| Liver Function Tests a Simple FactSheet from the AIDS Treatment Data Network |
| ||||| What are Liver Function Tests? | ||
| LFTs (liver function tests) are a group of blood tests that can help to show how well a person's liver is working. LFTs include measurements of albumin, various liver enzymes (ALT, AST, GGT and ALP), bilirubin, prothrombin time, cholesterol and total protein. All of these tests can be performed at the same time. | ||
| ||||| Measuring Liver Proteins: | ||
| Total protein testing (also called TP or serum total protein) measures the amount of proteins in the bloodstream. Many different things can cause abnormally high or low protein levels. A doctor may order total protein testing to help diagnose kidney or liver disease, blood cancer, malnutrition or abnormal body swelling. Normal protein levels in the bloodstream range from 6.5 to 8.2 grams per deciliter Two of the main proteins found in the bloodstream are albumin and globulin. Globulins are made by various liver cells and the immune system. They help to fight off infections. Low globulin levels can have many causes other than liver damage. Albumin is a protein made in the liver. If the liver is badly damaged, it can no longer produce albumin. Albumin maintains the amount of blood in the veins and arteries. When albumin levels become very low, fluid can leak out from the blood vessels into nearby tissues, causing swelling in the feet and ankles. Very low levels of albumin may be a sign of liver damage. The normal albumin range is from 3.9 grams/ deciliter to 5.0 grams/deciliter. Prothrombin (also called factor II) is a protein that helps to clot blood. Prothrombin is made in the liver. A prothrombin time test measures how much time it takes for a person's blood to clot. The normal time needed for blood to clot is between 10 and 15 seconds. A person with an abnormally long prothrombin time may be at risk for excessive bleeding. A longer prothrombin time can be caused by serious liver disease or:
| ||
| ||||| Measuring Liver Enzymes: | ||
ALT and AST are enzymes made in the liver. They are also known as transaminases. The liver uses these enzymes to metabolize amino acids and to make proteins. When liver cells are damaged or dying, ALT and AST leak into the bloodstream. Many different things can cause liver enzymes to rise above normal levels, including:
AST (also called aspartate aminotransferase or SGOT) is found in other organs besides the liver. High AST levels in the bloodstream can be a sign of liver trouble. AST testing measures the level of AST in a person's bloodstream at a given time. The normal range for AST levels in the bloodstream are 5 IU/L to 43 IU/L. Like ALT levels, AST levels in people with HCV often vary over time and can't be used to forecast disease progression or specifically measure liver damage. | ||
| ||||| Cholestatic Liver Enzymes: | ||
| GGT and ALP are also called cholestatic liver enzymes. Chloestasis is a term used for partial or full blockage of the bile ducts. Bile ducts bring bile from the liver into the gallbladder and the intestines. Bile is a green fluid produced in liver cells. Bile helps the body to break down fat, process cholesterol and get rid of toxins. If the bile duct is inflamed or damaged, GGT and ALP can get backed up and spill out from the liver into the bloodstream. ALP metabolizes phosphorus and brings energy to the body. GGT brings oxygen to tissues. Causes of elevated ALP and GGT levels include:
| ||
| ||||| Bilirubin: | ||
Bilirubin is a yellow fluid produced in the liver when worn-out red blood cells are broken down. Bilirubin can leak out from the liver into the bloodstream if the liver is damaged. When bilirubin builds up, it can cause jaundice - a yellowing of the eyes and skin, dark urine and light colored feces. The causes of abnormal bilirubin levels include:
| ||
| Thank you Craig... I always know where to go to find good information. I met a man today (who is doing GREAT post-transplant) that needed a new liver due to PBC, which of course I had to find out more information about as soon as possible... so here it is! |
 The name "Primary Biliary Cirrhosis" is somewhat deceiving since cirrhosis only occurs in the last stage of the disease (stage 4) after many years of inflammation. With early diagnosis and proper medications, most with PBC will never reach the cirrhosis stage of PBC. PBC is also called "Chronic Nonsuppurative Destructive Cholangitis" and "Primary Autoimmune Cholangitis." However, these alternative terms are not widely accepted and therefore not in use. Definition from New American Medical Dictionary: Primary: First in order of development, most important, arising spontaneously. Biliary: Relating to or affecting the bile duct system or bile. Cirrhosis: An inflammatory disease of the liver associated with the replacement of liver cells by fibrous tissue. Passage of blood through the liver may eventually be obstructed by the cirrhosis. The cause of PBC is still unknown, but it is not alcohol or drug induced. Current studies suggest it may involve autoimmunity, infection, or genetic predisposition, and does seem to appear more often in certain families. Women are affected 10 times more than men, and PBC is usually diagnosed in patients between the ages of 35 to 60 years. Those with PBC usually look extremely healthy, and many are 10 to 30 pounds overweight. The slight bronze pigmentation of the skin is often present in the advanced stage of the disease, and makes the individual look tanned. The outward appearances doesn't tell the story of what is going on inside their bodies. Even on the transplant list stage, many with PBC look healthy. A person with PBC commonly hears comments such as "you look so healthy or you don't look sick." Upon diagnosis, some doctors may suggest their patient start: Start a reduced sodium diet and or low fat diet. Nutrition In severely damaged livers, proteins may be restricted. Drink plenty of water and other fluids such as juice. Calcuim and Vitamin D. Calcium is the most common mineral in the body and is required for proper functioning of most organs. It is particularly needed in the normal development of the bones and teeth. Osteoporosis is a bone disease where calcium leaves the bones, causing them to weaken, and is commonly associated with PBC. Avoid or lower intake of alcohol Lower caffeine intake Avoid undue stress Exercise, if possible. Walking is the most common recommendation for exercise. Stop smoking The above suggestions have been found to be very helpful in liver disease, but are common sense considered part of healthy living. PBC Menus and meal plans by Norma J. Thiel, RD, Clinical Nutrition Manager Mountainview Hospital. The number of patients being diagnosed at the asymptomatic stage has risen dramatically over the past few years due to widespread laboratory screening. Typically, the blood lab pattern reveals an elevated alkaline phosphatase level with a normal bilirubin. Bilirubin does not increase until final disease stage. There are four disease stages of PBC. Medical tests used to confirm PBC: A liver biopsy helps confirms the diagnosis, but is not a requirement. Ultrasound exam may be performed to visualize the bile ducts to exclude an obstruction. Blood lab tests that show liver dysfunction: Liver function tests Antimitochondrial antibodies. Positive AMA is found in about 95% of PBC patients. Serum cholesterol and lipoproteins may be increased. Haptoglobin & ACE levels may be altered Diagnostic tests PBC advances slowly over a period of years. Most patients lead normal lives for years without symptoms, depending on how early diagnosis is made. There is no cure for PBC, but patients are showing good results in slowing the disease progress with URSO 250 , Actigall and methotrexate. With the current medications, it is becoming more common for the PBC patient to live a long life without any complications from PBC, and in some cases actually lowering the disease stage from original diagnosis stage. PBC is considered an autoimmune disease. Some diagnosed with PBC, may also be diagnosed with one or more other autoimmune diseases. Click for diseases and conditions associated with PBC. Most patients remain without symptoms for many years, and some may never notice any symptoms. The initial symptoms vary among PBC patients, and the varying symptoms can sometimes make it difficult for doctors to actually diagnose PBC. The varying symptoms may be do to the individual, autoimmune nature or other diseases associated with PBC. Symptoms may be present in any combination and include any of the following: Fatigue may be the first symptom the patient notices, causing him or her to visit their doctor. The fatigue associated with PBC appears to be totally different from any other sort of fatigue. In early stages, many patients have commented they could sleep for hours. While some in the later stages say sleeping becomes more difficult. At this time, there is little research into the cause and treatment of the liver disease fatigue. It is usually not due to depression, and some researchers believe it is an abnormality of the axis between the pituitary and the adrenal glands. Support and understanding from family members, friends and the doctor is very important, making it somewhat bearable. Intense and unrelenting itching of the skin. Gradual darkening (hyperpigmentation) or changes in skin texture, and various skin rashes. Small yellow or white bumps (xanthomas) under the skin, or around the eyes. Dry Eye Syndrome Dry mouth, sometimes referred to as cotton mouth. Thyroid problems Arthritic aches and pains in bones, muscles and joints are common. In some, the pains can be severe and debilitating. Some even report severe pain just touching leg, feet and hip bones, but this is NOT common. Over the years, as the PBC progresses, other symptoms may appear. These symptoms may include any of the following: Osteoporosis or other metabolic bone disease. See osteoporosis exercises. Enlarged abdomen from fluid accumulation. Easy bruising or bleeding Jaundice (yellowing of the skin and eyes) Increased bilirubin Internal bleeding in upper stomach and esophagus, that may be caused by varcies. Hepatic encephalopathy causing personality changes: dulling of mental functions, neglect of personal appearance, forgetfulness and trouble concentrating, changes in sleeping habits, confusion, breath odor and muscle stiffness. Encephalopathy occurs in final stage of PBC. Hypersplenism, enlarged spleen Fever, nausea and vomiting Reflux and stomach ulcers Weight increase or decrease Swelling of the hands, legs and ankles. See edema and ascites Sexual problems (impotence in men, absence of periods in women, lack of desire.) Trembling hands Difficulty in sleeping and changes in sleeping habits. Some PBC patients have noted that itching intensifies when they lay down to sleep, and those who have liver pain say it is more severe in a sleeping position. Hepatorenal syndrome, progressive deterioration of kidney function leading to kidney failure in a person with liver failure. Hepatopulmonary syndrome, associated with difficulty with breathing. Liver cancer (hepatocellular carcinoma) Abdominal pain or pressure in the liver area. (Yes it's real) As the PBC progresses, some patients require vitamin A, vitamin D, vitamin E and vitamin K replacement therapy to add back fat-soluble vitamins which are lost in fatty stools. A calcium supplement may be prescribed to help prevent osteomalacia and osteoporosis. When medical treatments, such as URSO 250 & URSO Forte, Actigall and methotrexate, no longer control the disease, the patient should be evaluated for a liver transplant. The end stage of PBC is liver failure. Many signs indicate liver failure: increased bilirubin, jaundice, fluid accumulation or ascites, malnutrition, gastrointestinal bleeding, intractable itching, bone fractures and hepatic coma. Transplant is recommended before most of these symptoms occur. Recent studies suggest that about 30% of those diagnosed with PBC will require a transplant. The transplant outcome for PBC patients is excellent. As with any other chronic illness, support and understanding is very important in helping the PBC patient cope with day to day living. |
| Author: CNL Created: 4/25/2010 Ref #:46546 |
Living donor liver transplantation has two major advantages over deceased-donor transplantation. First, there is an improved survival rate for the adult transplant recipients who received living-donor livers over deceased-donor livers. Please see charts below. Secondly, the wait for transplantation can be greatly reduced.
Recipient Survival with Deceased-Donor liver – 86.5%
Recipient Survival with Living-Donor liver - 96.1%
Three Year Liver Transplant Survival Rate (7/1/04 – 12/31/06)
Patient Survival with Deceased-Donor liver - 73.3%
Patient Survival with Living-Donor liver - 91.6%
| Rank | Type | Food item | Serving size | Total antioxidant capacity per serving size |
| 1 | Beans/Legumes | Red Beans (dried) | Half cup | 13727 |
| 2 | Fruit, Berry | Wild blueberry | 1 cup | 13427 |
| 3 | Beans/Legumes | Red kidney beans (dried) | Half cup | 13259 |
| 4 | Beans/Legumes | Pinto beans | Half cup | 11864 |
| 5 | Fruit, Berry | Blueberry | 1 cup | 9019 |
| 6 | Fruit, Berry | Cranberry | 1 cup (whole) | 8983 |
| 7 | Vegetable | Artichoke (cooked) | 1 cup (hearts) | 7904 |
| 8 | Fruit, Berry | Blackberry | 1 cup | 7701 |
| 9 | Fruit | Prune | Half cup | 7291 |
| 10 | Fruit, Berry | Raspberry | 1 cup | 6058 |
| 11 | Fruit, Bery | Strawberry | 1 cup | 5938 |
| 12 | Fruit | Red Delicious apple | One | 5900 |
| 13 | Fruit | Granny Smith apple | One | 5381 |
| 14 | Nut | Pecan | 1 ounce | 5095 |
| 15 | Fruit, Bery | Sweet cherry | 1 cup | 4873 |
| 16 | Fruit | Black plum | One | 4844 |
| 17 | Vegetable | Russet potato (cooked) | One | 4649 |
| 18 | Beans/Legumes | Black beans (dried) | Half cup | 4181 |
| 19 | Fruit | Plum | One | 4118 |
| 20 | Fruit | Gala apple | One | 3903 |
| Fruits | Antioxidant Value ORAC units per 100 grams | Vegetables | Antioxidant Value ORAC units per 100 grams |
| Prunes | 5570 | Kale | 1770 |
| Raisins | 2830 | Spinach | 1260 |
| Blueberries | 2400 | Brussels sprouts | 980 |
| Blackberries | 2036 | Alfalfa sprouts | 930 |
| Strawberries | 1540 | Broccoli flowers | 890 |
| Raspberries | 1220 | Beets | 840 |
| Plums | 949 | Red bell pepper | 710 |
| Oranges | 750 | Onion | 450 |
| Red grapes | 739 | Corn | 400 |
| Cherries | 670 | Eggplant | 390 |
| Kiwi fruit | 602 | ||
| Grapefruit | 483 |
