1. LAB DIAGNOSIS
IN
ALCOHOLIC
LIVER DISEASE
RESOURCE FACULTY-Dr.S.MAJHI
PRESENTED BY-PRATEEK SINGH

2. OBJECTIVE
 To enumerate the biochemical parameters for
diagnosis of ALD
 To interpret the above parameters

3. BIOCHEMICAL TESTS
TEST FOR LIVER
BIOSYNTHETIC ACTIVITY
*Serum bilirubin
*Serum albumin
*Albumin/Globulin ratio
*Prothrombin time

4. SERUM ENZYME TEST
*Aspartate aminotransferase (AST)
*Alanine amino transferase (ALT)
* Alkaline phosphatase (ALP)
* Gammaglutamyl transferase (GGT)
*5'nucleotidase (5'-NT)
*DE-RITIS ratio (AST/ALT)

5. INTERPRETATIONS OF
BIOCHEMICAL FINDINGS
DE-RITIS RATIO
*THIS IS THE MOST IMPORTANT
BIOCHEMICAL INDICATOR OF
ALCOHOLIC LIVER DISEASE.
*This is the ratio of Aspartate aminotransferase
and Alanine aminotransferase

6. *In normal individuals the DE-RITIS
ratio is 1.10:1
*But in patients of alcoholic liver disease
it is more than 2.
*Studies in regard to deritis ratio has also been
conducted in b.p.k.i.h.s by. Dr S.majhi, Dr N.Baral and Dr Lamsal

7. ALKALINE PAHOSPHATASE
*Not specific for liver disease
*Normal value is 25-90IU/l
*It will be elevated in ALD
*If its rise is in parallel to GGT it can be
said that this elevation is due to ALD.

8. ASPARTATE
AMINOTRANSFERASE
*Normal value is 35.00 +/- 23.49 IU/L
*It will be elevated in ALD 2-7 folds,
but not more than 400IU/L
*AST will be elevated more than ALT

9. ALANINE
AMINOTRANSFERASE
*Normal value is 31.48 +/- 17.79 IU/L
*It will be elevated 2-5 folds in ALD,
but not more than 400IU/L.

10. GAMMA
GLUTAMYLTRANSFERASE
*Normal value is 70.55 +/- 27.35 IU/L
*It will be moderately increased in
chronic alcoholics & All forms of fatty
liver.
*It is an Inducible enzyme.
*So,it is not a specific marker of ALD

11. BILLIRUBIN
*Normal serum concentration is
0.3-1mg/dl
*It will be increased in ALD >5mg/dl.
ALBUMIN
*Normal serum concentration is 3.5-
5gm/dl
*It decreases in ALD upto 2-3gm/dl

12. GLOBULIN
*Serum globulin will increase during
liver disease in response to antigenic
stimulation reflecting the immune
changes associated with alcoholic liver
disease.
*Normal Globulin level is 2.5-3.5gm/dl

13. OUT OF THREE GAMMA
GLOBULIN
IgA-Increases in 90% of cases.
IgG-Increases in 64% of cases.
IgM-Increases in 25% of cases.

14. ALBUMIN GLOBULIN RATIO
The normal A/G ratio is 1.2-1.5:1
*But in alcoholic liver disease this ratio is
reversed

15. PROTHROMBIN TIME
*Normal Prothrombin time is 12-16secs.
*In ALD Prothrombin time increases
Due to decrease synthesis of clotting
factors.

16. INTERPRETATION CHART
MILD MODERATE SEVERE
GGT 70.35+/-
17.79 IU/L
AST 35+/-
23.49 IU/L
ALT 31.48+/-
17.79 IU/L

17. MILD MODERATE SEVERE
ALP
25-90U/L
BILLIRUBIN N
25-90U/L
PROTHROMB
IN TIME
12-16secs

18. MILD MODERATE SEVERE
SERUM
ALBUMIN
3.5-5gm/dl
5‘NUCLEOTIDas
e
0-11mg/dl

19. THANK YOU