Kuliah Uji Faal Hati

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    Uji Faal Hati

    Indriani Silvia 26 April 2016

    FK UNSWAGATI

    Cirebon

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    Liver Fn!tion Te"t Liver !#e$i"tr% te"t Clini!al i$pli!ation o& abnor$alit%

    ALT Hepato!elllar da$a'e

    AST Hepato!elllar da$a'e

    (ilirbin C#ole"ta"i") i$pair !onj'ation) or biliar% ob"tr!tion

    AL* C#ole"ta"i") in&iltrative di"ea"e) or biliar% ob"tr!tion

    *T S%nt#eti! &n!tion

    Alb$in S%nt#eti! &n!tion

    GGT C#ole"ta"i" or biliar% ob"tr!tion

    (ile a!id" C#ole"ta"i" or biliar% ob"tr!tion

    +,-n!leotida"e C#ole"ta"i" or biliar% ob"tr!tion

    L.H Hepato!elllar da$a'e) not "pe!i&i!

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    Nor$al Laborator% /ale"

    2 S.

    Abnor$alNor$al

    nor$al vale"  $ean  2S. o& nor$al poplation

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    Liver Fn!tion Te"t

    • interpretation $"t be per&or$ed it#in t#e !onte3t o& t#e patient4" ri"5 &a!tor") "%$pto$") !on!o$itant !ondition")

    $edi!ation") and p#%"i!al &indin'" • rarel% provide "pe!i&i! .3) bt rat#er

    "''e"t a 'eneral !ate'or% o& liver

    di"ea"e • di&&erin' laboratorie" di&&erin' nor$al

    vale"

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    Liver Fn!tion Te"t

    ild

    7ti$e"8

    oderate

    7ti$e"8

    ar5ed

    7ti$e"8

    AST 92-: 2-: to 20 ;20

    ALT 92-: 2-: to 20 ;20

    AL* 91

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    Liver Fn!tion Te"t

    • "#old be evalated and =3 in $ore e3peditio" $anner  – $ar5ed abnor$alitie"

     – S>S o& !#roni! liver di"ea"e or de!o$pen"ation

    • $ild elevation i" non"pe!i&i! and "all%

    nor$al #en repeated  – ob"erve v"< additional evalation

    $"t be $ade in !onte3t o& !lini!al "!enario

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    Advanta'e"

    • "en"itive) noninva"ive $et#od o& "!reenin' liver d%"&n!tion

    • pattern o& laborator% te"t abnor$alitie" to re!o'ni?e t%pe o& liver di"order 

    • a""e"" "everit% o& liver

    d%"&n!tion• &ollo !a"e o& liver di"ea"e

    .i"advanta'e"

    • la!5 "en"itivit%  – nor$al re"lt" in "erio"

    liver di"ea"e • not "pe!i&i! &or liver

    d%"&n!tion

    • "eldo$ lead to "pe!i&i!

    dia'no"i"

    Liver Fn!tion Te"t

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    Initial Approa!#

    #i"tor% • patient4" "%$pto$"

    • ri"5 &a!tor" &or liver di"ea"e

    • !on!o$itant !ondition"• $edi!ation"

    • o!!pational e3po"re to #epatoto3in"

    p#%"i!al e3a$ination • bod% #abit"

    • "pleno$e'al%

    • a"!ite"

    • !taneo" "ti'$ata o& !#roni! liver di"ea"e

    •#i"tor% and p#%"i!al e3a$ination•al'orit#$ approa!# "e&l $ainl% #en no !lini!al !le"

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    !la""i&ied in : 'rop"

    •"%nt#eti! &n!tion @ alb$in) *T

    •#epato!%te injr% @ AST) ALT •!#ole"ta"i" @ bilirbin) AL*) GGT

    *T) alb$in) bilirbin-$o"t !o$$on te"t" "ed a" pro'no"ti! &a!tor"

    Liver Fn!tion Te"t

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    Alb$in

    • depend on ntrition) vol$e "tat") va"!lar inte'rit%) !ataboli"$) #or$one) lo"" in "tool and rine

    • not "pe!i&i! &or liver di"ea"e • T12 1B-21 .

     – not reliable indi!ator o& a!te liver di"ea"e

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    H%poalb$ine$ia

    'loblin !#olTG Hb

    1

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    Globlin

    • prod!ed b% "ti$lated ( l%$p#o!%te

    • elevation in

    • !#roni! liver di"ea"e • !#roni! in&la$$ation and $ali'nant

    di"ea"e

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    ผ  ปวยหญงอาย D0 ป  มาดวย ถายเหลว 2 เดอนกอน * @ T :E C) $ar5edl% pale) no jandi!e) 5oilon%!#ia)

    'lo""iti") !oar"e #air) no "i'n o& !#roni! liver di"ea"e) liver and "pleen not palpated

    LFT @ T( 1 $'dl 0

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    ผ  ปวยหญงอาย D0 ป  มาดวย บวม 2 เดอนกอน * @ T :E C) not pale) no jandi!e)

      no "i'n o& !#roni! liver di"ea"e) liver and "pleen not palpated

    LFT @ T( 1 $'dl 0

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    ผ  ปวยหญงอาย D0 ป  มาดวย !องบวม 2 เดอนกอน * @ T :E

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    ผ  ปวยหญงอาย D0 ป  มาดวย !องบวม 2 เดอนกอน * @ T :E C) $ildl% pale) no jandi!e)

    "pider nevi) pal$ar er%t#re$a)  liver and "pleen not palpated) "#i&tin' dllne"" J

    LFT @ T( 1 $'dl 0

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    *rot#ro$bin ti$e

    • liver "%nt#e"i?e !oa'lation &a!tor e3!ept F/III

    • $o"t pre"ent in e3!e"") !lottin'

    abnor$al o!!r onl% #en "b"tantial i$pair$ent in abilit% o& liver to "%nt#e"i"

    • *T @ FI) II) /) /II) I and  • T12 F/II 6 #r"< 7"#orte"t8

    • pro'no"i" @ a!te) !#roni!

    #epato!elllar di"ea"e

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    *rot#ro$bin ti$e

    prolon'ed @

    • vita$in K de&i!ien!% 7$alntrition) $alab"orption) antibioti!"8

    • $a""ive tran"&"ion

    • !on'enital di"ea"e

    • liver di"ea"e

    • ar&arin

    • .IC

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    *rot#ro$bin ti$e

    • in vit K de&i!ien!%) vit K 10 $' SC de!rea"e prolon' *T ;:0 it#in 2D #r"<

    • IN= @ no advanta'e over *T

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    AST and ALT

    • $o"t &reMent "ed $ar5er" o& #epato!elllar ne!ro"i") bt not !orrelate it# evental ot!o$e

    • de!rea"e @ re!over% or poor pro'no"i"  – poor pro'no"i" @ rapid &all it# ri"in' o&

    bilirbin and *T

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    AST ALT

    !atal%?e tran"&er a$ino 'rop" to &or$ p%rvate

    !atal%?e tran"&er a$ino 'rop" to &or$ o3aloa!etate

    !%to"ol 7208 and

    $ito!#ondria 708

    !%to"ol

    T12 1E #r< 7!%to"ol8

      E #r< 7$ito!#ondria8

    T12 DE #r<

    liver) !ardia! $"!le)

    "5eletal $"!le) 5idne%") brain) pan!rea") ln'") le!o!%te") and =(C

    lo !on!entration in ot#er

    ti""e"

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    • level o& tran"$ina"e elevation

    • predo$inant AST elevation

    • rate o& tran"a$ina"e de!lination

    AST) ALT

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    ALT and AST

    • ;1+ ti$e" @ a!te #epati! injr%

    +-1+ ti$e" @ le"" "e&l

    9+ ti$e" @ !#roni! #epati! injr%   i$proved a!te #epati! injr%

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    ASTALT ratio

    • 9 1 @ $ajorit% o& liver di"ea"e • ;2

     – e3tra#epati! "or!e

     – al!o#oli! #epatiti"  – i"!#e$i! and to3in  – a!te Wil"on4" di"ea"e @ #e$ol%"i"  – !irr#o"i"

    • ;D @ &l$inant Wil"on4" di"ea"e

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    ASTALT ratio

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    =ate o& Tran"a$ina"e .e!lination

    rapid 

    • i"!#e$i!

    • "#ort #al& li&e dr' • a!te biliar% tra!t

    ob"tr!tion

    • &l$inant #epatiti"

    "lo

    • a!te viral #epatiti"

    • lon' #al& li&e dr' • AIH

    • $etaboli! di"ea"e

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    ALT and AST 9 + ti$e" ALT predo$inant • C#roni! #epatiti" () C • A!te #epatiti" 7A-)

    (/) C/8

    • Steato#epatiti" • He$o!#ro$ato"i" • edi!ation"to3in" • Atoi$$ne #epatiti"

    • Alp#a1-antitr%p"inde&i!ien!% • Wil"on4" di"ea"e • Celia! di"ea"e

    AST predo$inant

    • Al!o#ol-related liver injr%

    • Steato#epatiti"

    • Cirr#o"i"

    • .r'

    • Non#epati!  – He$ol%"i"

     – %opat#%

     – T#%roid di"ea"e  – Streno" e3er!i"e

    • a!ro AST

    al$o"t an% t%pe" o&