Evaluation Liver Function Tests

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    DR. Dr. Hanifah Oswari, Sp.A(K)

    S1 FKUI 1983-1989 Spesialis anak FKUI 1994-1999

    Fellow Gastroenterology-hepatology and nutrition,Royal Childrens Hospital, Brisbane, Australia,2000-2001

    Saat ini:

    Konsultan Gastroenterohepatologi FKUI 2005 S3 Program studi Ilmu Kedokteran FKUI 2009

    Staf Gastroenterohepatologi Anak FKUI

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    Abnormal liver function test:

    how to evaluate

    DR. Dr. Hanifah Oswari, Sp.A(K)Pediatric Gastroentero-hepatologist

    Faculty of Medicine, Cipto Mangunkusumo Hospital

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    Presentation

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    LFTLiver Function Test

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    BILIRUBIN

    Alk Phosphatase

    Gamma GT

    80% heme20% others

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    Albumin

    Prothrombin time

    Synthetic function

    20 days

    hours

    Chronic process

    Cirrhosis

    Vit K def

    significant hepatocellular dysfunction

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    Liver function test

    May be abnormal

    Health of the liverTuesday, July 12, 2011

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    AST

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    CytoplasmMitochondria

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    ALT

    Cytoplasm

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    Gamma GT

    Newborn

    6-7x adultTuesday, July 12, 2011

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    AgeTuesday, July 12, 2011

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    HepatocellularBile duct

    ALT

    AST

    Bilirubin

    GGT

    Alk Phosp

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    Mild chronic elevation in serum aminotransferases

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    Mild chronic elevation in serum aminotransferases

    < 4 ULN

    > 6 months one or both

    > 2 ULN

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    Mild chronic elevation in serum aminotransferases

    21 3 4Tuesday, July 12, 2011

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    Mild chronic elevation in serum aminotransferases

    Identifymost

    common

    cause ofliver

    disease

    Drug/herbal

    Hepatitis BHepatitis C

    NAFLD1

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    hep-Chep-BTuesday, July 12, 2011

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    hep-B HBsg

    AntiHBc IgMTuesday, July 12, 2011

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    hep-C AntiHCVTuesday, July 12, 2011

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    O

    besity

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    Mild chronic elevation in serum aminotransferases

    Look fornon-

    hepaticcauses

    Muscledisorders

    Thyroiddisorders

    2

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    Thyroid disorders

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    Thyroid disorders

    TSHFT4

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    Muscle disorders

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    Muscle disorders

    Creatinin kinaseTuesday, July 12, 2011

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    Mild chronic elevation in serum aminotransferases

    Identifyrarer

    cause ofLD

    Autoimmunehepatitis

    Wilsonsdisease

    3

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    Autoimmune hepatitis

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    Wilsons disease

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    Mild chronic elevation in serum aminotransferases

    observe inALT & AST

    < 2 ULN

    May be needed whennoetiology found +

    ALT & AST

    persistently2 ULN

    4

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    BilirubinTuesday, July 12, 2011

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    Uptake

    Conjugation

    Excretion

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    Cholestasis

    Intrahepatik Extrahepatik

    Biliary atresia

    20%total

    >1 mg/dl

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    Sign & Symptoms

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    g y p

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    Sign & Symptoms

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    g y p

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    I l t d h bili bi i

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    Isolated hyperbilirubinemia

    Hemolysis

    Unconjugated

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    I l t d h bili bi i

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    Isolated hyperbilirubinemia

    Hemolysis

    Impaired

    hepatic

    bilirubin

    uptake

    Hepatic blood flow

    Drugs

    Unconjugated

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    I l t d h bili bi i

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    Isolated hyperbilirubinemia

    Hemolysis

    Impaired

    hepatic

    bilirubin

    uptake

    Hepatic blood flow

    Drugs

    Unconjugated

    Impaired

    hepatic

    bilirubin

    conjugation

    Gilberts diseaseCrigler-Najjar

    Drugs

    HyperthyroidismTuesday, July 12, 2011

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    Isolated hyperbilirubinemia

    Conjugated

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    Isolated hyperbilirubinemia

    Conjugated

    Dubin-Johnson

    syndrome

    Rotor

    syndrome

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    Isolated hyperbilirubinemia

    Conjugated

    Dubin-Johnson

    syndrome

    Rotor

    syndrome

    direct bili + 50% total ANDnormal other LFTsTuesday, July 12, 2011

    Conclusion

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    ConclusionAbnormal LFT

    Not directly to liver function

    2 types: hepatocellular & cholestasis

    High aminotransferases-steps approach Cholestasis-dont miss biliary atresia

    Isolated unconjugated hyperbilirubinemia:

    hemolysis-impaired uptake or impairedconjugation

    Isolated conjugated-Rotor & Dubin Johnson

    remember

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    Exercise

    Bilirubin total 10 mg/dl

    Bilirubin direk 1,5 mg/dl

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    Exercise

    Bilirubin total 20 mg/dl

    Bilirubin direk 3 mg/dl

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