interpertation of hepatobiliary and pancreas laboratory tests fix

7/24/2019 Interpertation of Hepatobiliary and Pancreas Laboratory Tests Fix

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PEMERIKSAANLABORATORIUM PENYAKITHEPATOBILIER DAN

PANKREAS


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Liver ( Hepar )

Produces bilirubin

Produces albumin, coagulation factors, & other crucial

proteins

Cholesterol synthesis; lipid metabolism Primary site of drug and hormone metabolism


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Liver Function Tests (LFTs)

AST, ALT, ALK Phos, LD

!hat are "e measuring##

epatic or biliary inflammation $unctional capabilities


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Billiary System. %ilirubin is useful in the diagnosis and monitoring of lier

disease and hemolytic anemia and in the assessment of the

seerity of 'aundice(

A patient is generally isibly 'aundiced if the bilirubin leel is

greater than ) mg*dl(


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Bilirubin Metabolism

%ilirubin + product of hemoglobin breado"n from

erythrocyte ++ uncon'ugated --lier -- con'ugated

-- bile -- gut

Total bilirubin ./(0 + 1 mg*dl23ot sensitie for hepatic dysfunction; eleated in

other diseases; false eleations "ith some drugs

) + 4 mg*dl -- 'aundice


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Indirect Bilirubin.5t is uncon'ugated bilirubin( 3 6 /(7 mg*dl

Primary eleations often not associated "ith lier

disease

emolysis

ereditary diseases

3eonatal 'aundice

Physiological8 ) + 9 days after birth; usuallybenign

Kernicterus8 - )/mg*dl


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Direct Bilirubin. A "ater+soluble con'ugated posthepatic bilirubin(

3 6 /(4 mg*dl

:leated in rare congenital disorders

:leated in lier disease and biliary tractobstruction, but need to ealuate AST, ALT, ALP &

TP to determine cause

Degree of hyperbilirubinemia correlates "ith

outcome in alcoholic lier disease, biliary cirrhosis

& halothane to


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Alkaline Pos!atase

$ound in may body tissues; mostly lier and bone

-- nonspecific; reflect tissue damage

5n chloestatic disease, may be more than 4 times

normal; lesser eleations are nonspecific for anytype of lier disease

3on+hepatic causes8 mild eleations may be

normal; bone disorders .healing fractures, Paget=s,

tumors, osteomalacia2; sepsis; cancer; drugs.lithium, anticonulsants, oral contracepties2

38 0/+10/ 5>*L


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Hepatic Synthetic Function. ?ne "ay of assessing the lier@s ability to metabolie drugs is

to assess it=s synthetic function by ealuating the Buantity of

specific products produced by the lier(

Ammonia. The lier synthesies urea from ammonia(

Serum ammonia is increased if the lier is damaged or if blood

flo" is compromised

not used as a routine screening test, but used to confirm a

diagnosis of hepatic encephalopathy(


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Hepatic Synthetic Function.Protein Production.

The serum albumin and the itamin K+dependent clotting

factors are commonly used to assess hepatic synthetic function(

Albumin. Circulating albumin taes seeral "ees to clear from

the body(

A rapidly declining leel indicates greatly impaired

hepatic function( Long+standing lier disease is associated "ith ery lo"

concentrations(

3 0,9+9(9 g*dl


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Hepatic Synthetic Function.Protein production

Vitamin K-Dependent Clotting Factors Factors

!!"V!!"!#" and #$.

Lac of production of these factors prolongs theprothrombin time .PT2 and partial thromboplastin time

.PTT2(

The PT is prolonged earlier than the PTT and often is

used as an early indicator of impaired hepatic syntheticfunction(

%oth the PT and PTT are prolonged in long+standing

seere hepatic dysfunction(


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Tests o" Li#er S$nteti%&a!abilit$ Prothrombin Time / I!

:leated "hen the lier is unable to synthesie

clotting factors .55, 55, 5, 2

PT prolongation8 inadeBuate it K in diet, poor fatabsorption, poor nutrition, drugs ."arfarin and

antibiotics2, diseases

3 8 1/+14 deti


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Hepatocellular %n&ymes. epatocytes contain numerous enymes that lea into the

serum "hen lier cells die or are damaged(

:leations occur in the presence of mared changes inhepatic circulation .e(g(, cardioascular shoc2 and diseases

associated "ith hepatocellular damage .hepatitis, cirrhosis,

inflammatory diseases, and infiltratie hepatic diseases2(

Serum enymes may not be maredly eleated in seere,

chronic, end+stage lier disease


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Hepatocellular %n&ymes. ery high eleations .-)/ n2 are associated "ith iral or

to


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Hepatocellular %n&ymes.Alanine Aminotrans'erase.

ALT is found in high concentrations in hepatocytes

and is considered a specific marer of

hepatocellular damage( Eared eleations .-1/// 5>*L2 found in iral

hepatitis, seere drug reactions, or ischemic

hepatitis

3ormal or mild eleations in cholestasis

'astrointestinal S$stem


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Hepatocellular %n&ymes.Aspartate Aminotrans'erase.

AST is found in hepatocytes, myocardial muscles,

seletal muscle, the brain, and the idneys(

5t is used as a nonspecific marer of hepatocellulardamage(

false eleations in etoacidosis, drugs8 leodopa,

erhtyromycin, methyldopa

lo" in uremia, %F deficiency, drugs

assay interference8 hemolysis and hyperlipidemia


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Hepatocellular Enzymes. (amma (lutamyl )ranspeptidase.

T is found in hepatobiliary, pancreatic, and idney

cells(

5t is eleated in most hepatocellular and hepatobiliarydiseases,

:leations correlate better "ith obstructie disease

An early indicator of alcoholic lier disease(


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Hepatocellular %n&ymes. *actic Dehydrogenase.

LD is found in the heart, brain, erythrocytes, idneys,

lier, seletal muscle, and ileum(

:leations occur during shoc syndrome and diseasesassociated "ith hepatocellular damage .hepatitis,

cirrhosis, inflammatory disease, and infiltratie

diseases2(


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Pan%reas

:


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Tests to Assess tePan%reas

"m#lase.44 + 1)G 5>*L2

Eay increase to )9 times normal; does not

correlate "ith disease seerity or prognosis

Eay be eleated in alcoholism, drugs, gallstones,infections, trauma, hypertriglyceridemia

Lipase .61(9 >*ml2

more specific for pancreatitis .0H times normal2


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Dru(s Tat &ausePan%reatitis

Asparaginase

Aathioprine

Didanosine

:strogens $urosemide

Steroids

) antagonists

Thiaides


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+iscellaneous

Alpha-Fetoprotein.

is the ma'or protein produced by the fetus in the first

1/ "ees of life(

5t also is produced by rapidly multiplyinghepatocytes and is used as a marer of hepatocellular

carcinoma(

Carcinoembryonic Antigen.

C:A is a tumor marer found in the blood(

5t is associated "ith rapid multiplication of digestie

system epithelial cells and is used to monitor tumor

recurrence

interpertation of hepatobiliary and pancreas laboratory tests fix

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