Liver Function Tests Liver functions tests classified as

Liver Function Tests

Liver functions tests classified as • Test based on hepatic secretion and excretion. • Test based on serum enzyme activity • Test based on biochemical activity of liver. Practical 1 History Taking 2

Bilirubin Pathway 3

Type of Jaundice Causes Unconjugated hyperbilirubinemia Extravascular hemolysis Heme is converted to unconjugated bilirubin Right heart failure and Cirrhosis There is a defect in the delivery of unconjugated bilirubin to liver Hypothyroidism and Crigler-Najjar There is a defect in the conjugation of syndrome bilirubin in the hepatocytes Drugs like Rifampicin and Gilbert There is a defect in the uptake of syndrome unconjugated bilirubin into hepatocytes Conjugated hyperbilirubinemia Pathophysiology Mechanical obstruction by tumors, stones There is a defect in the flow of conjugated or strictures, and primary biliary cirrhosis bilirubin through canaliculi and bile ducts. Called cholestatic jaundice. Drugs like estrogen and cyclosporine Dubin-Johnson syndrome Pregnancy There is a defect in the transmembrane secretion of conjugated bilirubin into the canaliculus. This is also called hepatocellular jaundice Sepsis Like above 4

Tests Van-Den Bergh reaction Indirect- Pre -hapatic - infectious causes Biphasic - Hepatic – Poisoning / Nutritional causes Direct – Post hepatic – obstructive causes Practical 1 History Taking 5

Bases on enzyme activity ALT (Alanine Aminotrasferase) liver specific enzyme for dog, cat and primate Sources : Liver, cardiac muscles, skeletal muscle, pancreas and renal cells. AST (Aspartate Aminotrasferase) NOT liver specific enzyme. Sources : Liver, cardiac muscles and skeletal muscle 6

Bases on enzyme activity ID (Iditol Dehydrogenase) Liver specific enzyme for horse and ruminant. Care : Immediate assessment after collection GD (Glutamate Dehydrogenase) Liver specific enzyme for Cattle, sheep and goat. Sources : Hepatocytes Arginase Specific enzyme for ruminants and horse. Ideal to confirm hepatic necrosis 7

Bases on enzyme activity AP (Alkanine Phosphatase) Cholestasis specific enzyme for dog, cat and primate Young animal : Osteoblasts and chondroblasts Older animal : Hepatobiliary systems and steroid Elevation of 10 to 15 times consider as positive GGT (Gamma Glutamyl Transpeptidase) Cholestasis specific enzyme for dog Sources : Cell membrane near bile canaliculi 8

Bases on biochemical activity of liver Protein Total protein Albumin Globulin : Elevated … Alpha 2 (Cirrhosis and Hepatitis) Beta ( Cirrhosis) Gamma ( Carcinoma) Cogluation factors: PT and APT Urea / BUN 9

Bases on biochemical activity of liver Carbohydrate Galactose test Albumin Lipid metabolism Cholesterol is estrified in liver and used in synthesis of bile acids and steroid hormones. Elevated: Bile duct obstruction, hyperthyrodism , Pancreatic diseases, hyper -adrenocortisim , diabetes and nephrotic syndrom. Decreased: Cirrhosis 10

Kidney Function • Retention of water and electrolytes • Elimination of water and eletrolytes • Excretion or retention of hydrogen ions to maintain blood p. H. • Excretion of urea, creatinine and allantoin. • Elimination of toxic substance • Production of renin and prostaglandins • Help in activation of Vit D. 11

Kidney Function Tests • Blood Urea Nitrogen (BUN) • Creatinine • Endogenous and exogenous Creatinine clearance • Urine Protein / Creatinine ratio • Water Deprivation Test • Urinalysis KFT 12

Kidney Function Tests Blood Urea Nitrogen (BUN) Ability of kidney to remove nitrogenous waste from blood but it is not sensitive (Normal : Dog: 8 -25 mg/dl) Creatinine It is formed from creatine which stroes energy in muscle in the form of phosphocreatinine. Not Sensitive test (Normal : Dog: 0. 5 -1. 5 mg/dl) KFT 13

Kidney Function Tests Urine Protein / Creatinine ratio Divide Urine Protein by Urine Creatinine Normal : 0. 5 Doubtful : 0. 5 to 1. 0 Azotemic : > 1. 0 KFT 14

Kidney Function Tests Urinalysis • Voided sample • Manual compression of bladder • Catheterization • Cystocentesis KFT 15

Kidney Function Tests Physical examination • Volume • Colour • Transperancey , odour, Foam • Specific gravity (1. 015 to 1. 050) KFT 16

Kidney Function Tests Chemical examination • p. H • Protein • Glucose • Ketones • Creatinine and Blood • Transperancey , odour, Foam KFT 17

Kidney Function Tests Microscopic examination Examination for Bacteria and casts and sediments KFT 18

Thank You… 19