Liver Function Tests - University of Washington肝功能试验-华盛顿大学.pptVIP

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Liver Function Tests - University of Washington肝功能试验-华盛顿大学.ppt

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Liver Function Tests - University of Washington肝功能试验-华盛顿大学

Liver Function Tests Steve Bradley Chief Medical Resident, HMC Inpatient Services What are “Liver Function Tests” Few are truly associated with function Albumin: protein synthetic function INR: clotting factor synthesis Most are related to cell injury Patterns point to specific cell injury Tests of Liver Injury AST/ALT Cytoplasmic enzymes found in hepatocytes Very sensitive marker for hepatocyte injury Specificity is poor (other sources, e.g. muscle) Mitochondrial isoenzyme AST increased by ethanol (explains 2:1 ratio) Alkaline Phosphatase/GGT Canicular enzymes Gradual increase in plasma levels with obstruction of canicular flow Patterns of Enzyme Elevation Hepatocellular injury AST/ALT Cholestatic Bilirubin/alkaline phosphatase Mixed Isolated/predominant alkaline phosphatase elevatioin Caveats to Patterns Hepatocellular injury Also results in release of bilirubin Alkaline phosphatase also found in hepatocyte Cholestatic Biliary obstruction can lead to hepatocellular injury History and Physical guide your thinking!! Patient #1: Suzie Duzie Presents with two days of fever, abdominal pain, yellow skin, nausea, vomiting. Labs demonstrate the following: AST 3210 ALT 3060 Alk phos 249 TBili 6.2 (Direct 4.3) Albumin 3.1 INR 1.2 What targets the hepatocyte? Toxins Alcohol Medications Tylenol Mushrooms Viral Hepatitis A/B/C EBV/HSV/CMV Ischemia Severe hypotension Vasoconstriction Sepsis Autoimmune Wilson’s Alpha-1 antitrypsin deficiency Degree of elevation points to etiology 1000 to 2000 Ischemia Toxin Virus 500 to 1000 Acute biliary obstruction 300 Alcoholic liver disease, cirrhosis, chronic obstruction AST/ALT2 and each 300 suggests EtOH or cirrhosis If 500, unlikely EtOH Back to our patient Transaminases in the 1000s Suggests ischemia/toxin/viral IVDU Risk of acute Hep B or acute Hep C Cocaine Risk of ischemia Recent infection Doxycycline Patient #2: Ima Hurtin 40 year-old overweight woman presents with right UQ abd pain, fever, chills. Previous episodes after fatt