Kuliah Uji Faal Hati
Transcript of Kuliah Uji Faal Hati
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Uji Faal Hati
Indriani Silvia26 April 2016
FK UNSWAGATI
Cirebon
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Liver Fn!tion Te"tLiver !#e$i"tr% te"t Clini!al i$pli!ation o& abnor$alit%
ALT Hepato!elllar da$a'e
AST Hepato!elllar da$a'e
(ilirbin C#ole"ta"i") i$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$in S%nt#eti! &n!tion
GGT C#ole"ta"i" or biliar% ob"tr!tion
(ile a!id" C#ole"ta"i" or biliar% ob"tr!tion
+,-n!leotida"e C#ole"ta"i" or biliar% ob"tr!tion
L.H Hepato!elllar da$a'e) not "pe!i&i!
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Nor$al Laborator% /ale"
2 S.
Abnor$alNor$al
nor$al vale" $ean 2S. o& nor$al poplation
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Liver Fn!tion Te"t
• interpretation $"t be per&or$ed it#int#e !onte3t o& t#e patient4" ri"5 &a!tor")"%$pto$") !on!o$itant !ondition")
$edi!ation") and p#%"i!al &indin'"• rarel% provide "pe!i&i! .3) bt rat#er
"''e"t a 'eneral !ate'or% o& liver
di"ea"e• di&&erin' laboratorie" di&&erin' nor$al
vale"
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Liver Fn!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 Fn!tion Te"t
• "#old be evalated and =3 in $oree3peditio" $anner – $ar5ed abnor$alitie"
– S>S o& !#roni! liver di"ea"e orde!o$pen"ation
• $ild elevation i" non"pe!i&i! and "all%
nor$al #en repeated – ob"erve v"< additional evalation
$"t be $ade in !onte3t o& !lini!al "!enario
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Advanta'e"
• "en"itive) noninva"ive$et#od o& "!reenin' liverd%"&n!tion
• pattern o& laborator% te"tabnor$alitie" to re!o'ni?et%pe o& liver di"order
• a""e"" "everit% o& liver
d%"&n!tion• &ollo !a"e o& liverdi"ea"e
.i"advanta'e"
• la!5 "en"itivit% – nor$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 Fn!tion Te"t
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Initial Approa!#
#i"tor%• patient4" "%$pto$"
• ri"5 &a!tor" &or liverdi"ea"e
• !on!o$itant !ondition"• $edi!ation"
• o!!pational e3po"reto #epatoto3in"
p#%"i!al e3a$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 $ainl% #enno !lini!al !le"
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!la""i&ied in : 'rop"
•"%nt#eti! &n!tion @ alb$in) *T
•#epato!%te injr% @ AST) ALT•!#ole"ta"i" @ bilirbin) AL*) GGT
*T) alb$in) bilirbin-$o"t !o$$onte"t" "ed a" pro'no"ti! &a!tor"
Liver Fn!tion Te"t
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Alb$in
• depend on ntrition) vol$e "tat")va"!lar inte'rit%) !ataboli"$)#or$one) lo"" in "tool and rine
• not "pe!i&i! &or liver di"ea"e• T12 1B-21 .
– not reliable indi!ator o& a!te liver di"ea"e
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H%poalb$ine$ia
'loblin !#olTG Hb
1
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Globlin
• prod!ed b% "ti$lated ( l%$p#o!%te
• elevation in
• !#roni! liver di"ea"e• !#roni! in&la$$ation and $ali'nant
di"ea"e
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ผ ปวยหญงอาย D0 ป มาดวย ถายเหลว 2 เดอนกอน* @ T :E C) $ar5edl% pale) no jandi!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 ปวยหญงอาย D0 ป มาดวย บวม 2 เดอนกอน* @ T :E C) not pale) no jandi!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 ปวยหญงอาย D0 ป มาดวย !องบวม 2 เดอนกอน* @ T :E
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ผ ปวยหญงอาย D0 ป มาดวย !องบวม 2 เดอนกอน* @ T :E C) $ildl% pale) no jandi!e)
"pider nevi) pal$ar er%t#re$a) liver and "pleen not palpated) "#i&tin' dllne"" J
LFT @ T( 1 $'dl 0
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*rot#ro$bin ti$e
• liver "%nt#e"i?e !oa'lation &a!tore3!ept F/III
• $o"t pre"ent in e3!e"") !lottin'
abnor$al o!!r onl% #en "b"tantiali$pair$ent in abilit% o& liver to"%nt#e"i"
• *T @ FI) II) /) /II) I and • T12 F/II 6 #r"< 7"#orte"t8
• pro'no"i" @ a!te) !#roni!
#epato!elllar di"ea"e
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*rot#ro$bin ti$e
prolon'ed @
• vita$in K de&i!ien!% 7$alntrition)$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 $' SCde!rea"e prolon' *T ;:0 it#in 2D#r"<
• IN= @ no advanta'e over *T
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AST and ALT
• $o"t &reMent "ed $ar5er" o&#epato!elllar ne!ro"i") bt not!orrelate it# evental ot!o$e
• de!rea"e @ re!over% or poor pro'no"i" – poor pro'no"i" @ rapid &all it# ri"in' o&
bilirbin and *T
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AST ALT
!atal%?e tran"&er a$ino'rop" to &or$ p%rvate
!atal%?e tran"&er a$ino'rop" to &or$ o3aloa!etate
!%to"ol 7208 and
$ito!#ondria 708
!%to"ol
T12 1E #r< 7!%to"ol8
E #r< 7$ito!#ondria8
T12 DE #r<
liver) !ardia! $"!le)
"5eletal $"!le) 5idne%")brain) pan!rea") ln'")le!o!%te") and =(C
lo !on!entration in ot#er
ti""e"
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• level o& tran"$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$e" @ a!te #epati! injr%
+-1+ ti$e" @ le"" "e&l
9+ ti$e" @ !#roni! #epati! injr% i$proved a!te #epati! injr%
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ASTALT ratio
• 9 1 @ $ajorit% o& liver di"ea"e• ;2
– e3tra#epati! "or!e
– al!o#oli! #epatiti" – i"!#e$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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ASTALT 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"• Atoi$$ne #epatiti"
• Alp#a1-antitr%p"inde&i!ien!%• Wil"on4" di"ea"e• Celia! di"ea"e
AST predo$inant
• Al!o#ol-related liver injr%
• Steato#epatiti"
• Cirr#o"i"
• .r'
• Non#epati! – He$ol%"i"
– %opat#%
– T#%roid di"ea"e – Streno" e3er!i"e
• a!ro AST
al$o"t an% t%pe" o& liver di"ea"e
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=i"5 &a!tor o& !#roni! viral #epatiti"
• inje!tion dr' "e
• birt# to $ot#er it# H(/
• blood tran"&"ion prior to 1BB2
• needle "ti!5 &ro$ a donor "b"eMentl%te"tin' po"itive &or H(/ or HC/
• !#roni! #e$odial%"i"
• nva!!inated #ealt# !are or5er"• #o$o"e3al
• bod% pier!in' or tattooin'
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Co$$on $edi!ation
• A!eta$inop#en overdo"e
• Statin"
• NSAI."
• Antibioti!"
• Antiepilepti!"
• Antitber!lo"i" dr'"
• Herbal re$edie") alternative$edi!ation" and "b"tan!e ab"e
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ALT and AST 9 + ti$e"
• di"!ontine all none""ential $edi!ation"
• i& $ild elevation and e""ential$edi!ation" $"t be !ontined – i& liver en?%$e elevation" !ontine to ri"e)
""pe!t $edi!ation "#old be "topped – lon'-ter$ e&&e!t" o& !#roni!) $edi!ation
ind!ed #epatoto3i!it% are la!5in' &or $an%dr'"
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ผ ป วยหญงอาย D0 ป มาต"วจสข#า$ป"ะจ%าป ต"วจ"างกายปกต
LFT @ T( 1 $'dl 0
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ผ ปวยหญงอาย D0 ป มาต"วจสข#า$ป"ะจ%าป (มมอากา"ผดปกต &ด) (มด * มส"า (มกนยา&ด) (มเคย(ด"บเลอด (มเคย&+สา"เส$ตด
ต"วจ"างกายปกต) (W B0 5') Hei'#t 160 !$
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ผ ป วยหญงอาย D0 ป มาต"วจสข#า$ป"ะจ%าป (มมอากา"ผดปกต&ด) (มด * มส"า (มกนยา&ด) (มเคย(ด"บเลอด (มเคย&+สา"เส$ตด ต"วจ"างกายปกต) (W B0 5') Hei'#t 160 !$
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NAFL.NASH
• NAFL. $a!rove"i!lar "teato"i" it# $ildor it#ot in&la$$ation) no &ibro"i"
• NASH NAFL. J in&la$$ation
balloonin'&ibro"i"• al!o#ol 9E0 '. in o$en) 91D0 '. in $en
• 2 #it" #%pot#e"i"
– #%perin"line$ia in!rea"ed FFA in liver"teato"i"
– #epato!%te ne!ro"i" and in&la$$ation
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NAFL.NASH
• a"%$pto$ati!) va'e =UO pain)&ati'e) $alai"e
• #epato$e'al%) "pleno$e'al%) "pideran'io$ata) pal$ar er%t#e$a) a"!ite"
• AST) ALT 2-D3) ASTALT91
1: AL* "li'#tl% elevated
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NAFL.NASH
• US Pbri'#t liver
CT-loer den"it% t#an "pleen
=I-bri'#t on T1W
• biop"% 7'old "tandard8 @$a!rove"i!lar "teato"i") paren!#%$alin&la$$ation) #epato!%te ne!ro"i")
balloonin' #epato!%te de'eneration
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NAFL.NASH
• ei'#t red!tion) e3er!i"e) !ontrol .and d%"lipide$ia
orli"tat) "ibtra$ine) (ariatri! "r'er%
• avoidan!e o& to3in" @ dr'") al!o#ol
• in"lin "en"iti?in' a'ent"
– t#ia?olidinedione" – $et&or$in
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ผ ปวยหญงอาย D0 ป มาต"วจสข#า$ป"ะจ%าป มป"ะวต I/.Uต"วจ"างกายปกตLFT @T( 1 $'dl 0
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ALT and AST 9 + ti$e"and AST predo$inant
• #i"tor% al!o#ol inta5e 7#i"tor% &ro$patient and &a$il% $e$ber"8
• #e$ol%"i" "tdie"
• aldola"e
• C*K
• $a!ro-AST
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ผ ป วยหญงอาย D0 ป มาต"วจสข#า$ป"ะจ%าป ต"วจ"างกายปกตLFT @T( 1 $'dl 0
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Al!o#oli! #epatiti"
• appropriate #i"tor% o& al!o#oli!!on"$ption) "erolo'i! e3!l"ion o&ot#er liver di"ea"e
• Q D0-0 '.) R 20-D0 '. 10-12 %r"<
• !#ara!teri"ti! pattern – AST rarel% e3!eed" :00 IUdl
– ASTALT ;1 in B2) ;2 in E0• p%rido3ine de&i!ien!%
• al!o#ol ind!e" relea"e o& $ito!#ondrial AST
– GGTAL* ;2
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ผ ปวยหญงอาย D0 ป มาต"วจสข#า$ป"ะจ%าป ด * มส"า ขวดกลมตอวน 20 ป ต"วจ"างกายปกตLFT @T( 1 $'dl 0
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Al!o#oli! #epatiti"
=3• ab"tinen!e al!o#ol drin5in'• "evere al!o#oli! #epatiti" 7.F ;:28
.F D
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ALT and AST ; 1+ ti$e"
• A!te viral #epatiti"7A-) #erpe"8
• edi!ation"to3in"
• I"!#e$i! #epatiti"• A!te bile d!t
ob"tr!tion
• Atoi$$ne#epatiti"
• Wil"on4" di"ea"e
• A!te (dd-C#iari"%ndro$e
• Hepati! arter%
li'ation• Heat "tro5e
AST predo$inate @ $edi!ationto3in) i"!#e$i! ;E+ ti$e" @ i"!#e$i!) to3i!) viral 7le"" !o$$on8
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ผ ปวยหญงอาย D0 ป nderl%in' di"ea"e AF) HT มาดวย CHFLFT @T( 2 $'dl 0
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I"!#e$i! #epatiti"
• lo-&lo #e$od%na$i! "tate – #%poten"ion) "ep"i") !ardia! arr#%t#$ia)
I) HF) #e$orr#a'e) e3ten"ive brn")
"evere tra$a) #eat "tro5e• #%poten"ion o&ten not do!$ented
• "all% "b!lini!al
7"#o!5 liver) a!te #epati! !ir!lator% in"&&i!ien!%8
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• "dden and $a""ive 7;20008 elevationo& liver en?%$e) tend to de!rea"erapidl% and retrn nor$al it#in 1 5<
• $ild and tran"ient elevation o& bilirbin70 9 2 $'dl8 and AL*
• e3tre$e elevation L.H 7;+0008)
ALTL.H 9 1
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I"!#e$i! #epatiti"
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ผ ป วยหญงอาย D0 ป มาดวย =UO pain 12 + * ว,มงกอนLFT @T( 2 $'dl 0
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A!te biliar% ob"tr!tion
• a$inotran"&era"e pea5 earl% andde!line rapidl% over 2D-E2 #r< de"pitenre"olved ob"tr!tion
• a&ter a$inotran"&era"e de!rea"e)bilirbin and AL* in!rea"e
• 2+ o& patient" it# AST ; 10
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A!te biliar% ob"tr!tion
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ผ ป วยหญงอาย D0 ป มาดวย =UO pain 12 + * ว,มงกอนLFT @T( 2 $'dl 0
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L.H
• non "pe!i&i!
• r#abdo$%ol%"i") I) #e$ol%"i") "tro5e)renal in&ar!tion) a!te or !#roni! liver
di"ea"e• "e in
– i"!#e$i! #epatiti" @ tran"ient) $a""ive
elevation – $ali'nant in&iltration o& liver @ ""tained
elevation it# AL*
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= !ell pla"$a #epato!%te
H UC( UC(
J
alb$in
UC(Jli'andin
(G
(.G
bile
robilino'en "ter!obilino'en
(ilirbin
U.*-'l!oron%ltran"&era"e
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• .ire!t bilirbin @ rea!ted dire!tl% it#rea'ent
Indire!t bilirbin @ reMire addition o&al!o#ol &or !olor develop$ent
• Un!onj'ated bilirbin indire!t &or$
Conj'ated bilirbin bilirbin $onoand di-'l!oronide"
(ilirbin
.ia'no"ti! approa!# in elevated "er$ bilirbin
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.ia'no"ti! approa!# in elevated "er$ bilirbin
elevated bilirubin
History and PE
unconjugated bilirubin
normal ALP, ALT, AST
conjugated bilirubin
#e$ol%"i" "tdie")revie $edi!ation"
I"olated n!onj'ated
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I"olated n!onj'ated#%perbilirbine$ia
• I.( &ra!tion ; + o& total bilirbin
1< in!rea"e prod!tion @• #e$ol%"i"
!#roni! #e$ol%"i"-not ""tained in!rea"e o& bilirbin;+ $'dl in nor$al #epati! &n!tion
• ine&&e!tive er%t#ropoie"i" @ &olate) I.A
• dr' @ ri&a$pi!in) ribavirin) probene!id
• re"oltion o& #e$ato$a
2< de&e!t" in #epati! pta5e!onj'ation• Gilbert4" "%ndro$e
• Cri'ler-Najjar "%ndro$e
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Gilbert4" "%ndro$e
• beni'n) n!onj'ated #%perbilirbine$iait# ot#eri"e nor$al liver !#e$i"trie"
• p to + o& nor$al poplation
• pol%$orp#i"$ in TATA bo3 o& 'eneen!odin' bilirbin U.*-GT
i$pair abilit% to !onj'ate bilirbin
• pro$inent in &a"tin' "tate) "%"te$i!illne""e") #e$ol%"i") "o$e $edi!ation"
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Gilbert4" "%ndro$e
• .3 @ – a"%$pto$ati!) #ealt#%
– $ild n!onj'ated #%perbilirbine$ia
79D $'dl8 it# ot#eri"e nor$al liver!#e$i"trie" te"t
– e3!l"ion $edi!ation" and #e$ol%"i"
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Ca"e 10
ผ ป วย+ายอาย :0 ป มาดวยออนเ$ลย : วนกอน* @ T : C) $ar5edl% pale) $ild jandi!e) no "i'n o&
!#roni! liver di"ea"e) liver and "pleen not palpated
LFT @ T( +
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Indire!t H%perbilirbine$ia
(ilirbin AST) ALT Alb Glob *T
#e$ol%"i" + $'dl in!rea"e AST N N N
Gilbert4""%ndro$e
+ $'dl nor$al N N N
.ia'no"ti! approa!# in elevated "er$ bilirbin
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.ia'no"ti! approa!# in elevated "er$ bilirbin
elevated bilirubin
History and PE
unconjugated bilirubin
normal ALP, ALT, AST
conjugated bilirubin
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• .( ; +0 o& total bilirbin
• !an4t di&&erentiate ob"tr!tion andparen!#%$al di"ea"e
• .elta &ra!tion – C( ti'#tl% bond to alb$in
– tenden!% o& #%perbilirbine$ia to re"olve
$ore "lol% t#an ot#er bio!#e$i!al te"t"
Conj'ated #%perbilirbine$ia
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Conj'ated #%perbilirbine$ia
• (ile d!t ob"tr!tion• Hepatiti"• Cirr#o"i"•
edi!ation"To3in"• *ri$ar% biliar%!irr#o"i"
• *ri$ar% "!lero"in'!#olan'iti"
• Sep"i"• Total parenteral
ntrition
• Intra#epati!!#ole"ta"i" o&pre'nan!%
• (eni'n re!rrent!#ole"ta"i"
• /ani"#in' bile d!t"%ndro$e"
• .bin-o#n"on"%ndro$e
• =otor "%ndro$e
.ia'no"ti! approa!# in elevated "er$ bilirbin
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' pp
elevated bilirubin
History and PE
unconjugated bilirubinnormal ALP, ALT, AST
conjugated bilirubinnormal ALP, ALT, AST abnormal ALP, ALT, AST
=otor4" "%ndro$e.bin-o#n"on "%ndro$e
.ia'no"ti! approa!# in elevated "er$ bilirbin
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' pp
elevated bilirubin
History and PE
unconjugated bilirubin
normal ALP, ALT, AST
conjugated bilirubin
normal ALP, ALT, AST abnormal ALP, ALT, AST
=otor4" "%ndro$e AST, ALT ALP.bin-o#n"on "%ndro$e predominate predominate
#e$ol%"i" "tdie")revie $edi!ation"
a" elevated
ALT evalation US
=C* a" elevated ALT evalation
revie $edi!ation"
AA) =C*) liver biop"%
pre"ent ab"ent
/ /
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Ca"e 11
ผ ปวย+ายอาย :0 ป มาดวยจกแนนล 'นป * : วนกอน* @ T :E C) not pale) $ild jandi!e) no "i'n o& !#roni! liver
di"ea"e) liver and "pleen not palpated
LFT @ T( 6
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8/17/2019 Kuliah Uji Faal Hati
70/88
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8/17/2019 Kuliah Uji Faal Hati
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*#%"iolo'i!
• ;60 %r<
• !#ild and adole"!ent
• pre'nan!%• blood 'rop
• po"t $eal 7&att% $eal8
*at#olo'i!
• intra#epati!
• e3tra#epati!
Al5aline p#o"p#ata"e
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Al5aline p#o"p#ata"e
Intra#epati!viral al!o#ol
dr' pre'nan!%
*(C *SC
T*N "ep"i"vani"#in' bile d!t "%ndro$e
beni'n re!rrent !#ole"ta"i"
beni'n po"t-op< !#ole"ta"i"
paraneopla"ti! "%ndro$evenoo!!l"ive di"ea"e
G/H.
3tra#epati!intral$inal ob"tr!tion @
'all "tone") a"!aria"i")
#e$obilia
di"ea"e o& (. @*SC) !#oledo!#al !%"t)
!#olan'ioCA)
AI.S !#olan'iopat#%
e3ternal !o$pre""ion @
LN) G( CA) iri??i4" "%ndro$e)
CA pan!rea") a$pllar adeno$a
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8/17/2019 Kuliah Uji Faal Hati
73/88
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8/17/2019 Kuliah Uji Faal Hati
74/88
Al5aline p#o"p#ata"e
• initial evalation @ deter$ine #epati!or non#epati! ori'in) !on!o$itantelevation o& ot#er "er$ LFT
• level not a reliable indi!ator o&"everit% o& nderl%in' liver di"ea"e
• de'ree not #elp to di"tin'i"#
intra#epati! and e3tra#epati!
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I"olated #epati! AL* elevation
• *artial bile d!t ob"tr!tion• edi!ation"
• In&iltrative liver di"ea"e
• Hepati! $eta"ta"i"• *(C
• *SC
• Hepatiti"
• Cirr#o"i"• /ani"#in' bile d!t "%ndro$e"
• (eni'n re!rrent !#ole"ta"i"
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In&iltrative di"ea"e"
• T(
• Fn'al in&e!tion• HCC• L%$p#o$a• eta"tati! $ali'nan!%• A$%loido"i"• Sar!oido"i"• t#er 'ranlo$ato" di"ea"e"
$ode"t 7p to :38 ri"e in a$inotran"&era"e)and p to 203 ri"e in AL*) bilirbin N-+3
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Al5aline p#o"p#ata"e
• AL* ; 1000 @ $ali'nant biliar%ob"tr!tion) "ep"i") AI.S it# "%"te$i!in&e!tion
• de!rea"e @ #%pot#%roidi"$) perni!io"ane$ia) Vn de&i!ien!%) !on'enital)Wil"on4" di"ea"e) "evere #epati!in"&&i!ien!%
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.ia'no"ti! approa!# in elevated "er$ al5aline p#o"p#ata"e
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elevated ALP
History and PE
normal bilirubin, ALT, AST abnormal liver cemistries
!!T or "#nucleotidase $/S
not epatobiliary $/S
revie% medication
A&A
E'(P A&A
liver biopsy observation
as elevated ALT evaluation, liverbiopsy, E'(P
ne'ative po"itive
no d!t dilatation
%e" no
ne'ative
; 6 $ont#"
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ผ ปวยหญงอาย D0 ป มาต"วจสข#า$ป"ะจ%าปต"วจ"างกายปกตLFT @ T( 1 $'dl 0
-
8/17/2019 Kuliah Uji Faal Hati
81/88
[-'lta$%ltran"&era"e 7GGT8
• !atal%?ed tran"&er o& [-'lta$%l 'rop"o& peptide" to ot#er a$ino a!id
• abndant in liver) 5idne%) pan!rea")
inte"tine) and pro"tate) "pleen) #eart)brain bt not in bone
• T12
– E-10 da%" – 2 da%" in al!o#ol-a""o!iated liver injr%
l t lt & 7GGT8
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[-'lta$%ltran"&era"e 7GGT8
• in!rea"e – al!o#ol
– dr'
• anti!onvl"ant 7C(V) p#en%toin) andbarbitrate8) ar&arin) C
– al$o"t all t%pe o& liver di"ea"e"
– C*.) renal &ailre) .) #%pert#%roidi"$)=A) AI) pan!reati! di"ea"e
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8/17/2019 Kuliah Uji Faal Hati
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ผ ป วยหญงอาย D0 ป มาต"วจสข#า$ป"ะจ%าป กนคมก%าเนดอย ต"วจ"างกายปกตLFT @ T( 1 $'dl 0
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S$$ar%
Hepato!elllar ne!ro"i" (iliar% ob"tr!tion In&iltration
to3ini"!#e$ia
viral al!o#ol !o$plete partial
ASTALT +0-100 +-+0 2-+ 1-+ 1-+ 1-:
AL* 1-: 1-: 1-10 2-20 2-10 1-20
(ilirbin 1-+ 1-:0 1-:0 1-:0 1-+ 1-+
*T in!rea"e in "evere)
nre"pon"ive to vit K
in!rea"e)
re"pon"ive to vit K
nor$al
alb$in in!rea"e in "ba!te!#roni! "all% nor$al)de!rea"e in advan!e
nor$al
T 5 #
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Ta5e #o$e $e""a'e
• initial evalation @ a""e"" in !lini!al!onte3t
• !la""i&ied in : 'rop"
"%nt#eti! &n!tion @ alb$in) !lottin'ti$e
!#ole"ta"i" @ bilirbin) AL*) GGT
#epato!%te injr% @ AST) ALT
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$i"no$er – not e&&e!tivel% a""e"" a!tal &n!tion
– not ala%" "pe!i&i! &or t#e liver
– li$ited in&or$ation re'ardin' pre"en!e or"everit% o& !o$pli!ation
Liver Fn!tion Te"t
Liver C#e$i"tr% Te"t
Li F ti T t
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8/17/2019 Kuliah Uji Faal Hati
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Liver Fn!tion Te"t
• nor$al $a% #ave abnor$al te"t
• nor$al vale not en"re t#at patient i"&ree o& liver di"ea"e
• level o& abnor$alit% doe" not re&le!t"everit% bt $a% #elp in ..3
• de!rea"e in t#e vale doe" not $eani$prove$ent
• li$itation in "en"itivit% and "pe!i&i!it%
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8/17/2019 Kuliah Uji Faal Hati
88/88
Thank You