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

Tuesday, July 12, 2011


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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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< 4 ULN

> 6 months one or both

> 2 ULN



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21 3 4Tuesday, July 12, 2011


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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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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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Identifyrarer

cause ofLD

Autoimmunehepatitis

Wilsonsdisease

3



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Autoimmune hepatitis



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Wilsons disease



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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


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


I l t d h bili bi i


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Hemolysis

Impaired

hepatic

bilirubin

uptake

Hepatic blood flow

Drugs

Unconjugated


I l t d h bili bi i


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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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Conjugated



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Conjugated

Dubin-Johnson

syndrome

Rotor

syndrome



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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 direk 3 mg/dl



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Exercise


Bilirubin direk 3 mg/dl



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Exercise


Bilirubin direk 0,9 mg/dl



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Bayi 30 days old


bilirubin direk 1,5 mg/dl

other LFTs normal

What do you think of the etiology?



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Boy, 10 years

AST 65 IU/L ALT 70 IU/L

What is your plan for the boy?



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No



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Please

No



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Evaluation Liver Function Tests

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