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LIVER FUNCTION STUDIES

NCM 104 - B

The principal protein in plasma, present in blood plasma and in serous fluids. Participates in fatty acid transport and helps regulate osmotic pressure of blood.

Measure of albumin and globulin an indirect indicator of liver function and disease

Normal Value: 6 – 8 g/dL

Serum Protein/Albumin

Also called SGPT – serum glutamic pyruvic transaminase

An enzyme transferring amino groups from l-alanine to 2-ketoglutarate

Serum concentration is increased in viral hepatitis and MI

Liver enzyme used to diagnose hepatocellular distraction

Also found in small amounts in the kidney, heart and skeletal muscle

Normal Value: 0 – 35 µ/L

Alanine transaminase

Also called SGOT - serum glutamic oxaloacetic transaminase

Enzyme found mainly in the heart and liver with moderate amounts in skeletal muscle, kidneys and pancreas

Normal value: 8 – 38 µ/L

Aspartate Transaminase

A phosphatase with an optimum pH of above 7 present in many tissues

Low levels of this enzyme are seen in cases of hypophosphatasia

Enzyme mainly produced in the liver and bone

Normal Value: 42 – 136 µ/L

Alkaline Phosphatase

A yellow bile pigment found as sodium bilirubinate or as an insoluble calcium salt in gallstones.

Excess is associated with jaundice Formed form the breakdown of hemoglobin by

the reticuloendothelial system and conjugated in the liver

Normal Values:: Total Bilirubin: 0.1 to 1.2 mg/dL

Measurement of direct and indirect total bilirubin

Direct Bilirubin: 0.1 to 0.3 mg/dL Measurement of conjugated bilirubin

Bilirubin

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Coagulation Studies

The time required for blood to clot in a glass tube

Normal Value: 7 – 15 minutes

Clotting Time

Looks at how fast small blood vessels close to stop you from bleeding

Normal Value: 1 – 9 minutes

Bleeding Time

The time required for clotting after thromboplastin and calcium are added in optimal amounts to blood of normal fibrinogen content

If diminished, the clotting time increases

Useful in testing for impaired liver synthesis of Factors II, VII, X

Normal Value: 11 – 15 seconds

Prothrombin Time

The time needed for plasma to form a fibrin clot following the addition of calcium and a phospholipid agent

To check for defects in Factors I, II, V, VIII, IX, XI, XII

Screens for hemophilia A and B may not detect minor clotting defects

Normal Value: 35 – 45 seconds

APTT

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Nursing Responsibilities

Before the procedure, tell the patient that no fasting or preparation is required

Collect first voided morning specimen or a 24-hour specimen. No preservative is required as long as the specimen is kept refrigerated

Obtain consent form if required by the institution Obtain a drug history to detect if the patient has

recently had aspirin, anticoagulants, alcohol, or any other medications that may affect test results.

If the patient is receiving warfarin, obtain the blood specimen before the patient is given the daily dose of warfarin. The daily dose may be increased, decreased, or kept the same depending on the Prothrombin Time test results for that day.

Assess the venipuncture site for bleeding If the PT is greatly prolonged, evaluate the

patient for bleeding tendencies: check for blood in the urine and all excretions and assess the patient for bruises, petechiae and low back pain (back pain may be a symptom of retroperitoneal bleeding).

If severe bleeding occurs, administer vitamin K as prescribed.

Instruct the patient not to take any medication unless specifically ordered by the physician

Lewis, S. (1996). Medical surgical nursing: assessment and management of clinical problems. 4th ed. Mosby. Philadelphia

Smeltzer, S. & Bare, B. (2010). Brunner and suddarth’s textbook of medical surgical nursing. 12th ed. Lippincott Williams and Wilkins. Philadelphia

Pagana K., & Pagana T. (2002). Mosby’s Manual of Diagnostic & Laboratory Tests. 2nd ed. Mosby Inc. Missouri

Dirckx, J. (2001). Stedman’s concise medical dictionary for the health professions 4th ed. Lippincott Williams and Wilkins. Philadelphia

References