Laboratory Tests for Abdominal Sonography

Bilirubin-Direct (Conjugated/Water Soluble)

From destroyed RBCs; once conjugated by liver it becomes water soluble and can be excreted in urine, feces and stored in bile.

Bilirubin-Indirect (Unconjugated/Not Water Soluble)

From destroyed RBCs; unconjugated remains in blood because not water soluble; Overproduction of bilirubin (↑RBC breakdown with hemolytic anemia); Liver unable to conjugate.

Total Bilirubin

Normal = 0.1-1.2 mg/dL.

Urobilinogen

Bacterial by-product from bilirubin in the intestine. It could be reabsorbed. Found in Urine and Feces.

Alanine aminotransferase [ALT (SGPT)]

Enzyme in energy production (mostly liver; but some in kidney, heart, skeletal muscles); increases with tissue damage.

Aspartate aminotransferase [AST (SGOT)]

Enzyme; found most in organs that are highly metabolic (liver, heart, skeletal muscles); is released with cell injury.

Alkaline phosphatase [ALP; ALK PHOS]

Enzyme in tissues of biliary duct walls, liver, bone, intestine, kidney, and placenta.

Lactic dehydrogenase (LDH)

Enzyme found in all tissues (heart, liver, kidney, brain, muscle).

ϒ-(Gamma) Glutamyl transpeptidase (GGTP or GGT)

Transportation of amino acids and peptides across cell membranes (primarily Liver, bile ducts, kidney, pancreas).

Prothrombin Time (PT); Partial Thromboplastin Time (PTT)

Evaluates blood clotting factors.

Globulin

Protein produced in liver.

Albumin

Protein primarily created in the liver; affects water balance (cellular and whole body).

Albumin/globulin (A/G) ratio

Globulins are produced in Kupffer cells; this is albumin level divided by globulin level.

Α-Fetoprotein (AFP)/Fetal Antigen

Globulin; should only see trace amounts after birth.

Cholesterol

Waxy, fat-like substance made by the liver. Needed to make hormones and aiding in digestion of fatty foods.

Blood Urea Nitrogen (BUN)

Measures amount of waste produce (urea nitrogen) in blood.

Creatinine

Waste product of muscles.

Urinalysis (UA)

Analyzes urine for presence of blood, WBC's, bacteria.

Hemoglobin and Hematocrit (H&H)

Indicators of blood levels.

Urine pH

How acidic or basic the urine is (may be related to stone formation).

Urine Protein

Protein molecules are large and if they are exiting the kidney by way of the urine, this does damage to the kidney.

Urine Glucose

"Sugar" in the urine.

White Blood Cells (WBC)

Part of the immune response.

Amylase

Enzyme that helps break up carbohydrates.

Lipase

Enzyme that helps break up fats.

Bilirubin-Direct (Conjugated/Water Soluble) will be abnormally elevated with

Increased with hepatocellular disease [Hepatitis or cirrhosis (jaundice); obstructive liver disease]

Increased with Biliary Tract Obstruction

Bilirubin-indirect (Unconjugated/Not Water Soluble) will be abnormally elevated with

Overproduction of bilirubin (↑RBC breakdown with hemolytic anemia); Liver unable to conjugate

Small increase with hepatocellular disease

Urobilinogen will be abnormally increased with

Urine: Increases with hemolytic disease

Fecal: Increases with hemolytic disease

Urobilinogen will be abnormally decreased with

Urine: decreases with biliary obstruction

Fecal: Decreases with biliary tree obstruction

What is Alanine Aminotransferase also known as?

ALT or SGPT

What condition is associated with abnormally increased ALT levels?

Hepatocyte damage (hepatitis, cirrhosis, liver cancer)

What can cause mildly elevated ALT levels?

Biliary tract obstruction

What other conditions can lead to increased ALT levels?

Other liver diseases, heart failure, alcohol/drug abuse, some renal and musculoskeletal diseases, Lupus

What happens to AST and ALT levels with liver cell damage?

AST & ALT will increase

In which condition is AST greater than ALT?

Cirrhosis and liver metastases

In which condition is ALT greater than AST?

Acute hepatitis and non-malignant hepatic obstruction

Aspartate aminotransferase [AST (SGOT)] will be abnormally increased with

Hepatitis, cirrhosis (Hepatocyte damage)

Mildly elevated with bile duct obstruction

Shock, trauma, Pulmonary embolus/infarct

What condition causes a significant increase in alkaline phosphatase due to biliary obstruction?

Biliary neoplasm

What condition is associated with a significant increase in alkaline phosphatase due to cholelithiasis?

Cholelithiasis

What type of liver damage can cause a mild elevation in alkaline phosphatase?

Metastatic disease

Which liver condition is associated with mild elevation of alkaline phosphatase?

Hepatitis

What heart condition can lead to a mild elevation in alkaline phosphatase?

Congestive Heart Failure

What type of cancer can cause an increase in alkaline phosphatase due to pancreatic head involvement?

Pancreatic head carcinoma

Which organs, when affected, can lead to an increase in alkaline phosphatase?

Bone or kidney

Lactic dehydrogenase (LDH) will abnormally increase with

Mildly elevated in obstructive jaundice and hepatic disease

What does an increase in Gamma Glutamyl transpeptidase (GGT) indicate?

It can indicate liver disease.

What condition is associated with an increased level of GGT?

Biliary obstruction.

Which other diseases can cause an elevation in GGT levels?

Pancreatic, kidney, prostate, heart, lung, or spleen diseases.

What does an increase in Prothrombin Time (PT) indicate?

Deficiency of clotting factors due to liver disease or absence of vitamin K

What does an increase in Partial Thromboplastin Time (PTT) indicate?

Deficiency of clotting factors due to liver disease or absence of vitamin K

What is the effect of liver dysfunction on clotting factors?

Liver dysfunction leads to decreased clotting factors

How does liver dysfunction affect PT/PTT and clotting time?

Liver dysfunction increases PT/PTT and clotting time

Globulin increases with what?

Increases with inflammatory and neoplastic diseases

albumin increases with

Dehydration; destruction of RBCs; anxiety, depression

albumin decreases with

Chronic liver disease (hepatitis, cirrhosis); Rt Heart Failure, Cancer, Peritonitis; inflammation, pregnancy, aging

What happens to the albumin/globulin (A/G) ratio in chronic liver disease?

The A/G ratio decreases.

What is a reversed A/G ratio indicative of?

Decreased total protein and elevated globulins.

What conditions can lead to a decreased A/G ratio?

Chronic liver disease, right heart failure, cancer, peritonitis, inflammation, pregnancy, and aging.

Α-Fetoprotein (AFP)/Fetal Antigen increases with

Liver carcinoma—Present in 50% of patients with HCC.

Some Testicular Cancers, lung ovarian, GI, and pancreatic cancers

Cholesterol increases with

Increases with biliary obstruction

Cholesterol decreases with

Decreases with chronic liver disease

Blood Urea Nitrogen (BUN) will be increased with

Acute and Chronic renal disease/failure

CHF

Dehydration,

High protein diet

Hemorrhage

Creatinine is increased with what?

Acute and Chronic renal disease/failure

Complications of diabetes

Urinary obstruction

Hemoglobin and Hematocrit (H&H) decreases with what

Blood Loss or Anemia

Lactic Dehydrogenase

(LDH) increases with what?

Renal failure and Renal tissue damage

Also elevated in liver disease, muscle injury, heart attack, pancreatitis, anemia, cancer

Urine pH increases with what?

Possible kidney failure; renal tubular acidosis

Urine pH decreases with what?

Possible infection

Urine Protein increases with what lab values?

- Kidney disease/failure

- Dehydration

- Immune disorders

Urine glucose increases with

diabetes

White blood cells increases with

infection and inflammation

Amylase will increase with

Biliary disease, pancreatic duct obstruction, and/or malignancy

Amylase will decrease with

Permanent Pancreatic damage; Cirrhosis, Hepatitis

Lipase will increase with

Pancreatic duct obstruction and/or carcinoma, acute cholecystitis, cirrhosis

Amylase and Lipase with both increase with

inflammation/Infection (Pancreatitis)

Alanine Aminotransferase (ALT/SGPT)