Dr Yasir M Khayyat,MBcHB,FRCPC,FACP

1

Khayyat Y

600

ريال2

Khayyat Y

Hepatocellu

lar

Necrosis

Markers

INR

Markers of Cholestasis

Markers

of

syntheti

c

function

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Khayyat Y

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Khayyat Y

AST

ALT

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Khayyat Y

ALT: Specific from the liver ,Cytosolic Enzyme AST: Muscle(skeletal ,

Cardiac),Brain,Kidney,Pancreas, cytoslic 20% and mitochondrial 80%.

Levels are normal in advanced cirrhosis AST/ALT ratio : Acute liver injury ≤ 1 , Alcoholic

hepatitis > 2 Its elevation does not correlate with

hepatic necrosis.6

Khayyat Y

In Alcoholic liver disease

AST Alcohol increase release of mitochondrial AST

ALT in alcohol there is pyridoxal 5 deficiency with decrease in ALT > AST activity

In NAFLD,chronic liver disease:AST ( early low ,then with progressive disease and cirrhosis increase) ,

advanced cirrhosis decrease hepatic clearance of AST.

ALT

Khayyat Y

7

Alkaline phosphatase: From

Liver,Bone,Kidney,placenta,leukocytes,various neoplasms.

From the apical membrane of the hepatocyte and luminal domain of the bile duct.

Predominantly in infiltrative hepatic disorders, biliary obstruction ,extrahepatic biliary tree obstruction.

Due to increased de novo synthesis rather than release of the stored enzyme or impaired clearance

GGT ( Gamma Glutamyl Transpeptidase)

From kidney,spleen,pancreas,heart,lung,brain 8

Khayyat Y

Bilirubin Conjugated Bilirubin Unconjugated BilirubinMarkers of Hepatic Synthesis: INR or PT : The liver is factory for all coagulation

factors except 8. INR if dependant on Vit K ( 2,7,9,10) Increased in: vitamin K

deficiency( malnutrition-malabsorption-antibiotic use)warfarin use, consumptive coagulpathy.

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Khayyat Y

Albumin : Synthesize 10g by the liver daily. It is

not only reflect liver status but it reflects nutritional and volume status, vascular integrity,catabolism,hormonal factors, loss in the urine or stool.

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Khayyat Y

Khayyat Y

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Marked Elevations > 2000

> 15 folds

Moderate Elevations

250-10005-15 folds

Mild persistent Elevation < 250

≤ 5 folds

Drug inducedAnyNAFLD

Toxin inducedAutoimmune hepatitisAlcohol use

Ischemic liver injury ( shock)

Alpha one alpha antitrypsin deficiency

Chronic hepatitis C Infection

Autoimmune hepatitisWilson diseaseCirrhosis

Acute viral hepatitisDrug inducedNeoplasms

Hemochromatosis

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Khayyat Y

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Khayyat Y

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Khayyat Y

Infectious HepatobiliaryMiscellaneous

TBPBCBerylliosis

Atypical Mycobacteria

Sarcoidosis

BrucellosisDrugs

Candidasis

Syphilis

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Khayyat Y

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Khayyat Y