Knowing Liver Function Tests (LFT)

Liver function tests

Liver function tests
Intervention
ICD-10-PCS	K-70 to K-77
MeSH	D008111
MedlinePlus	003436

Liver function tests (LFTs or LFs) are groups of blood tests that give information about the state of a patient'sliver. These tests include prothrombin time (PT/INR), aPTT, albumin, bilirubin (direct and indirect), and others. Liver transaminases (AST or SGOT and ALT or SGPT) are useful biomarkers of liver injury in a patient with some degree of intact liver function. 

Most liver diseases cause only mild symptoms initially, but these diseases must be detected early. Hepatic (liver) involvement in some diseases can be of crucial importance. This testing is performed on a patient's blood sample.

 Some tests are associated with functionality (e.g., albumin), some with cellular integrity (e.g.,transaminase), and some with conditions linked to the biliary tract (gamma-glutamyl transferase and alkaline phosphatase). 

Several biochemical tests are useful in the evaluation and management of patients with hepatic dysfunction. These tests can be used to detect the presence of liver disease, distinguish among different types of liver disorders, gauge the extent of known liver damage, and follow the response to treatment. 

Some or all of these measurements are also carried out (usually about twice a year for routine cases) on those individuals taking certain medications, such as anticonvulsants, to ensure the medications are not damaging the person's liver.

Contents

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• 1 Standard liver panel
  • 1.1 Albumin
  • 1.2 Aspartate transaminase
  • 1.3 Transaminases
  • 1.4 Alkaline phosphatase
  • 1.5 Total bilirubin
  • 1.6 Direct bilirubin
  • 1.7 Congenital bilirubin disorders
  • 1.8 High bilirubin in neonates
  • 1.9 Gamma glutamyl transpeptidase
  • 1.10 INR
• 2 Other tests
  • 2.1 5' Nucleotidase
  • 2.2 Coagulation test
  • 2.3 Serum glucose
  • 2.4 Lactate dehydrogenase
• 3 See also
• 4 References
• 5 External links

Standard liver panel[edit]

This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (November 2008)

Although example reference ranges are given, these will vary depending on age, gender, ethnicity, method of analysis, and units of measurement. Individual results should always be interpreted using the reference range provided by the laboratory that performed the test.

Albumin[edit]

Reference range

3.5 to 5.3 g/dL

Albumin is a protein made specifically by the liver, and can be measured cheaply and easily. It is the main constituent of total protein (the remaining from globulins). 

Albumin levels are decreased in chronic liver disease, such as cirrhosis. It is also decreased in Nephrotic_syndrome, where it is lost through the urine. The consequence of low albumin can be edema since the intravascular oncotic pressure becomes lower than the extravascular space. 

An alternative to albumin measurement is prealbumin, which is better at detecting acute changes (half-life of albumin and prealbumin is about 2 weeks and about 2 days, respectively).

Aspartate transaminase[edit]

Reference range

6-40 IU/L[5]

AST, also called serum glutamic oxaloacetic transaminase or aspartate aminotransferase, is similar to ALT in that it is another enzyme associated with liver parenchymal cells. It is raised in acute liver damage, but is also present in red blood cells, and cardiac and skeletal muscle, so is not specific to the liver. 

The ratio of AST to ALT is sometimes useful in differentiating between causes of liver damage.^[6][7] Elevated AST levels are not specific for liver damage, and AST has also been used as a cardiac marker. When the AST is higher than ALT, a muscle source of these enzymes should be considered. 

For example, muscle inflammation due to dermatomyositis may cause AST>ALT. This is a good reminder that AST and ALT are not good measures of liver function because they do not reliably reflect the synthetic ability of the liver and they may come from tissues other than liver (such as muscle).

Transaminases

Main article: Elevated transaminases

AST/ALT elevations instead of ALP elevations favor liver cell necrosis as a mechanism over cholestasis. When AST and ALT are both over 1000 IU/L, the differential can include acetaminophen toxicity, shock, or fulminant liver failure. When AST and ALT are greater than three times normal but not greater than 1000 IU/L, the differential can include alcohol toxicity, viral hepatitis, drug-induced level, liver cancer, sepsis, Wilson's disease, post-transplant rejection of liver, autoimmune hepatitis, and steatohepatitis (nonalcoholic). AST/ALT levels elevated minorly may be due to rhabdomyolysis, among many possibilities.

Alkaline phosphatase

Reference range

30 to 120 IU/L[8]

Main article: Elevated alkaline phosphatase

Alkaline phosphatase (ALP) is an enzyme in the cells lining the biliary ducts of the liver. ALP levels in plasma rise with large bile duct obstruction, intrahepatic cholestasis, or infiltrative diseases of the liver. 

ALP is also present in bone and placental tissue, so it is higher in growing children (as their bones are being remodelled) and elderly patients with Paget's disease. In the third trimester of pregnancy, ALP is about two to three times higher.

Total bilirubin

Reference range

0.1–1.0 mg/dL

Measurement of total bilirubin includes both unconjugated and conjugated bilirubin. Unconjugated bilirubin is a breakdown product of heme (a part of hemoglobin in red blood cells). It is very hydrophobic and is mainly transported bound to albumin circulating in the blood. 

Addition of high-concentration hydrophobic drugs (certain antibiotics, diuretics) and high free fatty acids can cause elevated unconjugated bilirubin. Heme can also come from myoglobin, found mostly in muscle, cytochromes, found mostly in mitochondria, catalase, peroxidase, and nitric oxide synthase. 

The liver is responsible for clearing the blood of unconjugated bilirubin, and about 30% of it is taken up by a normal liver on each pass of the blood through the liver by the following mechanism: bilirubin is taken up into hepatocytes, 'conjugated' (modified to make it water-soluble) by UDP-glucuronyl-transferase, and secreted into the bile by CMOAT (MRP2), which is excreted into the intestine. 

In the intestine, conjugated bilirubin may be metabolized by colonic bacteria, eliminated, or reabsorbed. Metabolism of bilirubin into urobilinogen followed by reabsorption of urobilinogen accounts for the yellow color of urine, as urine contains a downstream product of urobilinogen.

 Further metabolism of urobilinogen into stercobilin while in the bowels accounts for the brown color of stool. Thus, having white or clay-colored stool is an indicator for a blockage in bilirubin processing and thus potential liver dysfunction or cholestasis.

Increased total bilirubin (TBIL) causes jaundice, and can indicate a number of problems:

• 1. Prehepatic: Increased bilirubin production can be due to a number of causes, including hemolytic anemias and internal hemorrhage.
• 2. Hepatic: Problems with the liver are reflected as deficiencies in bilirubin metabolism (e.g., reduced hepatocyte uptake, impaired conjugation of bilirubin, and reduced hepatocyte secretion of bilirubin). Some examples would be cirrhosis and viral hepatitis.
• 3. Posthepatic: Obstruction of the bile ducts is reflected as deficiencies in bilirubin excretion. (Obstruction can be located either within the liver or in the bile duct).
• 
  

Direct bilirubin

Reference range

0.1–0.4 mg/dL

The diagnosis is narrowed down further by evaluating the levels of direct bilirubin.

• If direct (conjugated) bilirubin is normal, then the problem is an excess of unconjugated bilirubin (indirect bilirubin), and the location of the problem is upstream of bilirubin conjugation in the liver. Hemolysis, or internal hemorrhage can be suspected.
• If direct bilirubin is elevated, then the liver is conjugating bilirubin normally, but is not able to excrete it. Bile duct obstruction by gallstones, hepatitis, cirrhosis or cancer should be suspected.
• 
  

Congenital bilirubin disorders

About 5% of the population has Gilbert's syndrome, a mutation (or variation) in the UDP-glucuronyl-transferase promotor that manifests itself as jaundice when the individual is stressed (i.e. starves). 

Autosomal recessive knockouts of UDP-glucuronyl-transferase can lead to Crigler-Najjar syndrome and elevations of unconjugated bilirubin. Defects in CMOAT (MRP2) results in Dubin-Johnson syndrome and elevations of conjugated bilirubin.

High bilirubin in neonates

Neonates are especially vulnerable to high bilirubin levels due to an immature blood-brain barrier that predisposes them to kernicterus/bilirubin encephalopathy, which can result in permanent neurological damage. 

Neonates also have a low amount of functional UDP-glucuronyl-transferase and can have elevated unconjugated bilirubin, since conjugation is limited. So, newborns are often treated with blue light (420-470 nm) to turn the hydrophobic, albumin-binding unconjugated bilirubin into a form that is more hydrophilic and able to be secreted in urine, sparing the neonate's brain.

Gamma glutamyl transpeptidase

Reference range

0 to 42 IU/L[8]

Although reasonably specific to the liver and a more sensitive marker for cholestatic damage than ALP, gamma glutamyl transpeptidase (GGT) may be elevated with even minor, subclinical levels of liver dysfunction. 

It can also be helpful in identifying the cause of an isolated elevation in ALP (GGT is raised in chronic alcohol toxicity).

INR

Prothrombin time (PT) and its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) are measures of the extrinsic pathway ofcoagulation. 

This test is also called "ProTime INR" and "INR PT". They are used to determine the clotting tendency of blood, in the measure of warfarin dosage, liver damage, and vitamin K status.

Other tests

Other tests commonly requested alongside LFTs include:

5' Nucleotidase

5' Nucleotidase (5'NTD) is another test specific for cholestasis or damage to the intra- or extrahepatic biliary system, and in some laboratories, is used as a substitute for GGT for ascertaining whether an elevated ALP is of biliary or extrabiliary origin.

Coagulation test

The liver is responsible for the production of coagulation factors. INR measures the speed of a particular pathway of coagulation, comparing it to normal. Increased levels of INR means blood is taking more time than usual to clot. 

The INR increases only if the liver is so damaged that synthesis of vitamin K-dependent coagulation factors has been impaired; it is not a sensitive measure of liver function.

It is very important to normalize the INR before operating on people with liver problems (usually by transfusion with blood plasma containing the deficient factors), as they could bleed excessively.

Serum glucose

The serum glucose test, abbreviated as "BG" or "Glu", measures the liver's ability to produce glucose (gluconeogenesis); it is usually the last function to be lost in the setting of fulminant liver failure.

Lactate dehydrogenase

Lactate dehydrogenase (LDH) is found in many body tissues, including the liver. Elevated levels of LDH may indicate liver damage. LDH isotype-1 (or cardiac) is used for estimating damage to cardiac tissue, although troponin and creatine kinase tests are more preferred.
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Know about infections of the uterus, vagina and cervix

All you need to know about infections of the uterus, vagina and cervix

The uterus, vagina and cervix are major components of the female reproductive system. Their functioning impacts the overall growth and health of the female body as well as sexuality.

There are a number of infections and diseases that affect the female reproductive organs. Most cases require clinical care and treatment in consultation with a gynaecologist.

Following are the symptoms of infection in the uterus, cervix or vagina:

•  pain or numbness in the pelvic region
•  unusual discharge from the vagina
•  bleeding during or after intercourse
•  pain or burning sensation during urination
•  skipped periods
•  excessively painful menstrual cramps
•  nausea and vomiting
•  urinary incontinence

There are three main types of infections that affect the organs of the female reproductive system. They are as follows:

1. Vaginitis
This is an infection that affects the vagina. It occurs when the walls of the vagina get inflamed and irritated. It is caused by bacteria, viruses, yeast, chemicals and even clothing. It often occurs due to sexually transmitted diseases (STDs). The different types of infections that occur as vaginitis are yeast infection, viral vaginitis, bacterial vaginitis, trichomoniasis vaginitis, etc.

2. Cervicitis
This infection affects the cervix. Cervicitis can either be acute or chronic in nature, depending upon what causes the cervix to get inflamed. It occurs most commonly due to sexually transmitted infections such as gonorrhoea, chlamydia and herpes. This condition is often confused with vaginitis as the two have similar causes and symptoms.

3. Pelvic inflammatory disease
Pelvic inflammatory disease (pid) is a serious infection that affects the uterus, ovaries and fallopian tubes. It is caused by sexually transmitted infections like chlamydia and gonorrhoea and can lead to severe complications. It often causes scar tissue to grow between the internal organs and may even lead to ectopic pregnancy. If not properly diagnosed, it can cause infertility and other chronic problems.

Treating the various infections that affect the female reproductive system depends on a number of factors such as nature of the problem, age and medical history of the patient, and the root causes. Early detection and diagnosis ensure effective treatment which makes it important to see a gynaecologist at the onset of symptoms.


Related Tip: Infections Of The Vagina, Cervix and Uterus: Facts You Must Know

Mystical powers of names and talismans

Mystical powers of names and talismans:

Photo by  isawnyu

The mystical powers of names and talismans actually carry many similarities. Today names are looked at as simply a way to identify someone. But there was a time that names were more than just words.

It’s said that Holy names should be spoken with great respect, while the names of demons should be spoken with great caution. Many times children’s names are chosen with a great deal of symbolism attached and many are given with special ceremony. Some believe that names have potential powers equal to that of a talismans.

Who was Rumpelstiltskin

Rumpelstiltskin is the figure of a well known German fairy tale. As the story goes, a young girls father led people to believe that his daughter could spin straw into gold. So marveled by this mystical power, the King takes her captive so that she may make him a fortune. Then magically a dwarf by the name of Rumpelstiltskin appears to her and creates this wonderful feat of spinning gold for her.

Rumpelstiltskin requested that she give up her first born child to him in exchange for his magical services. Ironically, the young woman and the King become married and do in fact have a child. At which point the young maiden begs the dwarf to release her from her promise of giving up her first born, the dwarf reluctantly agrees but under one condition. She must guess his name within a three day period.

Amazingly and with great luck I might add, one of the girls servants over hearsRumpelstiltskin singing a song about his name. So the servant runs to tell the girl what he discovered and her child was spared when she told Rumpelstiltskin his name.

Such an interesting fairy tale, the old ones were always the greatest.

Powers of Talismans

A talisman is an object that is said to hold a magical active force. There are also what’s called amulets, and these are supposed to be a more passive and protective object. An amulet may shield against a curse or the evil eye, while a talisman can bring you positive benefits such as good luck.

The Egyptian ankh, which is in the shape of a cross with a loop at the top, stands for long life and fertility. Then there’s the hammer of Thore, a Scandinavian object that promises it’s wielder strength and success. China is home to the legends of the dragon, which they see as a great sign of good luck, prosperity and life-giving rain. And of course the heart is symbolic of peace and love, which is a universal symbol.

The Wreck of the Titan

This short novel was published in 1898 by Morgan Robertson and is a fictional story about an ocean liner called the Titan, that hits an iceberg in the North Atlantic. Of course the ocean liner sinks and kills many people.

Then amazingly in 1912 the real ocean liner the Titanic actually did strike an iceberg in the North Atlantic and sank taking many lives with it. Strangely enough many of the details about the incident and the ocean liner were predicted in Robertson’s novel which seemed like an act of premonition.

The Titanic was not the only coincidence related to the novel, The Wreck of the Titan. In 1935 a cargo vessel named Titanican became trapped in pack ice also in the North Atlantic and had to be freed by an icebreaker. Also followed by a passenger steamer, The Titan, that collided with a dock in Hamburg, Germany.

Some people just call these coincidences, but I think the similarities are a little too precise to be mere accident. Who can say for sure…

Names you Shouldn’t Call

It’s believed that if you call out the names “fairy” or “fairies” it can bring fierce consequences. So use something like The Little People or maybe The Good Neighbors if you have to refer to them. The Furies is another one to use caution with. The Furies are the three sisters from Greek Mythology, it’s more proper to refer to them as The Kindly Ones, in hopes they may appear as such if conjured.

It’s also good habit to take care when pronouncing anyone’s name. It is considered an insult to mispronounce someone’s name and is a sign of rudeness. By using a cruel nickname for someone, this can really damage their self esteem, but if you use an affectionate nickname, this can bring them warmth and love.

This is all a little mismatched info hitting you from both sides. But who knows when something like this may come in handy to know such things. Names, Talismans and Amulets have been the center of tradition, stories and superstition for many ages. By understanding them you may be armed with the information needed to effectively navigate through their realm, if faced with the opportunity.

What Causes Tears and What are the Effects of Crying

What Causes Tears and What are the Effects of Crying

Photo by  Ebtesam Ahmed

One of my readers put in a special request for a post concerning the effects of crying. They were reading my post The Medicine of Laughter and in their comment, asked about advantages and disadvantages to crying. I thought that was an excellent contrasting post to the other, so here it is folks.
We’ll go over what causes us to cry and some of the good and bad that may be associated with it. Also how our bodies react to it and the toll on our emotions it may take.

What Causes Crying

Most of us know the act of crying as associated with emotions. When our bodies are overwhelmed with a sensation of sorrow, pain or even great moments of joy. The act of crying is also known as lacrimation, this is because of the link between emotional states and the lacrimal glands. More commonly known as tear ducts.

Scientists believe that humans are the only creatures that are capable of producing tears in relation to emotional states. I tend to disagree with this however. I think it’s very possible that other animals have the ability to cry when their emotions are provoked.

But one theory is that the act of crying is nothing more than an unconscious behavior that is a way of seeking help in others. More of an instinctual act that is recognized by others and may in return produce an emotional reaction known as “feeling sorry” for another individual. Now in my opinion I’m not sure if this is an instinctual behavior or if it may be a learned behavior, but none the less it seems to ring true.

Is Crying Harmful

There are actually a few different types of tears that may produce different chemicals. The Basal Tears are produced as a means of lubrication for the eye. Reflexive Tears are produced in order to protect the eye from irritants, such as getting a grain of sand in your eye. Then we have the Psych Tears which are caused due to emotional responses.

As all of these categories of tears have an intended purpose, is it harmful to cry? I would say certainly not, except possibly to your own ego. I feel like the act of crying is an emotional outlet that we all need at one time or another. The human body is made up of so many complex systems and not having an outlet for emotion can be very dangerous to your health. Now if you are crying more than you feel is normal or doing it uncontrollably, then your hormones may be out of balance and a trip to the doctor could be in order.

There are some medical conditions that are not healthy forms of crying such as Bell’s

Palsy. Sufferers from this may experience crying while trying to eat. There really is no emotional cause for this, but is due to faulty regeneration of the facial nerve. There are also conditions that may causes infants to cry uncontrollably and also this same condition may exist in adults. There is a condition that is an epileptic episode known as gelastic seizure, the main symptom being uncontrollable laughter or crying.

The only harmful thing I can attribute to the act of crying would be the emotions associated with it. Times of sorrow or worry can be quite harmful to our bodies. They can cause a great deal of stress and nervousness which can often times lead to sickness. But I still believe these emotions in moderation are good for us, as we’re only human, and humans need these reactions as a learning experience.

The Joy of Crying

Now let’s talk a bit about the tears of joy. Crying when you are happy is such a rewarding experience. It’s hard to explain exactly the feeling you get, as it may differ depending on the individual. Some people explain tears of joy as a response to human kindness. Like when someone does something so exceptionally nice for you that it overwhelms your emotions. Or when you experience an amazing feat of compassion in others.

Have you ever been watching a funny movie and get to laughing so hard that you start crying? This is actually very common and is caused due to the pressure that’s produced against your tear glands while laughing. There is a drain in your eye that allows excess tears to flow into when crying, this is why your nose runs, it’s from the overflow. But when laughing, that drain is closed off so the normal build up of lubrication overflows out onto your eyelids. So tears of joy I don’t believe are actually caused from the happy emotions, it’s just the lubrication has no where to go so it spills out. But don’t let me be a kill joy, for all practical purposes we’re going to look at tears of joy as an awesome thing!

Benefits to Crying

So let’s take a look at some of the benefits to crying. Even though tears are mostly associated with emotions, they do serve a legitimate purpose where our health is concerned.

First and foremost, tears help us to see more clearly. Tears are constantly being produced by your eyes in order to lubricate and protect them. They will also keep your eyes hydrated, without them we would all eventually become blind.

Tears also act as an antibacterial and antiviral agent. They are known to contain lysozyme and it can kill up to 95% of bacteria in a matter of minutes. Very helpful in preventing sicknesses like the common cold. They are also useful in removing toxins from your body. Tears produced during an emotional episode will be loaded with toxins, this could be why we feel so much better after a “good cry”.

Tears are also an outlet for excess manganese in your body. Manganese is responsible for stressors and emotions such as nervousness, irritability, aggression and fatigue. Sounds like a build up of these types of emotions may be one reason we cry while under stress.

Speaking of stress, if we tend to hold our emotions in, this can lead to the build up of certain endorphins in our body that cause stress. Crying is an outlet for these endorphins, this is why over time we can become quite stressed and have a spike in blood pressure if we haven’t cried in a while.

One of the major benefits of crying is it brings people together. Showing emotion is the beauty of being human and it’s a form of unspoken communication between us. When you simply don’t have the words to express how you’re feeling, a nice cry can get the message across just fine.

Body lacks water if these signs appear

5 signs your body is lacking in water

Water is indispensable for the human body as 90% of the brain and almost 60 per cent of an adult body is chiefly made up of water. Water is just as important as any of your meals. Each cell and organ depends on water for its proper functioning and for flushing out toxins and fats from the body. An average man must consume roughly 3 litres (10-12 glasses) of water per day; and a woman requires about 2.5 litres (8-10 glasses). If you're not meeting this requirement, you might be fall prey to dehydration.
The state of water deficiency or dehydration can be determined through various symptoms.

Read on to know the 5 most common signs:

1. The colour of your urine is dark
The colour of your urine indicates your health. The lesser the water you drink, the darker is the colour of your pee. If your urine is pale yellow, you drink a sufficient amount of water. If it's dark yellow and concentrated, it's a sign for you to refill on water. Also, if you haven't urinated for more than two hours, you should immediately gulp 2 glasses of water.

2. You experience frequent headaches
Headaches are often caused by dehydration when the pressure from your blood vessels falls. Dehydration makes it tough for your heart to pump enough oxygen to the brain. Drinking sufficient amounts of water ensures the flow of oxygen in your body.

3. You feel dizzy and fatigued
Lack of water can often lead to laziness and restlessness. It may also cause a rapid change in your blood pressure. Low or high blood pressures are stimulants of fatigue. Water gives you instant energy that wakes up your whole system, thus making you feel revitalised.

4. You have constipated bowel movements
Water is one of the top natural remedies for constipation or troubled bowel movements. If your fluid intake is low, you're likely to have stomach, gastric and bowel problems. The digestive system depends on water to help food move through both the intestines. It checks the functions of the digestive tract, while also keeping it flexible and clean.

5. You experience brain fogs and blackouts
Your brain cells and nerves react severely to water loss. You may start feeling a lack of concentration along with temporary memory loss. Blackouts and fogs are common when you have a deficit of water. You might even experience difficulty in carrying out cognitive tasks.

If you're experiencing similar issues, you must enhance your daily water intake. You can try carrying a sipper around, which allows you to keep a tab on your water consumption. To relish water as a refreshing beverage, you can infuse freshly chopped fruits and herbs in a pitcher of chilled water. This flavoured water also cleanses your body of all toxins and chemicals, thus keeping you fresh.