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TEST IN LIVERDISEASE

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To detect Hepato-biliary diseases we useto check liver function test which is a

small batteray of biochemical tests for

initial detection and subsequentmanagement of the problems.

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Test used as indicates of uptake, conjugation andexcretion of anionic compounds : Serum total bilirubin direct and indirect Urinary bilirubin and urobilinogen Bile acids

Test reflecting hepatocellular damage : SGOT SGPT Serum Ferritin Gamma-GT

Tests to indicate obstruction to bile flow : Alkali phosphatase Gamma-GT LAP Lp-X

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Test of synthetic function : Serum albumin Pre albumin

Protein electrophoresis

Prothrombin

Test of increased hepatic collagen

formation : Procollagen peptide

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Additional tests to know the bacground of thedisturbances check :

Hepatitis virus markers Non hepatitis virus markers (varicella, DHF). Systemic infections

Drugs or chemicals Disturbances of circulatory system (CHF) Disturbances of biliary flow Metabolism (diabetes mellitus, lipids)

Hereditary or genetic (bilirubin metabolism, iron,copper).

Malignancy

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Test results may denote acute or

chronic necro-inflamatory condition ofliver cells

Liver cells consist of :Hepatocytes

cholangiocytes

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Incresed levels of bilirubin, SGOT,SGPT, ALP, Gamma-GT and low levels

of albumin may result frompathological processes outside theliver.

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Clinician or clinicalpathologists tend to selecttest with which they arefamiliar

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Confirmation is by :Imaging (USG, CT, Scanning,

MRI)Liver biopsy (Gold standard)

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Treatment is according tobackground problems.

Viral hepatitis : standard treatmentavailable.

Exotic hepatitis virus : use antiviral drugs(acyclovir etc).

Antibiotica for systemic infection.

Hereditary problem with special treatment(Penicillamin, Chelation).

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In malignancy we have toknow the type and severity.

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In parenchemal liver diseasewe have to know about :

ApoptosisNecrosis

Fibrosis

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Apoptosis is a programmed cell death,initiating a trigger to system signal

Necrosis is related to disturbances of

mitochondria, may cause cell membranefluidity.

Continuing necrosis may induce

fibrogenesis cirrhosis

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In the liver we have two kinds of bile

acids :

Hydrophobic bile acids : Chenodeoxycholic

acid and deoxycholic acid. Hydrophilic bile acids : Ursodeoxycholic

acid (UDCA)

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In liver, the intracellular accumulation ofhydrophobic bile acids (toxic) leads to an

array of cell damaging events rangingfrom increase cell-membrane fluidity andpermeability to programmed cell death(apoptosis) and necrosis.

Prolonged exposure of hepatocytes totoxic bile acids likely promotes liverfibrosis and cirrhosis.

Lazaridis KN et al. J of Heapatology.

VOL. 35 (2001) 134 - 146

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Mechanisms of actions of UDCA are :

CholareticAnti-apoptotic

Anti-inflamatory

Immune modulationAlteration of bile acid pool

Cell signaling

Mitochondrial integrity

Urdahex is UDCA 250 mg/capsule

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Conclusion :

Abnormal liver biochemistry can be divided in todifferent catagories.

Determine the casual bacground and doconfirmation.

Liver disturbances maybe related to : Apoptosis

Necrosis

Fibrosis

Cirrhosis

Some factors may trigger the intracellular hepaticdisturbances.

UDCA maybe considered as a factor to counter theintracellular cell disturbance

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