Synthetic Function Tests

• Serum Albumin

  • Albumin: synthesized by the hepatocytes at a rate dependent on dietary protein intake; subject to feedback regulation determined by the plasma albumin conc.

  • Half-life: 21 days

  • Found in almost ALL extracellular body fluids; little lost by excretion

  • Catabolized in various tissues; Can be taken up by cells

  • decrease w/ age
• • If liver function is normal --> serum albumin level low

  • Poor protein intake – Malnutrition

  • Protein loss - Malabsorption

  • Liver disease:

  • fall in serum albumin = decrease albumin synthesis = decrease in liver synthetic function and/or malnutrition
• Possible Interfering Factors

  1. Specimen Integrity Issues

  • Hemolysis: destruction of RBCs

  • Lipemia: lipid in the blood

  • lead to wrong results and medical decisions
• Possible Interfering Factors

  2. Drug hepatotoxicity

  • Type A vs Type B: Hepatotoxicity can be predicted; so patient history imp. in deciding which liver function tests to use to diagnose
• Possible Interfering Factors

  3. Race: African-Americans = higher ALT conc.

  4. BMI: BMI increase = increase ALT by 40-50%

  5. Exercise: ALT 20% decrease in those who exercise

  6. Smoking: increase ALP in the placenta (ALPP) in pregnant women
• Ultrasound (non-invasive)

  • Hepatitis: White spots
  • Steatosis (Fatty liver): Faint and blurry image
  • Can also detect: Cirrhosis, Fibrosis, Cancer, Necrosis
• Liver biopsy

  • Invasive technique to sample liver tissues; require anesthesia for the patient
  • Procedure:

  • Biopsy needle inserted between the ribs to obtain a small cylinder of liver tissues

  • X affect liver functions bc only a tiny bit is taken; liver regenerate quickly
  • Analysis for these tissues include:

  i) H&E staining

  ii) Staining using diff. markers (e.g. for Kupffer cells to confirm hepatitis)