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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    *#%"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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    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

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    [-'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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    ผ  ป วยหญงอาย D0 ป  มาต"วจสข#า$ป"ะจ%าป  กนคมก%าเนดอย  ต"วจ"างกายปกตLFT @ T( 1 $'dl 0

  • 8/17/2019 Kuliah Uji Faal Hati

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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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    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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    Thank You