lab kelainan hepar & sistem bilier_2011

8/18/2019 Lab Kelainan Hepar & Sistem Bilier_2011

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PEMERIKSAAN LAB PADAPENEGAKAN DIAGNOSA

KELAINAN HEPAR &SISTEM BILIER

Dr. Rahma Triliana, S.Ked. M.Kes

Blok Gastroenterohepatologi II

Mei 2011


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ANATOMY of LIVER


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a) li!er lo"#le to sho$ the dire%tion o& "lood &lo$ &rom the portal s'stem

to the %entrilo"#lar !eins and then%e to the in&erior !ena %a!a

") The "lood &lo$ thro#gh the sin#soids o& the li!er lo"#le and the passage

o& "ile &rom the "ile %anali%#li to the "ile d#%ts


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LIVER FUNCTION (%retion

(%rete $aste prod#%t !ia #rine or "ile e.g. monia% Bilir#"in meta"olism * detoi&i%ation

S'nthesis * Storage +rod#%e s#"stan%e related to gl#%ose, protein, * &at meta"olism +lasma proteins, lipoproteins s'nthesis e.g. l"#min, glo"#lin,

-D-, * D- +rod#%e %oag#lation &a%tors /I III) Storage o& &at, gl'%ogen, !itamins B12, , K Bile salts s'nthesis

Meta"olism Biotrans&ormation o& !ario#s eogeno#s or endogeno#s s#"stan%e dr#gs /a%ti!ation or dea%ti!ations)

ar"oh'drate, lipid, protein meta"olism

+ortal !ein %learan%e, toleran%e


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DIAGNOSING

HEPATIC & BILIARY

SYSTEM DISORDER


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SYMPTHOMS ofHEPATOBILIARY DISEASE 3a#ndi%e Dark 4rine * Stool hara%teristi%s %hanges 5atig#e +r#rit#s 66 in %holestasis +oor ppetite * 7eight -oss "dominal +ain

lterations in the Senses o& Taste * Smell %ompli%ations +ersonalit' hanges * Sleep Dist#r"an%es hepati% en%ephalopath' D'spnea Bleeding ision Dist#r"an%es !itamin De&i%ien%'

Bone +ain and 5ra%t#res

!itamin D De&i%ien%' +ain +eripheral ne#ropath' in li!er disease se%ondar' to %holestasis 'perpigmentation 8 9:melano%'testim#lating hormone hills and Rigors in&e%tion Se#al D'sn%tion * Disinterest ormonal %hanges, +s'%hologi%al M#s%le ramps


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SIGN

Breath so#nds %hanges +lat'pnea Dilated !eins on the

a"dominal $all. eno#s h#m, "r#it, hepati%

&ri%tion r#"

Distended a"domen $ith"#lging &lanks

Shi&ting d#llness, #nd#lation "dominal tenderness Splenomegal'

Red palms etremit' %;#ired &inger %l#""ing -o$er etremit' edema lterations in personalit'

epatomegal' 5etor epati%#s S%leral i%ter#s Skin:'ello$ dis%oloration Spider telangie%tases Skin h'perpigmentation *

hemo%hromatosis anthomatosis, anthelasmas +#rp#ra Telangie%tases (%oriations * pr#rigo

nod#laris +arotid Glands enlargement Testi%#lar atroph' *

&emini


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LABORATORY

EXAMINATION IN

HEPATIC &

BILIARY SYSTEMSDISORDERS


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BLOOD TEST

-i!er 5#n%tion Test

(!al#ate hepato%'tes integrit'* li!er %ell n%tion Serial o& test * dra$n together

elp to identi&'=

epato%ell#lar in>#r' or holestati% pro"lems Time /%#te ? hroni% disorder)

Se!erit'

Identi&' some %a#ses o& %irrhosis or hepati% damage

Dete%t a#toanti"odies

e.g. Antimitochondrialantibodies in +B

Geneti% testing haemo%hromatosis

ir%#lating hepatitis !iral marker


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Liver Function (%retion Dete%ts >a#ndi%e * se!erit'

Bilir#"in /Total @ on>#gated?dire%t A 4n%on>#gated?indire%t)

monia% sam emped#?"ile a%ids

S'nthesis * meta"olism hroni% * se!erit' marker l"#min, +rothrom"in, Total +rotein, :n#%leotidase Gl#%ose, holesterol, TG, -D-, D- le!el

Hepatic damage cellular integrity lkaline phos&atase /-+) holestati% pro"lems Gamma:gl#tam'l trans&erase /GGT) holestati% pro"lems spartate aminotrans&erase /ST?SGCT) li!er damage

lanine aminotrans&erase /-T?SG+T) li!er damage Dr#g?toin le!el e.g al%ohol le!el, para%etamol et% Marker o& !iral hepatitis

Cancer

lpha &etoprotein


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LIVER ENZYMESLIVER ENZYMESCellular IntegritCellular Integrit

ALT( N < 40 IU) > spec AST for liveracute cond. AST (N < 40 IU) Increase in

Rasio e Ritis ! AST"ALT Nor#al < $% if > $ s&o'sc&ronic condition or non liver cellular inur

To*ic% dru+s or viral &epatitis > $0,-0 URL ALT > AST /&ronic Liver diseases% /&olestatic intra,estra&epatal 1

c&irr&osis N or 4,2* URL /ancer (pri#ar or #etastasic) N to 2,$0 URL Alco&ol related disease Sli+&tl,3oderate (52 URL) 3ocardial Infraction"I3A 6 in $75-4 &ours% N in a,4

or ,2 if (,)ne' lesion. 6 2,$0* URL% if >$0,$2! fatal I3A. 3uscle inur or da#a+e 7 URL 8t&er or+an inur (Lun+% 9ancreas% :T/) N,,-,2 URL


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A;Nor#al LT

9enait =epatoseluler

AST > * URL

AL9 < - URL

AST < * URL

AL9 > - URL

9enait olestati

Al;u#in

=epatitis

Aut

=epatitis

ronis

olestasisAut

olestasisronis

Intra&epatiolestasis

:stra&epatiolestasis

US? " olan+io+ra@

Nor#al 3enurun


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LIVER ENZYMESLIVER ENZYMESC!"le#tati$ En%e#C!"le#tati$ En%e#

??T (N < $2 ()% < -0 (3) increase in /&olestatic intra,estra&epatal 2,0 URL =epatitis -,2 URL (Not spesi@c) /ancer (pri#ar or #etastasic) =i+& 8 att liver 1 dru+ into*ication -,2 URL Acute,/&ronic 9anreatitis% /ancer of

panreas 'it& &epato;iliar o;struction 2,

$2 URL AL9 (N $70 5 --0) see Bo' c&art


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ALP Mening'at

2C nucleotidase " ??T

Nor#al 3enin+at

9enait =epato;ilier

US? " /T Scan

ilatasi Dilier

:stra&epatiolestasis

Focal Mass

e#un+inanE /a

=epatoselulerE Li#fo#aE 3etastase

ilatasi " 3assa(,)

A3A Test

SirosisDilier

9ri#ere#un+inanE ru+ induceE TD/E =istoplas#osisDiopsi =ati

ari tulan+%plasenta atau

usus

Aspirasi =ati

(F)(−)


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OTHER TESTS +lain :Ra' See " a"domen str#%t#re

"domen 4SG

dete%t li!er * gall "ladder si


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COMMON

DISORDERS


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Liver Disorders Wide range of symptoms & signs

Most common:

s'mptomati% Malaise, &atig#e, -oss o& appetite, a#sea 3a#ndi%e +ain in the right #pper ;#adrant

Common disorders: iral epatitis Toi% hepatitis 66 al%ohol, dr#gs, her"s * toi%s s#"stan%e -i!er a"s%esses "' amoe"ae, "a%teria or parasites. -i!er damage -i!er &ail#re de&e%ts in dr#gs, n#trition,

meta"olism * %oag#lation s'stems hroni% damage -i!er &i"rosis irrhosis. an%er /metastati% 66 primar' li!er %an%ers) +ortal h'pertension (sophageal "leeding, sites

epati% oma.


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SPESIFIC HEPATITISMARKER CAU! MA"#!"

epatitis IgM anti , Depatitis B Bsg, nti:Bs, Beg, nti Be, B

D, nti:B%,

epatitis nti: /IgM * IgG), R, agepatitis D Bsg, IgM anti D, Dg

#toimm#ne , STM, S-, nti -KM

Toi% epatitis Dr#gs, Toin le!el, -T?ST

Idiopathi% Biops'

ASTMA: Anti smooth muscle antibody, LKM: Anti-liver-kidney microsomal antibody, SLA:

Soluble liver antigen


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28Harisson’s: Principles of Internal Medicine

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Ink#"asi 5ase k#t 5aseKon!alesen

Sem"#h

E:12 mingg# 2:12 mingg# 2:1F "#lan Tah#n

Total Anti,=Dc

=DeA+

=DsA+

I#unitasonta

Anti =De

I+3 Anti,=Dc

Anti =Ds

HBV DNA

HBV- DNA , HBe Ag, HBs Ag muncul hampir bersamaan.

HBc Ag tidak terdapat diserum.

(in)"* +eri")


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INTERPRETATION of HEPATITIS BMARKER


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31Sumber : Isa K. Musahwar


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Ink#"asi 5ase k#t +en'em"#han

E: mingg# E:12 mingg# Tah#n

onta

Anti =/H

=/H RNA

=/H A+


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Drugs T!" C!use LiverD!#!ge

Analgesics +ara%etamol spirin onsteroidal antiin&lammator' dr#gs

Cardiac drugs Meth'ldopa miodarone

$sychotropic drugs Monoamine oidase inhi"itors +henothia


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Bi$i!r% Disorders Sign * S'mpthoms

3a#ndi%e lassi% S'mpthoms +ale stool * dark #rine It%hing pr#ritogeni% s#"stan%es in "ile De&e%ts in &at a"sorption Steatorrhoea, $eight loss *

n#tritional de&i%ien%'. +ain, &e!er * malaise

Disorder o& Biliar' Sistems Intrahepati% %holestasis o "lo%kage in "iliar' s'stem

#toimm#ne Intrahepati% Damage o& Bile D#%ts @ +rimar'"iliar' %irrhosis /+B)

D#e to li!er disorders (trahepati% %holestasis Blo%kage in "iliar' s'stem A

Gallstones hole%'stitis, holangitis +an%reatitis


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Bilir#"in -e!el /Total, dire%t * indire%t) = @ H 1,00? 0,2 ? 0,

3a#ndi%e /A) "ilir#"in 2 ormal -imit or 6 2,0:2, mg?dl)

L!& Tes" I' (!u'di)e

+rehepatik3a#ndi%e

epati%3a#ndi%e

+osthepati%3a#ndi%e

4n%on>#gatedBilir#"in /Indire%t Bil) on>#gated Bilir#"in/Dire%t Bil)

Bilir#"in in #rine 'race () * +) , -)4ro"ilin in #rine )) ).* ).*

5e%es %olo#r /ro0n Light/ro0n

pale


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CAUSES PORTALHYPERTENSION 1ncreased resistance to flo0

Prehepatic (portal vein obstruction) ongenital atresia or stenosis Throm"osis o& portal !ein or spleni% !ein (trinsi% %ompression /&or eample, t#mo#rs)

Hepatic irrhosis %#te al%oholi% li!er disease ongenital hepati% &i"rosis Idiopathi% portal h'pertension /hepatoportal s%lerosis) S%histosomiasis

Posthepatic B#ddhiari s'ndrome onstri%ti!e peri%arditis

1ncreased portal blood flo0 rterialportal !eno#s &ist#la In%reased spleni% &lo$


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lab kelainan hepar & sistem bilier_2011

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