Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical...
-
Upload
eugene-hines -
Category
Documents
-
view
218 -
download
1
Transcript of Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical...
![Page 1: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/1.jpg)
Interpreting Your Liver Test Results
Sumeet Asrani MD MSc
Hepatologist
Baylor University Medical Center, Dallas
April 2015
![Page 2: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/2.jpg)
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
![Page 3: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/3.jpg)
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
![Page 4: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/4.jpg)
![Page 5: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/5.jpg)
Bilirubin
![Page 6: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/6.jpg)
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)
![Page 7: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/7.jpg)
Bilirubin
• Normal bilirubin 1 mg/dL. Usually there is some elevation 1-2 mg/dL.
• HIGH BILIRUBIN causes• Jaundice• Scleral Icterus
![Page 8: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/8.jpg)
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
![Page 9: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/9.jpg)
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
![Page 10: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/10.jpg)
Aminotransferases
AST ALT
AST
ALT
Hepatocyte (Liver cell)
AST and ALT leak into bloodfrom damaged cells
hepatocyte
![Page 11: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/11.jpg)
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?
![Page 12: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/12.jpg)
Location
Non liver related
![Page 13: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/13.jpg)
Pattern
• Increased AST/ALT• Liver injury
• Increased Bilirubin/Alkaline phosphatase
• Bile duct injury
![Page 14: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/14.jpg)
Context: Advanced Disease
• HIGH Bilirubin
• HIGH Creatinine
• HIGH INR
• LOW Platelets
• LOW Albumin
![Page 15: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/15.jpg)
Bilirubin going up: PSC related causes
• Medication?
• Infection?
• Blockage?• Stone• Stricture
![Page 16: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/16.jpg)
Explaining elevated liver tests
![Page 17: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/17.jpg)
MELD score
• Mathematical model• Bilirubin• Creatinine• INR
http://reference.medscape.com/calculator/meld-score-end-stage-liver-disease
![Page 18: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/18.jpg)
MELD score
MELD 28MELD 16
![Page 19: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/19.jpg)
Joe and Mike: compensated cirrhotics in the community
MELD 28MELD 16
![Page 20: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/20.jpg)
Current system: Why does Mike get the liver?
MELD c statistic: 0.87
MELD 28MELD 16
![Page 21: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/21.jpg)
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
![Page 22: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/22.jpg)
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
![Page 23: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/23.jpg)
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
![Page 24: Interpreting Your Liver Test Results Sumeet Asrani MD MSc Hepatologist Baylor University Medical Center, Dallas April 2015.](https://reader035.fdocuments.net/reader035/viewer/2022062518/56649e995503460f94b9bd8f/html5/thumbnails/24.jpg)
Interpreting Your Liver Test Results
Sumeet Asrani MD MSc
Hepatologist
Baylor University Medical Center, Dallas
April 2015