evaluation liver function tests
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DR. Dr. Hanifah Oswari, Sp.A(K)
S1 FKUI 1983-1989 Spesialis anak FKUI 1994-1999
Fellow Gastroenterology-hepatology and nutrition,Royal Childrens Hospital, Brisbane, Australia,2000-2001
Saat ini:
Konsultan Gastroenterohepatologi FKUI 2005 S3 Program studi Ilmu Kedokteran FKUI 2009
Staf Gastroenterohepatologi Anak FKUI
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Abnormal liver function test:
how to evaluate
DR. Dr. Hanifah Oswari, Sp.A(K)Pediatric Gastroentero-hepatologist
Faculty of Medicine, Cipto Mangunkusumo Hospital
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Presentation
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LFTLiver Function Test
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BILIRUBIN
Alk Phosphatase
Gamma GT
80% heme20% others
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Albumin
Prothrombin time
Synthetic function
20 days
hours
Chronic process
Cirrhosis
Vit K def
significant hepatocellular dysfunction
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Liver function test
May be abnormal
Health of the liverTuesday, July 12, 2011
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AST
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CytoplasmMitochondria
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ALT
Cytoplasm
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Gamma GT
Newborn
6-7x adultTuesday, July 12, 2011
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AgeTuesday, July 12, 2011
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HepatocellularBile duct
ALT
AST
Bilirubin
GGT
Alk Phosp
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Mild chronic elevation in serum aminotransferases
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Mild chronic elevation in serum aminotransferases
< 4 ULN
> 6 months one or both
> 2 ULN
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Mild chronic elevation in serum aminotransferases
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Mild chronic elevation in serum aminotransferases
Identifymost
common
cause ofliver
disease
Drug/herbal
Hepatitis BHepatitis C
NAFLD1
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hep-Chep-BTuesday, July 12, 2011
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hep-B HBsg
AntiHBc IgMTuesday, July 12, 2011
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hep-C AntiHCVTuesday, July 12, 2011
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O
besity
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Mild chronic elevation in serum aminotransferases
Look fornon-
hepaticcauses
Muscledisorders
Thyroiddisorders
2
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Thyroid disorders
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Thyroid disorders
TSHFT4
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Muscle disorders
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Muscle disorders
Creatinin kinaseTuesday, July 12, 2011
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Mild chronic elevation in serum aminotransferases
Identifyrarer
cause ofLD
Autoimmunehepatitis
Wilsonsdisease
3
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Autoimmune hepatitis
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Wilsons disease
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Mild chronic elevation in serum aminotransferases
observe inALT & AST
< 2 ULN
May be needed whennoetiology found +
ALT & AST
persistently2 ULN
4
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BilirubinTuesday, July 12, 2011
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Uptake
Conjugation
Excretion
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Cholestasis
Intrahepatik Extrahepatik
Biliary atresia
20%total
>1 mg/dl
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Sign & Symptoms
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g y p
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Sign & Symptoms
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g y p
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I l t d h bili bi i
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Isolated hyperbilirubinemia
Hemolysis
Unconjugated
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I l t d h bili bi i
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Isolated hyperbilirubinemia
Hemolysis
Impaired
hepatic
bilirubin
uptake
Hepatic blood flow
Drugs
Unconjugated
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I l t d h bili bi i
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Isolated hyperbilirubinemia
Hemolysis
Impaired
hepatic
bilirubin
uptake
Hepatic blood flow
Drugs
Unconjugated
Impaired
hepatic
bilirubin
conjugation
Gilberts diseaseCrigler-Najjar
Drugs
HyperthyroidismTuesday, July 12, 2011
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Isolated hyperbilirubinemia
Conjugated
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Isolated hyperbilirubinemia
Conjugated
Dubin-Johnson
syndrome
Rotor
syndrome
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Isolated hyperbilirubinemia
Conjugated
Dubin-Johnson
syndrome
Rotor
syndrome
direct bili + 50% total ANDnormal other LFTsTuesday, July 12, 2011
Conclusion
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ConclusionAbnormal LFT
Not directly to liver function
2 types: hepatocellular & cholestasis
High aminotransferases-steps approach Cholestasis-dont miss biliary atresia
Isolated unconjugated hyperbilirubinemia:
hemolysis-impaired uptake or impairedconjugation
Isolated conjugated-Rotor & Dubin Johnson
remember
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Exercise
Bilirubin total 10 mg/dl
Bilirubin direk 1,5 mg/dl
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Exercise
Bilirubin total 20 mg/dl
Bilirubin direk 3 mg/dl
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Exercise
Bilirubin total 25 mg/dl
Bilirubin direk 3 mg/dl
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Exercise
Bilirubin total 4 mg/dl
Bilirubin direk 0,9 mg/dl
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Bayi 30 days old
Bilirubin total 21 mg/dl
bilirubin direk 1,5 mg/dl
other LFTs normal
What do you think of the etiology?
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Boy, 10 years
AST 65 IU/L ALT 70 IU/L
What is your plan for the boy?
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No
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Please
No
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