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Group D Florendo-Gaspar Slide 2 Tests based on detoxification and excretory functions Tests that measure biosynthetic function Coagulation factors Other diagnostic tests Percutaneous liver biopsy Ultrasonography Slide 3 Serum bilirubin Urine bilirubin Blood ammonia Serum enzymes Reflecting damage to hepatocytes Reflecting cholestasis Slide 4 Conjugated Elevation of conjugated bilirubin Liver or biliary tract disease Unconjugated Isolated elevation of unconjugated bilirubin Hemolytic disorders Genetic conditions Normal total serum bilirubin concentration:Slide 5 Conjugated bilirubin Urine dipstick test Slide 6 Liver Striated muscle Elevated ammonia Severe portal hypertension Portal blood shunting Correlates with outcome in fulminant hepatic failure Slide 7 Enzymes that reflect damage to hepatocytes Enzymes that reflect cholestasis Slide 8 Aminotransferases (transaminases) Aspartate aminotransferase (AST) Alanine aminotransferase (ALT) Normally present in the serum in low concentrations Damage to liver cell membrane increased permeability greater amounts released into blood Elevation Up to 300 U/L nonspecific > 1000 U/L extensive hepatocellular injury ALT AST in acute hepatocellular disorders Low level of ALT in alcoholic liver disease Slide 9 Alkaline phosphatase (ALP) 5-nucleotidase (5NT) glutamyl transpeptidase (GGT) Less specific for cholestasis Slide 10 Not totally specific for cholestasis Elevations > 4 times normal Cholestatic liver disorders Infiltrative liver diseases Bone conditions Elevation in the absence of jaundice & aminotransferases Early cholestasis Hepatic infiltration by tumor or granulomata Slide 11 Proteins Coagulation Slide 12 Albumin -synthesized exclusively by hepatocytes -half-life: 18-20days -in hepatitis: albuminSlide 13 blood clotting factors are made exclusively in hepatocytes serum half lives: 6h-5days measurement of clotting factors measures hepatic synthetic function PT (prothrombin time) Slide 14 -blood clotting factors are made exclusively in hepatocytes -serum half lives: 6h-5days -measurement of clotting factors measures hepatic synthetic function -PT (prothrombin time) Slide 15 TYPE Aminotransferases BilirubinALPAlbuminPT Acute hepatocellular necrosisALT> AST Chronic hepatocellular disorders Alcoholic hepatits CirrhosisAST> ALT Cholestasis CASE: ELEVATED TRANSAMINASE Slide 16 Slide 17 Slide 18 Female 50 years old Dialysis nurse Elevated ALT-90 IU/L Known hypertensive on Metoprolol 50mg tab, irregular BMI 30.4 = Obese Elevated blood sugar 2y ago, advised exercise, weight reduction Occasional joint pains Celecoxib VS: BP 160/100, afebrile Slide 19 Salient features of Patient Female 50 year old Dialysis nurse ALT BP blood sugar BMI 30.4 (obese) Joint pains Salient features of Patient Female 50 year old Dialysis nurse ALT BP blood sugar BMI 30.4 (obese) Joint pains Clinical features of NAFLD Female > Male Middle-aged: mean 42, Metabolic Syndrome (Hypertension, DM, lipids, Obesity) ALT > AST Fatigue Vague RUQ discomfort Ferritin History ofMale Middle-aged: mean 42, Metabolic Syndrome (Hypertension, DM, lipids, Obesity) ALT > AST Fatigue Vague RUQ discomfort Ferritin History ofSlide 20 Clinical features of Clinical features of Autoimmune Hepatitis Female Young to middle age Fatigue Hepatomegaly Jaundice Itching Skin rashes Myalgia Arthtalgia Abdominal discomfort Spider angiomas Nausea and vomiting Loss of appetite Dark urine Pale or gray-colored stools Increase ALT Prolonged prothrombin time Clinical features of Clinical features of Autoimmune Hepatitis Female Young to middle age Fatigue Hepatomegaly Jaundice Itching Skin rashes Myalgia Arthtalgia Abdominal discomfort Spider angiomas Nausea and vomiting Loss of appetite Dark urine Pale or gray-colored stools Increase ALT Prolonged prothrombin time Salient features of Patient Female 50 year old Dialysis nurse ALT BP blood sugar BMI 30.4 (obese) Joint pains Salient features of Patient Female 50 year old Dialysis nurse ALT BP blood sugar BMI 30.4 (obese) Joint pains Slide 21 Salient features of Patient Female 50 year old Dialysis nurse ALT BP blood sugar BMI 30.4 (obese) Joint pains Salient features of Patient Female 50 year old Dialysis nurse ALT BP blood sugar BMI 30.4 (obese) Joint pains Slide 22