PEMERIKSAAN

LABORATORIUM PENYAKIT
HEPATOBILIER DAN
PANKREAS

Liver ( Hepar )
Produces bilirubin
Produces albumin, coagulation factors, & other crucial
proteins
Cholesterol synthesis; lipid metabolism
Primary site of drug and hormone metabolism

Liver Function Tests (LFTs)

AST, ALT, ALK Phos, LDH
What are we measuring??

Hepatic or biliary inflammation

Functional capabilities

Billiary System.
Bilirubin is useful in the diagnosis and monitoring of liver
disease and hemolytic anemia and in the assessment of the
severity of jaundice.
A patient is generally visibly jaundiced if the bilirubin level is
greater than 2 mg/dl.

Bilirubin Metabolism
Bilirubin - product of hemoglobin breakdown from
erythrocyte -- unconjugated >>liver >> conjugated
>> bile >> gut
Total bilirubin (0.3 - 1 mg/dl)
Not sensitive for hepatic dysfunction; elevated in
other diseases; false elevations with some drugs
2 - 4 mg/dl >> jaundice

Indirect Bilirubin.
It is unconjugated bilirubin. N < 0.7 mg/dl
Primary elevations often not associated with liver
disease
Hemolysis
Hereditary diseases
Neonatal jaundice
Physiological: 2 - 5 days after birth; usually
benign
Kernicterus: > 20mg/dl

Direct Bilirubin.
A water-soluble conjugated posthepatic bilirubin.
N < 0.4 mg/dl

Elevated in rare congenital disorders

Elevated in liver disease and biliary tract
obstruction, but need to evaluate AST, ALT, ALP &
GGTP to determine cause
Degree of hyperbilirubinemia correlates with
outcome in alcoholic liver disease, biliary cirrhosis
& halothane toxicity

Alkaline Phosphatase
Found in may body tissues; mostly liver and bone
>> nonspecific; reflect tissue damage
In chloestatic disease, may be more than 4 times
normal; lesser elevations are nonspecific for any
type of liver disease
Non-hepatic causes: mild elevations may be
normal; bone disorders (healing fractures, Pagets,
tumors, osteomalacia); sepsis; cancer; drugs
(lithium, anticonvulsants, oral contraceptives)
N: 30-130 IU/L

Hepatic Synthetic Function.

One way of assessing the liver's ability to metabolize drugs is
to assess its synthetic function by evaluating the quantity of
specific products produced by the liver.

Ammonia.
The liver synthesizes urea from ammonia.
Serum ammonia is increased if the liver is damaged or if blood
flow is compromised
not used as a routine screening test, but used to confirm a
diagnosis of hepatic encephalopathy.

Hepatic Synthetic Function.

Protein Production.
The serum albumin and the vitamin K-dependent clotting
factors are commonly used to assess hepatic synthetic function.

Albumin.
Circulating albumin takes several weeks to clear from
the body.
A rapidly declining level indicates greatly impaired
hepatic function.
Long-standing liver disease is associated with very low
concentrations.
N 3,5-5.5 g/dl

Hepatic Synthetic Function.

Protein production
Vitamin K-Dependent Clotting Factors (Factors
II,VII,IX, and X).
Lack of production of these factors prolongs the
prothrombin time (PT) and partial thromboplastin time
(PTT).
The PT is prolonged earlier than the PTT and often is
used as an early indicator of impaired hepatic synthetic
function.
Both the PT and PTT are prolonged in long-standing
severe hepatic dysfunction.

Tests of Liver Synthetic

Capability

Prothrombin Time / INR

Elevated when the liver is unable to synthesize
clotting factors (II, VII, IX, X)
PT prolongation: inadequate vit K in diet, poor fat
absorption, poor nutrition, drugs (warfarin and
antibiotics), diseases
N : 10-14 detik

Hepatocellular Enzymes.
Hepatocytes contain numerous enzymes that leak into the
serum when liver cells die or are damaged.
Elevations occur in the presence of marked changes in
hepatic circulation (e.g., cardiovascular shock) and diseases
associated with hepatocellular damage (hepatitis, cirrhosis,
inflammatory diseases, and infiltrative hepatic diseases).
Serum enzymes may not be markedly elevated in severe,
chronic, end-stage liver disease

Hepatocellular Enzymes.
Very high elevations (>20 X n) are associated with viral or
toxic hepatitis.
Moderately high elevations (3 to 10 X n) are associated with
infectious mononucleosis, chronic active hepatitis,
extrahepatic bile duct obstruction, and intrahepatic
cholestasis.
Modest elevations (1-3 X n) are associated with pancreatitis,
alcoholic fatty liver, biliary cirrhosis, and neoplastic
infiltration.

Gastrointestinal System
Hepatocellular Enzymes.
Alanine Aminotransferase.
ALT is found in high concentrations in hepatocytes
and is considered a specific marker of
hepatocellular damage.
Marked elevations (>1000 IU/L) found in viral
hepatitis, severe drug reactions, or ischemic
hepatitis
Normal or mild elevations in cholestasis

Hepatocellular Enzymes.
Aspartate Aminotransferase.
AST is found in hepatocytes, myocardial muscles,
skeletal muscle, the brain, and the kidneys.
It is used as a nonspecific marker of hepatocellular
damage.
false elevations in ketoacidosis, drugs: levodopa,
erhtyromycin, methyldopa
low in uremia, B6 deficiency, drugs
assay interference: hemolysis and hyperlipidemia

Hepatocellular Enzymes.

Gamma Glutamyl Transpeptidase.

GGT is found in hepatobiliary, pancreatic, and kidney

cells.
It is elevated in most hepatocellular and hepatobiliary
diseases,
Elevations correlate better with obstructive disease
An early indicator of alcoholic liver disease.

Hepatocellular Enzymes.

Lactic Dehydrogenase.

LDH is found in the heart, brain, erythrocytes, kidneys,

liver, skeletal muscle, and ileum.
Elevations occur during shock syndrome and diseases
associated with hepatocellular damage (hepatitis,
cirrhosis, inflammatory disease, and infiltrative
diseases).

Pancreas
Exocrine glands secretes proenzymes that aid in
digestion
Trypsin, chymotrypsin, lipase, amylase
Endocrine glands secrete insulin and glucagon
Pancreatitis - inflammation of the pancreas
gallstones, hypercalcemia, hyperlipidemia,
medications, alcoholism, trauma

Tests to Assess the

Pancreas
Amylase (44 - 128 IU/L)
May increase to 25 times normal; does not
correlate with disease severity or prognosis
May be elevated in alcoholism, drugs, gallstones,
infections, trauma, hypertriglyceridemia
Lipase (<1.5 U/ml)
more specific for pancreatitis (3+ times normal)

Drugs That Cause

Pancreatitis
Asparaginase
Azathioprine
Didanosine
Estrogens
Furosemide
Steroids
H2 antagonists
Thiazides

Miscellaneous

Alpha-Fetoprotein.
is the major protein produced by the fetus in the first
10 weeks of life.
It also is produced by rapidly multiplying
hepatocytes and is used as a marker of hepatocellular
carcinoma.
Carcinoembryonic Antigen.
CEA is a tumor marker found in the blood.
It is associated with rapid multiplication of digestive
system epithelial cells and is used to monitor tumor
recurrence