hepatic synthetic function

Q: Which of the following is NOT considered a marker of hepatic synthetic function? - select one

A) Alkaline phosphatase

B) Albumin

C) Bilirubin

D) Prothrombin time (INR)

Answer: A

Liver enzymes measured in the serum lead physician to understand liver injury or it's functional status.

Enzymes that mostly tell about liver injury are:

• Alanine aminotransferase (ALT; formerly called SGPT) 
• Aspartate aminotransferase (AST; formerly called SGOT)
• Alkaline phosphatase
• Gamma-glutamyl transpeptidase (GGTP)
• 5'-nucleotidase
• Lactate dehydrogenase (LDH)

Tests of hepatic synthetic function include:

• Serum albumin
• Prothrombin time/international normalized ratio

Bilirubin (choice C) is unique as its abnormality gives clues about both injury and synthetic function, particularly by division into direct and indirect bilirubinemia.

#hepatology

#lab-medicine

References:

1. Kalas MA, Chavez L, Leon M, Taweesedt PT, Surani S. Abnormal liver enzymes: A review for clinicians. World J Hepatol. 2021 Nov 27;13(11):1688-1698. doi: 10.4254/wjh.v13.i11.1688. PMID: 34904038; PMCID: PMC8637680.

2. Lee TH, Kim WR, Poterucha JJ. Evaluation of elevated liver enzymes. Clin Liver Dis. 2012 May;16(2):183-98. doi: 10.1016/j.cld.2012.03.006. PMID: 22541694; PMCID: PMC7110573.