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Liver Function Tests

Liver Function
Markers of Cirrhosis
Viral Hepatitis Screen
Other Tests

Alkaline Phosphatase

  • Alkaline phosphatase (ALP) is found in liver, bone, intestine, late placenta and kidney.
    • Normal Range
    • 35 - 100 U/L
    • Significance
    • ALP is used as a marker of cholestasis, though may also be raised in the setting of certain non-hepatic conditions.
  • ALP and GGT may also be mildly elevated in the presence of hepatocellular disease, with predominant derangement of the transaminases.

Cholestatic LFT Derangement

    • Look For
    • Elevated ALP and GGT
    • Mildly elevated ALT / AST
    • Elevated conjugated bilirubin
    • Causes of Cholestasis
    • Intrahepatic Cholestasis
    • Hepatitis (viral or alcoholic)
    • Autoimmune liver disease - primary biliary cirrhosis, primary sclerosing cholangitis
    • Infiltrative liver disease - amyloidosis, sarcoidosis, tuberculosis, lymphoma
    • Malignancy - hepatocellular carcinoma, cholangiocarcinoma, metastasis
    • Non-malignant mass - abscess, cystic liver disease, haematoma
    • Sepsis
    • Acalculous cholecystitis
    • Intrahepatic cholestasis of pregnancy
    • Total parenteral nutrition
    • Drugs - augmentin, isoniazid, rifampicin, chlorpromazine
    • Extrahepatic Cholestasis
    • Choledocholithiasis
    • Bile duct stricture
    • Parasitic infection of bile duct
    • Primary sclerosing cholangitis
    • Pancreatitis
    • Pancreatic cyst
    • Malignancy - pancreas, ampulla, common bile duct, gallbladder

Isolated ALP Elevation

    • Significance
    • Suggestive of a non-hepatobiliary cause.
    • Causes of Isolated ALP Elevation
    • Bone pathology - fracture, osteomyelitis, osteomalacia / Ricket’s, bony metastasis, Paget’s disease
    • Rapid bone growth (adolescents)
    • Late pregnancy
    • Hyperthyroidism
    • Congestive cardiac failure
    • End stage renal failure