Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical...
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Transcript of Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical...
Interpreting Your Liver Test Results
Sumeet Asrani MD MSc
Hepatologist
Baylor University Medical Center, Dallas
April 2015
Elevated liver tests
• Most patients with PSC have elevated liver tests
• Liver test elevation does NOT always imply that things are getting worse
• The context of elevation is very important
Liver function tests
• not specific • other disease, drugs may causes
elevations• hemolysis, muscle breakdown(AST)• hemolytic anemia or blood problems
(bilirubin)
• not sensitive• serious liver disease without
elevation in LFT’s
Bilirubin
Bilirubin
HIGH BILIRUBIN occurs due to one or more of the following
•overproduction (hemolysis)
•impaired metabolism (chronic liver disease, rare metabolic defects)
•impaired excretion (biliary obstruction)
Bilirubin
• Normal bilirubin 1 mg/dL. Usually there is some elevation 1-2 mg/dL.
• HIGH BILIRUBIN causes• Jaundice• Scleral Icterus
Alkaline phosphatase
• mechanism of increase in serum alkaline phosphatase is
• increased enzyme production by hepatocytes
• induced by bile acids which may cause leakage into blood
• normal is around 150
Aminotransferases (AST/ALT)
• Also called SGOT/SGPT
• increased serum aminotransferase levels caused by injury to enzyme-rich tissue
• enzyme-rich tissue • liver• heart• Muscle
• Normal is around 40
Aminotransferases
AST ALT
AST
ALT
Hepatocyte (Liver cell)
AST and ALT leak into bloodfrom damaged cells
hepatocyte
Elevated Liver tests• Is it real?
• Recheck
• Is the patient symptomatic?• Did we just happen to check it
• Stage of liver disease?• No scarring or some scarring• Cirrhosis• Post transplant
• Related to PSC or not related?
Location
Non liver related
Pattern
• Increased AST/ALT• Liver injury
• Increased Bilirubin/Alkaline phosphatase
• Bile duct injury
Context: Advanced Disease
• HIGH Bilirubin
• HIGH Creatinine
• HIGH INR
• LOW Platelets
• LOW Albumin
Bilirubin going up: PSC related causes
• Medication?
• Infection?
• Blockage?• Stone• Stricture
Explaining elevated liver tests
MELD score
• Mathematical model• Bilirubin• Creatinine• INR
http://reference.medscape.com/calculator/meld-score-end-stage-liver-disease
MELD score
MELD 28MELD 16
Joe and Mike: compensated cirrhotics in the community
MELD 28MELD 16
Current system: Why does Mike get the liver?
MELD c statistic: 0.87
MELD 28MELD 16
Other tests: CA 19-9
• CA 19-9• Tumor marker• Can be elevated without other
reasons• Sometimes even a blockage can
cause this number to go high
Other tests: PSC after LT
• Multiple reasons for elevation
• Weight gain: fatty liver
• Medication side effects
• NOT always imply recurrence
• Transplant center intimately involved in interpretation
Elevated liver tests
• Some elevation in liver tests is common
• Elevation is not simply an on/off position
• Context, pattern and trend is very important
Interpreting Your Liver Test Results
Sumeet Asrani MD MSc
Hepatologist
Baylor University Medical Center, Dallas
April 2015