Page 14 - Clinical Biochemistry 08PB804

• They are always present in the plasma in an inactive form. When activated they act as
proteolytic enzymes which activate other inactive enzymes.
Diagnosis of liver diseases
The diagnosis of liver disease depends upon the following
• Complete history.
• Complete physical examination.
• Evaluation of liver function tests.
• Further invasive and noninvasive tests.
History
A. Acute or chronic symptoms.
B. Symptoms of liver disease such as: jaundice, dark urine, pruritus, abdominal pain, fever,
fatigue.
C. Drug and toxin exposure: acetaminophen, non-steroidal anti-inflammatory drugs
(NSAIDS), herbal remedies, mushroom poisoning.
D. Past History: previous biliary surgery, blood transfusions.
E. Family history of liver disease.
F. Social history: travel, alcohol abuse, tattoos.
Physical examination
A. General appearance: muscle wasting, testicular atrophy, gynecomastia.
B. Skin: abnormal pigmentation, needle tracks, scarring from skin abscesses, peripheral
edema.
C. Abdomen: Liver enlargement, firmness; ascites; splenomegaly.
D. Neuropsychiatric: Confusion, depression, memory loss, inappropriate or unusual behavior.
• In liver disease there are crossovers between purely biliary disease and hepatocellular
disease.