluate:
o Cause. o Location. o Extent of biliary obstruction.

Cholangiopancreatography:
Endoscopic Retrograde Cholangiopancreatography (ERCP): Alternative method of examining the bile ducts in older children. Magnetic Resonance Cholangiopancreatography (MRCP): Non-invasive technique replaced ERCP.

Radionuclide Scanning:
Radiopharmaceutical agent:
o Technetium 99m-labeled sulfur colloid. o Gallium 67.

Uses:
o Detect focal lesions (tumors, cysts & abscesses). o Detect possible cirrhosis. o Differentiate intrahepatic from extrahepatic obstruction in neonates.

LIVER BIOPSY

Indications:
Neonatal cholestasis.

Intrahepatic cholestasis.
Chronic active hepatitis. Congenital hepatic fibrosis. Stored material:
o Iron. o Copper.

THANKS FOR YOUR ATTENTION