Sorting out the Diagnostics.ppt

Sorting out the Diagnostics Ed Marino, PA-C Porter Adventist Hospital Liver Transplant Services Denver, CO Acknowledgements Thanks to the organizers for my invitation Especially Corinna Dan, RN, MPH Staff at Hepatitis Foundation International Staff at Porter Hospital Liver Transplant Service for allowing me time away for this Educational Objectives Review the most common liver lab tests Determine true liver synthetic function Review viral hepatitis lab values Discuss follow up for above labs Hepatic Physiology Liver: Largest solid organ in the body Performs over 500 chemical processes Produces over 160 different proteins Makes clotting factors for the blood Stores releases sugar as glycogen Metabolizes, detoxifies, synthesizes The Anatomy of the Liver CT Liver Histology Defining Terms Hepatitis: refers to any swelling, inflammation, or irritation of the liver Over 100 causes including: Viruses, alcohol, enzyme deficiencies Iron or copper overload, microvesicular fat Genetic disorders, licit illicit drugs, toxins Hypotension (shock liver / reperfusion) Defining Terms Inflammation that lasts long enough will create fibrosis Extreme fibrosis is called cirrhosis Cirrhosis can be either compensated or decompensated Compensated cirrhosis can be subtle Decompensated cirrhosis is more obvious Normal Liver Cirrhotic Liver Defining Terms Normal Lab Values: 95% of normal, asymptomatic patients have numbers in this range on a “bell shaped curve” Abnormal Labs: By definition, 2.5% of normal patients have lab values either above or below the “normal” range Liver “Function” Tests ALT: alanine aminotransferase (SGPT) AST: aspartate aminotransferase (SGOT) Alkaline Phosphatase Bilirubin Known as LFT’s (but they’re really not) Liver Synthetic Function Total Protein and serum albumin Total Bilirubin Prothrombin Time (PT / INR) These are “true” tests of liver function Traditional LFT’s ALT: Found primarily in hepatocytes Released when cells are hurt or d