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# Liver Function Tests

### Introduction

• Determination of ALP

The equation obtained from the graph is used to calculate the amount of phenol liberated by the action of ALP. The equation is: Y = 0.1753 The enzyme activity is measured in international unit per 1 minute (IU/1) therefore to obtain the activity, the result has to be converted first to umol/1 and then divided by the incubation time (15 minutes) as follow: (Value of phenol concentration in mmol/1 X 1000) / 15 = IU/L Patient 1: Result: 0.207 / 0.1753 = 1.18083 x 1000                                    = 1180.8 umol/L To get the enzyme activity in 1 minute: = 1180.8 / 15 = 78.7 IU/L ALP enzyme activity of patient 1= 78.7 IU/L Patient 2: Result: 0.215 / 0.1753 = 1.2264 x 1000                                    = 1226.4 umol/L To get the enzyme activity in 1 minute: = 1226.4 / 15 = 81.7 IU/L ALP enzyme activity of patient 2 = 81.7 IU/L

• Determination of bilirubin

The concentration of bilirubin is calculated by using the following equation Absorbance of the test x STD concentration Absorbance of STD Result: Patient 1 = (0.413/0.431) x 350 = 335.3 umol/L Patient 2 = (0.037/0.431) x 350 = 30 umol/L The results of Aspartate transaminase (AST), albumin and total protein were provided by the tutor. Conclusion The biochemical finding shows that patient 1 may have haemolytic disease where as the other patient (patient 2) suffer from acute hepatitis. Discussion Liver function test are done to asses the integrity of the liver to carry out its normal synthetic and metabolic functions. This is achieved through series of numerical tests that reflect the healthiness of the liver when comparing the result obtained with normal reference ranges. The measurements of enzyme activities are very useful in following the progress of the liver disease once the diagnosis has been made. From the result it is obvious that patient 1 has got normal TP, ALB, AST and ALP results, which means that there is liver damage. Total protein is combined of immunoglobulin proteins and other proteins. A person’s total protein level gives information about the liver damage, kidney damage and nutritional health. Albumin is small protein made in the liver. If a person suffers from liver damage, the albumin concentration will drop because the liver can not maintain the normal production of albumin. Aspartate transminase (AST) is the enzyme found in the liver, heart and muscle. Levels of this enzyme are usually assessed in conjugation with reading for other liver enzyme to determine or monitor the liver involvement. On other hand the bilirubin is very high above the normal range (hyperbilirubiaemia) and normally the bilirubin which is present in plasma is unconjugated bilirubin. Since the unconjugated bilirubin is high it indicates that is excessive red blood cells (RBCs) destruction (haemolysis) which occurs in haemolytic anaemia. Normally the red blood cells survival is 120 days, but in haemolytic anaemia is less. Because of that the RBCs are destroyed in large quantities in the RE system (particularly the spleen). When the RBCs are destroyed, the haemoglobin is released and bilirubin is produced. It is mainly produced from the haem moiety of the haemoglobin (it is also produced from myoglobin, cytochroms and peroxidase, which are widely distributed in the body). The liver can not conjugate and remove this large amount of unconjugated bilirubin and since it is protein bound the renal glomeruli can not filter it. That leads to overflow of unconjugated bilirubin in blood circulation. These mean that this patient may have haemolytic jaundice (prehepatic jaundice), because the protein synthesis is normal and ALP, AST are normal which means that there is no liver involvement. Haemolytic jaundice also occurs in haemolytic Disease of Newborn, transfusion of incompatible blood, hereditary spherocytosis and autoimmune red cell destruction. Marshall,(2000). The results of patient 2 show normal total protein, albumin and ALP. There is a slight increase in bilirubin level (hyperbilirubinaemia) and AST is above the very high. AST is an intracellular enzyme and is mostly found in the cytoplasmic and mitochondrial membrane of hepatocytes. So it is a sensitive marker for the severity of damage hepatocytes. ALP concentration usually rises in cholestasis (this is by extra-hepatic obstruction of the bile duct) but in this patient was normal, which means that the kupffer cells and sinusoidal surface is not yet damaged. Total protein and albumin were also normal and that indicates that the metabolism and synthesis in the liver is not yet affected. Bilirubin was slightly high which support that there is liver disease and due to this, there is defect of bile salt and bile pigment excretion. In addition to that, conjugation and detoxification functions are well defected because of hepatic cells damaged. These happen due to a condition called Hepatitis (liver inflammation). Hepatitis is the common cause of acute liver injury. Acute hepatitis usually occurs due to viral infection particularly with hepatitis viruses A, B, C, D and E, but also Epstein-bar virus and cytomegalovirus or toxin (e.g. alcohol and paracetamol). Marshall, (2000) In the early stages of hepatitis, increased plasma ALT and AST activities may be the only abnormal chemical finding. There will be also an increased level of urobilinogen and bilirubin in urine (the urine will be darkened). The stool may be very pale due to impaired biliary excretion of bilirubin and urobilinogen then disappears more or less completely from the urine. Marshall, (2000) The above results reveal that liver is functioning well but partly defected because of the early stage of the disease. This patient may have acute liver disease (Acute hepatitis). To confirm these results hepatitis virus profiles should be done. Question Jaundice in the newborn is common. Why? Jaundice in the newborn is called Neonatal Jaundice. It is common because before birth, an infant get rid of bilirubin through the mother’s blood and liver system. After birth, the baby’s liver has to take over processing on its own. The activity of the hepatic conjugation enzyme is usually low at birth but increases rapidly thereafter. Almost all newborns have higher than normal level of bilirubin; because the immaturity of their livers. In most cases, the baby’s system continues to develop and can soon process bilirubin. However, some infants may need medical treatment to prevent serious complications which can occur due to the accumulation of bilirubin. There are at least two significant processes that predispose normal infants to jaundice:

• The rate of bilirubin production is higher in infants than adults because their red blood cells have half-life and turn over more rapidly.
• Infants have a relatively limited ability to conjugate bilirubin and conjugation in the liver is necessary for efficient elimination.

Write short notes on Gilbert’s disease. Gilbert’s disease is a harmless inherited condition in which the unconjugated bilirubin level in the blood is increased. Bilirubin is an end product of haemoglobin breakdown and it is conjugated in the liver with glucuronate. This process is catalysed by specific enzyme called uidine diophosphate glucuronyl transferase which is found in endoplasmic reticulum, which helps the body to conjugate bilirubin and get rid of it. Thus Gilbert’s syndrome is a genetic disorder which means that there is slight deficiency of this enzyme. Patient with Gilbert’s disease can have intermittent bilirubin level but the values are often increased when blood is drown after a period of fasting or during a time of concurrent viral illness or when the person is stressed, either physically or mentally. People with Gilbert’s syndrome are not ill but they may complain of vague abdominal discomfort and general fatigue for which no cause found. The condition is not usually apparent until adolescence or early adult life. It is sometimes discovered incidentally, in the course of investigations done for related reasons. All liver function tests (LFTs) are normal, except for serum bilirubin which is raised. X-ray and liver biopsy show that there is no liver disease. Gilbert’s syndrome should not be regarded as a disease and people with the syndrome are not ill.

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Liver function tests. (2017, Jun 26). Retrieved August 3, 2021 , from
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