Pattern Of Liver Function Tests Research Articles

The Biochemical Pattern of Liver Function Tests in Adult Patients of Diabetes and the Association with Hypoglycemic Medications

Objective: To study the biochemical pattern of liver function tests in adult patients of diabetes and the association with hypoglycemic medications.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Creek General Hospital, Karachi Pakistan, from Jun 2021 to Sep 2021.
 Methodology: Two sixty patients were enrolled through consecutive non-probability sampling. Adult patients with diagnosed Type 2 diabetes mellitus were included in the study. While Type 1 diabetes patients, pregnant subjects, and people with diabetes with any other systemic disease or on any other non-diabetic medications or any history of drug abuse were excluded from the study.
 Results: Raised Alanine transaminase levels were seen in 193 (74%) patients, a high Alkaline Phosphatase in 208 (80%) and a high Aspartate Aminotransferase in 202 (77%) patients. Liver markers were higher in the middle age group, females, hypertensive, and with abdominal obesity. There was no association between glycemic control and the duration of diabetes. The number of subjects having raised ALT and ALP was higher in those taking oral hypoglycemic and lower in those with insulin.
 Conclusion: The liver markers are raised in patients with diabetes and can be the predictors of future hepatotoxicity.

Syphilis Presenting as Hepatitis in an HIV-Infected Patient

Abstract Syphilis presents with protean manifestations. We report the case of a 24-year-old Filipino, working in Zambia for the past 2 months, presenting with a 2-week history of fever and jaundice. Maculopapular rashes were noted on both palms of the hands and both soles of the feet. Workup revealed an abnormal cholestatic pattern of liver function tests, while negative for malaria, viral hepatitis, and bacteremia. He tested positive for both HIV and VDRL (Venereal Disease Research Laboratory). A magnetic resonance cholangiopancreatography showed only hepatomegaly and no signs of cholangiopathy or hepatobiliary tree anomalies. After administration of a single dose of penicillin G, resolution of fever and jaundice and normalization of liver enzymes were noted. Syphilitic hepatitis was the primary diagnosis because of the following: demonstration of liver injury, positive serology for syphilis, and exclusion of other causes of liver injury with resolution upon penicillin G administration.

The dynamic changes in the pattern of liver function tests in pregnant obese women.

Obesity is an important problem in healthcare regarding gestating women. The objective of the present study was to highlight the impact that obesity has on the hepatic function in pregnant women by comparing the functional tests used in current practice. In addition, the aim was to identify possible predictors of liver damage by analyzing specific anthropometric data. The present study was descriptive, observational, retrospective, and based on the observation sheets found in the database of the Institute for the Health of the Mother and Child, the Obstetrics Gynecology Department of Polizu Hospital. Patients who presented for consultation in each trimester of pregnancy were included in the study. Demographic data taken into account included age, body mass index (BMI), provenance environment, anthropometric data: Abdominal circumference and the complete set of paraclinical data from which we extracted these specific liver tests: Aspartate aminotransferase (AST), alanine transferase (ALT), direct bilirubin (BD), serum albumin and gamma-glutamyl transferase (GGT). The present study included 157 patients divided into two groups, distributed as follows: Group A: 66 obese pregnant women (BMI >25 kg/m2) and group B: 91 patients with normal weight (BMI <25 kg/m2). Measurement of serum ALT and AST were the most useful tests for routine diagnosis of liver disease. The effects of pregnancy on serum levels of ALT and AST are controversial. In some studies, there was a slight increase in ALT and AST during the second and third trimesters, a fact confirmed by our study, albeit the result was not statistically significant Most published studies claim that serum ALT and AST levels do not change during pregnancy. In conclusion, obesity during pregnancy does not drastically influence liver function. However, patients with greater abdominal circumference are prone to developing minor hepatic cytolysis syndrome during the gestation period. The liver functional tests described in the aforementioned groups agree with the results provided by the specialized studies.

Pattern of Liver Function Tests in Spectrum of Acute Viral Hepatitis

Objective: To find out the pattern of Liver Function tests (LFTs) in different spectrums of Acute Viral Hepatitis (AVH).Study Design: Cross sectional.Place and Duration of Study: The study was conducted at Pathology Department of Combined Military Hospital, Malir Karachi from March 2017 to August 2017.Materials and Methods: A total of 360 subjects of all age groups, both male and female, with biochemical features of acute viral hepatitis (AVH) were included. After clinical history and examination, liver function tests (LFTs) were performed that included total bilirubin, alanine amino transferases (ALT), alkaline phosphatase (ALP), followed by viral markers for hepatitis A virus (HAV), hepatitis B virus (HBV) hepatitis C virus (HCV) and hepatitis E virus (HEV).Results: Among the 360 patients studied, males (n=308, 86%) outnumbered females (n=52, 14%). Biochemical pattern showed ALT value reaching &gt;75 times the upper limit of normal (ULN). Similarly rise of serum total bilirubin was up to 30 times of ULN while rise of serum ALP was not more than 5 times of ULN. HEV was found to be the most common (28%) in seropositive AVH in the study group. Highest number (24.4%) of HEV infection was found among males in the age group of 20-30 years. ALT and bilirubin were significantly raised in patients with HEV as compared to other causes of AVH.Conclusion: Pattern of LFTs varies in spectrum of AVH. Highest rise of ALT indicates extensive liver damage in HEV infection.&#x0D; How to cite this: Yousaf S, Younas M, Murtaza M, Akhtar F, Jaffar SR, Ijaz A. Pattern of Liver Function Test in Spectrum of Acute Viral Hepatitis. Life and Science. 2020; 1(1): 29-33. doi: http://doi.org/10.37185/L&amp;S.1.1.38

Nodular regenerative hyperplasia – An under-recognized vascular disorder of liver

IntroductionNodular regenerative hyperplasia (NRH) is a rare hepatic vascular disorder which is often associated with wide variety of systemic diseases. Intrahepatic microvascular injury and subsequent altered perfusion state leads to development of non-cirrhotic portal hypertension in many of these patients. Diagnosis of NRH often remains unsuspected clinically and liver biopsy is essential for the diagnosis and exclusion of fibrosis. We herein, present clinicopathological features of 22 NRH cases. In addition we assessed CK7 and CD34 expression in hepatocytes and sinusoidal endothelial cells respectively. ResultsMost of the cases were associated with systemic disorders, predominantly immunological, inflammatory and drug-related injuries. Signs and symptoms of portal hypertension were found in 86.4 % patients. Majority of the patients showed a predominant mild cholestatic pattern of liver function tests. Nearly all the (21/22) cases showed CK7 positivity in centrizonal hepatocytes which ranged from <10 % cells to diffuse perivenular positivity extending into the midzonal areas. CD34 positivity in sinusoidal endothelial cells was seen in all the cases, which was prominent in periportal areas in all cases; while perivenular (n = 20) and midzonal (n = 14) areas also showed CD34 positive sinusoidal endothelial cells. ConclusionThis study highlights the role of pathologist in the diagnosis of NRH and stresses upon the need for awareness of NRH as a cause of unexplained portal hypertension in patients with underlying systemic diseases. The altered perfusion state in NRH leads to phenotypic shift in centrizonal atrophic hepatocytes and sinusoidal endothelial cells (as depicted by IHC) which may be responsible for development of portal hypertension.

Non-functional duodenal neuroendocrine carcinoma: a rare cause of diabetes mellitus.

SummaryA 40-year-old Caucasian female presented with hyperglycaemia, polyuria, polydipsia and weight loss of 6 kg over a 1-month period. There was no personal or family history of malignancy or diabetes mellitus. On examination, she was jaundiced with pale mucous membranes and capillary glucose was 23.1 mmol/L. Initial investigations showed iron deficiency anaemia and obstructive pattern of liver function tests. HbA1c was diagnostic of diabetes mellitus at 79 mmol/mol. Malignancy was suspected and CT chest, abdomen and pelvis showed significant dilatation of intra- and extra-hepatic biliary tree including pancreatic duct, with periampullary 30 mm mass lesion projecting into lumen of duodenum. Enlarged nodes were seen around the superior mesenteric artery. This was confirmed on MRI liver. Fasting gut hormones were normal except for a mildly elevated somatostatin level. Chromogranin A was elevated at 78 pmol/L with normal chromogranin B. Duodenoscopy and biopsy showed possible tubovillous adenoma with low-grade dysplasia, but subsequent endoscopic ultrasound and biopsy revealed a grade 1, well differentiated neuroendocrine tumour. The patient was started on insulin, transfused to Hb >8 g/dL and Whipple’s pancreatico-duodenectomy was undertaken. This showed a well-differentiated neuroendocrine carcinoma arising in duodenum (Grade G1 with Ki67: 0.5%), with areas of chronic pancreatitis and preservation of pancreatic islet cells. There was complete resolution of diabetes post Whipple’s procedure and patient was able to come of insulin treatment. Her last HBA1C was 31 mmol/mol, 4 months post tumour resection.Learning points:Diabetes mellitus and malignancy can be related.A high index of suspicion is needed when diabetes mellitus presents atypically.Non-functional neuroendocrine tumours can present with diabetes mellitus.

CATARACT SURGERY

Objectives: This study is conducted to determine the prevalence of hepatitis Band hepatitis C virus infection in patients presenting for cataract surgery and to see the pattern ofliver function tests in hepatitis positive and negative patients. Design: Descriptive study, Settingand Period: The study was conducted from September 2015 to February 2016 at Al-Shifa eyehospital, Rawalpindi, Pakistan. Methods: All the patients presenting for cataract surgery wereincluded in the study. Liver function tests were performed using automatic chemistry analyzerwhile hepatitis B surface antigen and antibodies to hepatitis C virus were checked using thirdgeneration ELISA. Results: A total of 315 patients were included in the study. Male to femaleratio was 1.18:1. Out of these 315 cases, there were 45 (14.29%) patients who tested positivefor hepatitis and all of these 45 cases were positive for anti-HCV antibodies with 18 (40%) malesand 27 (60%) females, showing high predilection for female gender. Majority of patients, about171 (54.29%), were in the age range of 21-40 years, followed by 57 (18.10%) patients in theage group of 40-50 years. The mean age of hepatitis positive patients was 33.33±13.37 years.Regarding liver function tests, the alanine transaminase levels (ALT) were 77.9 and 132 U/L inhepatitis negative and hepatitis positive patients respectively. Enzyme levels were 1.65 timeshigher in hepatitis positive patients than in hepatitis negative patients. Rest of the parameterswas within normal limits. Conclusion: Hepatitis B and C virus infections are common cause ofliver dysfunction in our country. Hepatitis C virus infection is more prevalent than Hepatitis Bvirus infection. Hepatitis infection can lead to raised ALT levels even when other parameters ofliver function tests are within normal limits. Therefore, all patients who have raised ALT levelsmust undergo hepatitis screening.

English

Objectives: This study is conducted to determine the prevalence of hepatitis Band hepatitis C virus infection in patients presenting for cataract surgery and to see the pattern ofliver function tests in hepatitis positive and negative patients. Design: Descriptive study, Settingand Period: The study was conducted from September 2015 to February 2016 at Al-Shifa eyehospital, Rawalpindi, Pakistan. Methods: All the patients presenting for cataract surgery wereincluded in the study. Liver function tests were performed using automatic chemistry analyzerwhile hepatitis B surface antigen and antibodies to hepatitis C virus were checked using thirdgeneration ELISA. Results: A total of 315 patients were included in the study. Male to femaleratio was 1.18:1. Out of these 315 cases, there were 45 (14.29%) patients who tested positivefor hepatitis and all of these 45 cases were positive for anti-HCV antibodies with 18 (40%) malesand 27 (60%) females, showing high predilection for female gender. Majority of patients, about171 (54.29%), were in the age range of 21-40 years, followed by 57 (18.10%) patients in theage group of 40-50 years. The mean age of hepatitis positive patients was 33.33±13.37 years.Regarding liver function tests, the alanine transaminase levels (ALT) were 77.9 and 132 U/L inhepatitis negative and hepatitis positive patients respectively. Enzyme levels were 1.65 timeshigher in hepatitis positive patients than in hepatitis negative patients. Rest of the parameterswas within normal limits. Conclusion: Hepatitis B and C virus infections are common cause ofliver dysfunction in our country. Hepatitis C virus infection is more prevalent than Hepatitis Bvirus infection. Hepatitis infection can lead to raised ALT levels even when other parameters ofliver function tests are within normal limits. Therefore, all patients who have raised ALT levelsmust undergo hepatitis screening.

Portal biliopathy: multidisciplinary management and outcomes of treatment

Portal biliopathy (PB) is a rare condition in which portal hypertension because of extrahepatic portal vein obstruction can lead to biliary abnormalities, with some patients developing obstructive jaundice. At present, there is no international consensus on the management of PB. We present the experience of an Australian tertiary referral hospital with the diagnosis and management of PB, and compare this with reported international experience. The records of nine patients presenting with PB between June 2003 and March 2012 were reviewed and analysed. All patients had portal hypertension because of portal vein thrombosis, with seven patients showing cavernous transformation of the portal vein. Biliary abnormality presented with jaundice (3/9), abdominal pain (2/9) or without symptoms (3/9). All patients developed a cholestatic pattern of liver function tests (LFTs). First-line endoscopic management was employed in 7 of 8 symptomatic patients. Four patients required endoscopic management alone (sphincterotomy alone (1/9), single stent (2/9), repeated stent changes (1/9) ), while four required second-line surgical intervention (portosystemic shunt (1/9), bilioenteric anastomosis (3/9) ). All patients were well, with stable LFTs, at median 18-month follow-up, with two patients undergoing regular stent changes, and the remainder requiring no further intervention. PB can be managed successfully with endoscopic therapy as the first-line option, but a multidisciplinary approach is necessary, with second-line surgical intervention often required. We recommend a management algorithm similar to that presented in the UK PB literature, and confirm that bilioenteric anastomosis can be performed successfully without prior portal decompression.

Analysis of abnormal recovery pattern of liver function tests after surgical repair of bile duct strictures

Gradual normalization of conventional liver function tests occurs in a majority of patients with extrahepatic biliary obstruction following adequate biliary drainage. Abnormal recovery pattern of liver function has been reported in up to 70% of these patients and there is scarcity of relevant information about this. The purpose of the present paper was to identify variables predictive of abnormal recovery pattern of liver function tests after surgical repair of benign biliary stricture. Patient data, disease-related characteristics and serial liver function tests were prospectively collected in 64 patients with post-cholecystectomy bile duct strictures undergoing hepaticojejunostomy. Hepatic histology (fibrosis, portal inflammation, ductular proliferation and cholestasis) was independently graded by two pathologists using a previously validated scale. A cut-off limit of longer than 2 weeks for normalization of liver function tests following definitive surgical repair was considered abnormal. The patients were accordingly dichotomized into groups. Univariate and multivariate analysis was performed. Fourteen patients (22%) each had abnormal recovery pattern of serum bilirubin and serum alanine aminotransferase (ALT) levels while 13 (20%) had abnormal recovery pattern of serum alkaline phosphatase (SAP) levels. Multivariate analysis revealed basal serum bilirubin level was an independent predictor of abnormal recovery pattern of serum bilirubin level while basal ALT level as well as degree of hepatic fibrosis were independent predictors of abnormal recovery of serum ALT level. Similarly, basal SAP level and degree of hepatic fibrosis were independent predictors of abnormal recovery of SAP level. Basal values of liver function tests and degree of hepatic fibrosis are the most important predictors of abnormal recovery pattern of liver function following adequate biliary decompression in patients with post-cholecystectomy bile duct stricture.

The pattern and significance of abnormal liver function tests in community-acquired pneumonia

Background The pattern of liver function tests (LFTs) in community-acquired pneumonia has not been investigated in detail. Although abnormal tests are thought to be more frequent in patients with atypical pneumonia, the prognostic value of LFTs have not been clearly established. Methods We assessed 96 consecutive patients admitted to one hospital with a chest infection over a period of 6 weeks. The infection was classified as bronchitis or lobar pneumonia on clinical and radiological criteria. The site and severity of the infection were assessed and correlated with LFTs and standard British Thoracic Society prognostic criteria. Mortality and length of stay in survivors were used as major outcome measures. Results There were 17 deaths (18%) overall and patients with abnormal LFTs were significantly more likely to die than those with normal tests (25% vs. 5%; p=0.026). Length of stay was significantly longer in survivors with abnormal liver function than in those with normal tests (9.7 vs. 5.8 days; p=0.006). A low albumin was the most useful predictor of poor outcome and carried a relative risk of dying of 1.8, comparable to the predictive value of tachypnoea. ALT was increased threefold in those succumbing to their disease, but alkaline phosphatase levels were not predictive of outcome and an increase in gamma GT appeared to be protective. Conclusions Abnormal LFTs are common in community-acquired pneumonia and are of prognostic value. Patients with a low albumin or raised ALT are significantly more likely to die from their disease or to stay in hospital for a prolonged period. However, other LFTs are of less value in predicting prognosis.

Enteral nutrition and liver function test abnormalities

There have been reports of liver enzyme abnormalities among enterally fed patients. The aim of this study was to determine the pattern of liver function tests (LFTs) in patients on enteral nutrition support receiving a minimum of 1500 kcal/day for at least two weeks. In addition, factors which might be responsible for such changes were defined. Patients with normal LFTs at the start of the study period had liver function tests repeated weekly during nutritional support. Body weight, arm muscle circumference, triceps skinfold and serum albumin were measured on entry to the study.Nineteen patients fulfilled the study entry criteria. Eleven patients (Group 1) developed abnormal LFTs; in the remaining eight patients LFTs remained normal (Group 2). There was no significant difference between the two groups at the start of enteral feeding with respect to anthropometric measurements or serum albumin. Six of the 11 patients in Group 1 developed septic complications. No patient in Group 2 had clinical or bacterial evidence of infection during nutritional support.Abnormalities in LFTs are more likely to be due to associated clinical complications than the enteral nutritional support alone.

Gram-negative bacteremia

The pattern of liver function tests (LFTs) in community-acquired pneumonia has not been investigated in detail. Although abnormal tests are thought to be more frequent in patients with atypical pneumonia, the prognostic value of LFTs have not been clearly established.We assessed 96 consecutive patients admitted to one hospital with a chest infection over a period of 6 weeks. The infection was classified as bronchitis or lobar pneumonia on clinical and radiological criteria. The site and severity of the infection were assessed and correlated with LFTs and standard British Thoracic Society prognostic criteria. Mortality and length of stay in survivors were used as major outcome measures.There were 17 deaths (18%) overall and patients with abnormal LFTs were significantly more likely to die than those with normal tests (25% vs. 5%; p=0.026). Length of stay was significantly longer in survivors with abnormal liver function than in those with normal tests (9.7 vs. 5.8 days; p=0.006). A low albumin was the most useful predictor of poor outcome and carried a relative risk of dying of 1.8, comparable to the predictive value of tachypnoea. ALT was increased threefold in those succumbing to their disease, but alkaline phosphatase levels were not predictive of outcome and an increase in gamma GT appeared to be protective.Abnormal LFTs are common in community-acquired pneumonia and are of prognostic value. Patients with a low albumin or raised ALT are significantly more likely to die from their disease or to stay in hospital for a prolonged period. However, other LFTs are of less value in predicting prognosis.

Recognition of biliary tract obstruction without jaundice.

Obstructive jaundice and the use of liver function tests for it's diagnosis are widely understood. Biliary tract obstruction in the absence of jaundice, however, is rarely recognized or even thought of, even though it is of relatively common occurrence and can be detected frequently by the application of appropriate liver function tests. The identification of obstructive jaundice depends on the presence of an increased level of directacting bilirubin in the serum or bilirubinuria and abnormal results in tests of biliary tract patency, that is, an elevated serum alkaline phosphatase level and/or cholesterol in the presence of tests of normal parenchymal function, such as the cephalin-cholesterol flocculation and thymol turbidity tests. Partial obstruction of the biliary tract may produce the same pattern of liver function tests, even though the serum bilirubin level is not elevated. In addition, the sulfobromophthalein test, which in the presence of jaundice provides no further information, may