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    1) Dr. Hanifah Oswari is a pediatric gastroentero-hepatologist who presented on evaluating abnormal liver function tests. 2) Liver function tests can be abnormal even when the liver is healthy. When elevated, further evaluation is needed to identify potential causes like viral hepatitis, non-alcoholic fatty liver disease, or rare conditions. 3) For mild chronic elevations in aminotransferases, the presenter recommends first identifying common causes then looking for non-hepatic factors and rare liver diseases, with liver biopsy if the cause remains unknown.

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    1) Dr. Hanifah Oswari is a pediatric gastroentero-hepatologist who presented on evaluating abnormal liver function tests. 2) Liver function tests can be abnormal even when the liver is healthy. When elevated, further evaluation is needed to identify potential causes like viral hepatitis, non-alcoholic fatty liver disease, or rare conditions. 3) For mild chronic elevations in aminotransferases, the presenter recommends first identifying common causes then looking for non-hepatic factors and rare liver diseases, with liver biopsy if the cause remains unknown.

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    49 views74 pages

    Evaluation Liver Function Tests

    Uploaded by

    Meylinda Lin
    1) Dr. Hanifah Oswari is a pediatric gastroentero-hepatologist who presented on evaluating abnormal liver function tests. 2) Liver function tests can be abnormal even when the liver is healthy. When elevated, further evaluation is needed to identify potential causes like viral hepatitis, non-alcoholic fatty liver disease, or rare conditions. 3) For mild chronic elevations in aminotransferases, the presenter recommends first identifying common causes then looking for non-hepatic factors and rare liver diseases, with liver biopsy if the cause remains unknown.

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    of 74

    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


    Tuesday, July 12, 2011
    Abnormal liver function test:
    how to evaluate
    DR. Dr. Hanifah Oswari, Sp.A(K)
    Pediatric Gastroentero-hepatologist
    Faculty of Medicine, Cipto Mangunkusumo Hospital
    Tuesday, July 12, 2011
    Presentation
    Tuesday, July 12, 2011
    LFT
    Liver Function
    Test
    Tuesday, July 12, 2011
    BILIRUBIN
    Alk Phosphatase
    Gamma GT
    80% heme
    20% others
    Tuesday, July 12, 2011
    Albumin
    Prothrombin time
    Synthetic function
    20 days
    hours
    Chronic process
    Cirrhosis
    Vit K def
    signicant hepatocellular dysfunction
    Tuesday, July 12, 2011
    Liver function test
    Health of the liver
    Tuesday, July 12, 2011
    Liver function test
    May be abnormal
    Health of the liver
    Tuesday, July 12, 2011
    AST
    Tuesday, July 12, 2011
    AST
    Cytoplasm Mitochondria
    Tuesday, July 12, 2011
    ALT
    Cytoplasm
    Tuesday, July 12, 2011
    AP
    Tuesday, July 12, 2011
    Gamma GT
    Newborn
    6-7x adult
    Tuesday, July 12, 2011
    Age
    Tuesday, July 12, 2011
    Hepatocellular
    Bile duct
    ALT
    AST
    Bilirubin
    GGT
    Alk Phosp
    Tuesday, July 12, 2011
    Mild chronic elevation in serum aminotransferases
    Tuesday, July 12, 2011
    Mild chronic elevation in serum aminotransferases
    < 4 ULN
    > 6 months
    one or both
    > 2 ULN
    Tuesday, July 12, 2011
    Mild chronic elevation in serum aminotransferases
    2 1 3 4
    Tuesday, July 12, 2011
    Mild chronic elevation in serum aminotransferases
    Identify
    most
    common
    cause of
    liver
    disease
    Look for
    non-
    hepatic
    causes
    Identify
    rarer
    cause of
    liver
    disease
    Liver
    biopsy
    2 1 3 4
    Tuesday, July 12, 2011
    Mild chronic elevation in serum aminotransferases
    Identify
    most
    common
    cause of
    liver
    disease
    Drug/herbal
    Hepatitis B
    Hepatitis C
    NAFLD
    1
    Tuesday, July 12, 2011
    Tuesday, July 12, 2011
    Tuesday, July 12, 2011
    Tuesday, July 12, 2011
    Tuesday, July 12, 2011
    Tuesday, July 12, 2011
    hep-C hep-B
    Tuesday, July 12, 2011
    hep-B
    HBsg
    AntiHBc IgM
    Tuesday, July 12, 2011
    hep-C
    AntiHCV
    Tuesday, July 12, 2011
    NAFLD
    Tuesday, July 12, 2011
    O
    b
    e
    s
    i
    t
    y
    Tuesday, July 12, 2011
    Tuesday, July 12, 2011
    Tuesday, July 12, 2011
    Mild chronic elevation in serum aminotransferases
    Look for
    non-
    hepatic
    causes
    Muscle
    disorders
    Thyroid
    disorders
    2
    Tuesday, July 12, 2011
    Thyroid disorders
    Tuesday, July 12, 2011
    Thyroid disorders
    TSH
    FT4
    Tuesday, July 12, 2011
    Muscle disorders
    Tuesday, July 12, 2011
    Muscle disorders
    Creatinin kinase
    Tuesday, July 12, 2011
    Mild chronic elevation in serum aminotransferases
    Identify
    rarer
    cause of
    LD
    Autoimmune
    hepatitis
    Wilsons
    disease
    3
    Tuesday, July 12, 2011
    Autoimmune hepatitis
    Tuesday, July 12, 2011
    Wilsons disease
    Tuesday, July 12, 2011
    Mild chronic elevation in serum aminotransferases
    observe in
    ALT & AST
    < 2 ULN
    May be needed when
    no etiology found +
    ALT & AST
    persistently
    > 2 ULN
    4
    Tuesday, July 12, 2011
    Bilirubin
    Tuesday, July 12, 2011
    B
    i
    l
    i
    r
    u
    b
    i
    n
    Total
    Direk
    Indirek
    20%total
    >1 mg/dl
    Tuesday, July 12, 2011
    Uptake
    Conjugation
    Excretion
    Tuesday, July 12, 2011
    Cholestasis
    Intrahepatik Extrahepatik
    Biliary atresia
    20%total
    >1 mg/dl
    Tuesday, July 12, 2011
    Tuesday, July 12, 2011
    Tuesday, July 12, 2011
    Tuesday, July 12, 2011
    Sign & Symptoms
    Tuesday, July 12, 2011
    Sign & Symptoms
    Tuesday, July 12, 2011
    Isolated hyperbilirubinemia
    Unconjugated
    Tuesday, July 12, 2011
    Isolated hyperbilirubinemia
    Bilirubin
    over
    production
    Hemolysis
    Unconjugated
    Tuesday, July 12, 2011
    Isolated hyperbilirubinemia
    Bilirubin
    over
    production
    Hemolysis
    Impaired
    hepatic
    bilirubin
    uptake
    Hepatic blood ow
    Drugs
    Unconjugated
    Tuesday, July 12, 2011
    Isolated hyperbilirubinemia
    Bilirubin
    over
    production
    Hemolysis
    Impaired
    hepatic
    bilirubin
    uptake
    Hepatic blood ow
    Drugs
    Unconjugated
    Impaired
    hepatic
    bilirubin
    conjugation
    Gilberts disease
    Crigler-Najjar
    Drugs
    Hyperthyroidism
    Tuesday, July 12, 2011
    Isolated hyperbilirubinemia
    Conjugated
    Tuesday, July 12, 2011
    Isolated hyperbilirubinemia
    Conjugated
    Dubin-Johnson
    syndrome
    Tuesday, July 12, 2011
    Isolated hyperbilirubinemia
    Conjugated
    Dubin-Johnson
    syndrome
    Rotor
    syndrome
    Tuesday, July 12, 2011
    Isolated hyperbilirubinemia
    Conjugated
    Dubin-Johnson
    syndrome
    Rotor
    syndrome
    direct bili + 50% total AND normal other LFTs
    Tuesday, July 12, 2011
    Conclusion
    Abnormal 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 impaired
    conjugation

    Isolated conjugated-Rotor & Dubin Johnson


    remember
    Tuesday, July 12, 2011
    Tuesday, July 12, 2011
    Please
    Tuesday, July 12, 2011
    Exercise

    Bilirubin total 10 mg/dl

    Bilirubin direk 1,5 mg/dl


    Tuesday, July 12, 2011
    Exercise

    Bilirubin total 20 mg/dl

    Bilirubin direk 3 mg/dl


    Tuesday, July 12, 2011
    Exercise

    Bilirubin total 25 mg/dl

    Bilirubin direk 3 mg/dl


    Tuesday, July 12, 2011
    Exercise

    Bilirubin total 4 mg/dl

    Bilirubin direk 0,9 mg/dl


    Tuesday, July 12, 2011
    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?


    Tuesday, July 12, 2011
    Boy, 10 years

    AST 65 IU/L

    ALT 70 IU/L

    What is your plan for the boy?


    Tuesday, July 12, 2011
    No
    Tuesday, July 12, 2011
    Please
    No
    Tuesday, July 12, 2011
    Tuesday, July 12, 2011
    The commonly used
    liver function tests
    may be abnormal
    even in patients
    with a healthy liver
    Tuesday, July 12, 2011
    Tuesday, July 12, 2011
    Tuesday, July 12, 2011
    Tuesday, July 12, 2011

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