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PEMERIKSAANLABORATORIUM SISTEM
GASTRO INTESTINAL
Indriani SilviaFK UNSWAGATI
26 April 2016
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LEARNING OBJECTIVES
mamp m!n"!la#$and!%ni#i dan &"an
p!m!ri$#aanla'(ra&(rim #i#&!m
)a#&r( in&!#&inal
Mamp m!n"!la#$an&ip! dan prin#ip
p!m!ri$#aanla'(ra&(rim #i#&!m
)a#&r( in&!#&inal
M!ma*ami in&!rpr!&a#i*a#il p!m!ri$#aan
la'(ra&(rim
#i#&!m )a#&r( in&!#&inal
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ANATOMI +ATI
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FUNGSI +EPAR
Hepar organ berukuran terbesar
organ interna paling kompleks
Seluruh darah dari intestin dan pankreas heparmelalui sistem vena porta
Hepar organ multifungsi banyak fungsi tubuh
1, Fn)#i M!&a'(li$
karbohidrat, lemak, protein, mineral dan vitamin
2, Fn)#i E$#$r!#i
pigmen empedu, garam empedu, kolesterolekskresi [pigmen empedu] intestin
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-, Fn)#i pr(&!$&i. dan /!&($#i%$a#i
Sel Kupfer hepar fagositosis benda asing
Contoh amonia didetoksikasi menjadibentuk urea dan dimetabolisme xenobiotikdetoksikasi!
klirens hormon insulin, hormon paratiroid
"#H!, estrogen, kortisol
, Fn)#i +!ma&(l()i dan Sin&!#i#
•. pembentukan sel darah saat embrio!•. sintesis of protein plasma albumin, protrombin!,
hormon seperti angiotensinogen, insulin-likegrowth factor $%&! dan triiodotironin
•. destruksi eritrosit Bilir'in!
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, Fn)#i p!nimpanan
glikogen, vitamins ', ( dan )*+
6, En3im #!rm penanda kerusakan hepar
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Hepatic uptake of bilirubin
and production of bile
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TES FUNGSI
+EPATOBILIER in&!rpr!&a#i ri#i$( .a$&(r4 )!"ala $lini#4 .a$&(rp!n!r&a4 p!m!ri$#aan %#i$
m!n))am'ar$an adana )an))an *!pa&('ili!r&, $r(ni#
*ar# dii$&i !vala#i5m(ni&(rin)
&iap la'(ra&(rim nilai n(rmal '!r'!da
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.
Roberts E A , Sarkar B Am J Clin Nutr 2008;88:851S85!S©2008 by American Society for Nutrition
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S&r$&r S'#!ll!r +!par
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BILIRUBIN
N(rmal $adar 'ilir'in #!rm
#otal bilirubin - . */ µmol01
Conjugated bilirubin0direk0glukuronida
2 . - µmol01
3n4onjugated bilirubin0indirek0kompleks bilirubin 5 albumin0bilirubin
hingga *+ µmol01
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BILIRUBIN SERUM /INILAIMENGGUNAKAN REAKSI AN/EN BERG+
"rinsip pemeriksaan
asam sulfanilat dalam HCl dan sodium nitrat 6 bilirubin
a7obilirubin n)!
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BILIRUBIN SERUM METO/E AN/EN BERG+
Conjugated bilirubin segera n) van den )ergh positif
Unconjugated bilirubin 6 alkohol n)
p(#i&i. indir!$ )ila kadar conjugated 8 unconjugated bilirubin9 segera n)
6 'lkohol intensitas n) 9 bifasik
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Pr(d$#i 'ilir'in
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$!)naan• sensitif, metode
noninvasif untukskrining disfungsi hati
• menggambarkanadanya jenis gangguanhati
• menilai keparahandisfungsi hati
• dilakukan setelah
ditentukan dugaanetiologi penyakit hati
$!$ran)an• sensitivitas :
;ilai normal pada
kelainan hati yang
berat
• tidak spesik untukdisfungsi hati
• jarangmenggambarkandiagnosis spesik
TES FUNGSI +ATI
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TES FUNGSI +ATILiv!r 7*!mi#&r&!#&
8lini7al impli7a&i(n (. a'n(rmali&
ALT +!pa&(7!lllar dama)!
AST +!pa&(7!lllar dama)!
Bilir'in 8*(l!#&a#i#4 impair 7(n")a&i(n4 (r 'iliar('#&r7&i(n
ALP 8*(l!#&a#i#4 in%l&ra&iv! di#!a#!4 (r 'iliar('#&r7&i(n
PT Sn&*!&i7 .n7&i(n
Al'min Sn&*!&i7 .n7&i(n
GGT 8*(l!#&a#i# (r 'iliar ('#&r7&i(n
Bil! a7id# 8*(l!#&a#i# (r 'iliar ('#&r7&i(n
9:n7l!(&ida#! 8*(l!#&a#i# (r 'iliar ('#&r7&i(n
L/+ +!pa&(7!lllar dama)!4 n(& #p!7i%7
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TES FUNGSI +ATI"il#
$times%
"o#erate
$times%
"arke#
$times%
AS& '2( 2( to 20 )20
A*& '2( 2( to 20 )20
A*+ '1.52 1.52 to 5 )5
& '2( 2( to 10 )10
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TES FUNGSI +ATI
$la#i%$a#i.n)#i #in&!#i# al'min4 PT
$!r#a$an #!l ; "arin)an *!pa&i$AST4 ALT
$(l!#&a#i# 'ilir'in4 ALP4 GGT
protro!bin ti!e4al'min4 'ilir'in
Pr()n(#i#
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ALBUMIN dip!n)ar*in&ri#i4 #&a&# v(lm!4 in&!)ri&a# va#$lar4$a&a'(li#m!4 *(rm(n4 !$#$r!#i rin ; .!#!#
&ida$ #p!#i%$ n&$ $!lainan *a&i
& 152 1?:21 *ari B$an indi$a&(r '!rma$na n&$ $!lainan *a&i an) a$&
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PEMERIKSAAN BILIRUBIN URIN 3rin bilirubin
)ilirubin oksidasi 6 3< biliverdin
A,P!r7('aan B#a
= ml urin segar dalam tabung di4ampurgerakan
kuat! bilirubin 6 kuningbilirubin 5 putih0kuning muda
6 palsu[urobilin] :
akri>avin, piridium
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PEMERIKSAAN BILIRUBIN URIN
B P!r7('aan +arri#(n
"rinsip pemeriksaan
bilirubin 6 barium klorida *2? 6 &ou4het
@arna hijau bilirubin
8ara $!r"a
•= ml urin dalam tabung di4ampur kuatA
•6 = ml lar barium klorida *2? saringA
•'ngkat kertas saring dari 4orong, dibukalipatannya, ditaruh mendatar, biarkan keringA
•6 + . B tetes reagen &ou4het di atas presipitat kertassaring *i"a
PEMERIKSAAN BILIRUBIN URIN
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PEMERIKSAAN BILIRUBIN URIN
8 M(di%$a#i p!r7('aan +arri#(n d!n)an
p(&(n)an $!r&a# #arin)
kertas saring tebal uk *2x* 4m S4hlei4her danSnull no -2! direndam di dalam lar barium kloridabeberapa lama hingga diserap kertas saring
keringkan di lemari panas digunakan
8ara K!r"a
"otongan kertas saring dipegang dan sebelah lain
dimasukkan ke dalam urin hingga *0B B2D . +E
Kertas diangkat biarkan hingga kering
6 * tetes &ou4het +i"a bilirubin 6!
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)ilirubin 7at lain kuning tua, kuning4ampur hijau, 4oklat
)ilirubin glukorinida oksidasi63< biliverdinhijau!
bilisianin biru!
koletelinkuning!
In&!rpr!&a#i Kadar rendah 6
Kadar tinggi 66
PEMERIKSAAN BILIRUBIN URIN
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PEMERIKSAAN BILIRUBIN URIN
8 8ara d!n)an 7ari$ 7!lp
bilirubin 6 senya@a dia7o pada 4arik 4elup
8a&a&an
3rin segar3rin tidak segar hidrolisi atau oksidasi
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TES FUNGSI +ATI
mendeteksi abnormalitas dan meluasnya
kerusakan sel hati 1ebih sensitif dari gejala klinis #es fungsi hati terdiri atas
5 T(&al pr(&!in yaitu 'lbumin and globulin
Prothrombin Time, "#, masa protrombin!
#ransaminases 'S# 8 '1#!
'lkaline "F-ase )ilirubin, biasanya dalam bentuk fraksi
Gamma Glutamyl Transpeptidase %%#!
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TOTAL PROTEIN
N(& a v!r #!.l m!a#r!4 n(n:#p!7i%7@(nl pr(vid!# in.(rma&i(n (nG!n!ral n&ri&i(nal #&a&#S!v!r! (r)an di#!a#!
l(#in) d5#>Fra7&i(na&!d val!# (. )r!a&!r #!
M!&*(d# (. m!a#r!m!n&
El!7&r(p*(r!#i# .(ll(=!d '4Pr!7ipi&a&i(n4 .(ll(=!d '48(lmn #!para&i(n,Ni&r()!n 7(n&!n& i# #al m!&*(d ina&(ma&i(n
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TOTAL PROTEIN
$ngatG "enilaian protein dalam serum
hindari pengen4eran protein dengan antikoagulan
"re4ipitation is used to fra4tionate proteins into albumin andglobulin 6 ;aSF-, ;a sulte, 'mmonium SF-, methanol
globulin mengendap
asio '0% I serum protein abnormal "erubahan kadar albumin
"erubahan kadar globulin
Sintesis 9 kadar 9
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TOTAL PROTEIN
$ndeks refratif bermakna bila I +,=g0d1! "anjang gelombang 3< +J2nm etode turbidimetrik
kolorimetrik L metode biuret otomatis
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ALBUMIN /AN
GLOBULINAl'min)iasanya protein abundant dalamserum *+2 mg0kg0hari!
:albuminKerusakan sintesis malnutrisi,malabsorpsi, disfungsi hepatik, sirosishati!
kekurangan asites, protein losing-nephropathy , enteropathy !
Mdeme perifer albumin :
Hingga +=? albumin padah er likemia men adi likosilasi
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ALBUMIN /AN
GLOBULINAl'min↑albumin #idak spesik L dapat terjadi padadehidrasi atau artefak akibat penggunaantorniket
Tip! )l('linα*5antitripsin ''#!α+5makroglobulinhaptoglobin
transferrin
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1:ANTITRIPSIN
• I abundant α 1-globulin• menghambat kerja tripsin
• terdiri atas beberapa variasi genetik
• ''#↑ emsema and neonatal jaundice
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2
:MAKROGLOBULIN
non5immunoglobulin protein plasma
jumlah terbanyak
↑ sindrom nefrotik
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+APTOGLOBIN
• 'nother major α+ protein• &un4tion L to 4ombine @ith Hb released by
)C lysis to preserve &e and protein stores
•
Cir4ulating half5life approx - days• ↑ in stress, infe4tion, a4ute in>amm, tissue
ne4rosis
• : post haemolyti4 episode
• 3seful to monitor slo@ rate of haemolysisiAeA fm me4hani4al valves, exer4iseasso4iated trauma, haemoglobinopathies
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8ERULOPLASMIN
Cu 4ontaining en7yme ferroxidase! in serum : in NilsonEs d0s
'sso4iated @ith 4hroni4 hepatitis o44 a4ute!
and may have neurologi40 psy4hiatri4
seOuelae
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:FETOPROTEIN Fne of the major plasma proteins in foetal life
&un4tion not kno@n, similar stru4ture to albumin
&alls thru5out gestation P*2,222 ng0m1 at birth!and by age one yr Q*2 ng0m1 L adult levels!
$n a4ute hepati4 injury '&" ↑ *2 L +2R upper reflimits
'bt *2? pt @ith viral hepatitis have ↑ '&"
&ibrosis post 4hroni4 liver d0s, '&" ↑ 3sed to s4reen and diagnose HCC 8hepatoblastoma
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PROT+ROMBIN TIME
ost 4oag fa4tors made in liver parti4ularly thoseasso4 @ith vitamin K! Hen4e in liver d0s, 4oagulopathies are 4ommon
Commonly "# is used for dete4ting liver asso44oagulopathies
)est "# method not 4lear
"# $; is useful for monitoring oral anti54oagtherapy, not very useful for liver disease
'n indire4t test of hepati4 syntheti4 fun4tion
in4ludes administration of vitamin K *2mg!sub4utaneously over three daysA Several days later,the prothrombin time may be measuredA $f theprothrombin time be4omes normal, then hepati4syntheti4 fun4tion is inta4tA #his test does notindi4ate that there is no liver disease, but issuggestive that malnutrition may 4oexist @ith or
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#';S'$;'SM [S%F#
S%"#]
#ests of liver injury
Hepato4ytes 4ontain high levels ofen7ymes that 4an leak into theplasma @hen there is liver injury
Mn7ymes found in hepato4ytesareCytoplasmi4 1(H, 'S#, '1#
ito4hondrial 'S#m
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ALANINE AMINOTRANSFERASE5SGPT
"rimer penyakit hati, monitoring terapi hepatitis,active postnecrotic cirrhosis 8 efek terapi
9 in>amasi, nekrosis
Sel rusak '1# dilepaskan ke sirkulasi darah
"erubahan kadar '1# kadang tidak spesik
#api '1# sensitif untuk kerusakan hepatosit
'1# dapat dibedakan antara hemolytic jaundice 8
jaundice
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ALANINEAMINOTRANSFERASE
$n4reased '1# levels are found in thefollo@ing 4onditions
- Hepato4ellular disease
- '4tive 4irrhosis mild in4rease!
- etastati4 liver tumor
- Fbstru4tive jaundi4e or billiary obstru4tionmild to moderate in4rease!
- viral, infe4tious or toxi4 hepatitis B25=2xnormal!
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ASPARTATE AMINOTRANSFERASE5SGOT
'lso re>e4ts damage to the hepati4 4ell $t is less spe4i4 for liver disease
$t may be elevated and other 4onditions su4h as amyo4ardial infar4t and mus4le disease
'lthough 'S# is not a spe4i4 for liver as the '1#, ra&i(# '!&=!!n ALT and AST are useful tophysi4ians in assessing the aetiology of liver en7ymeabnormalities
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MEASUREMENT 3ses 4oupled en7ymati4 rea4tions @ithni4otinamide adenine dinu4leotide
;'(H! as nal rea4tion produ4tmeasured
eagents @ith ;H-6 should be avoided
as it may arti4ially ↑ the 'S#0'1#values
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SPESIMEN
Stabil dalam whole blood selama +- jam lalu ↑karena dieksresikan dari)C! 'S#0'1# stabil pada -oC hingga Bminggu
'S# stabil dengan dibekukan freeed! '1# dapat: dengan free7ing sesuaibuTer yang digunakan
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ALKALIN FOSFATASE Sumber hati, tulang, plasenta dan intestin
9 '1" pada kelainan hati sintesis sel dikanalikuli bilier 9 kolestasis intra atau ekstrahepatik!
'1" 9 +x nilai normal kolestasis
'1" 9 kelainan hati inltratif spaceoccupying lesions SF1! tumor
#ulang yang sedang tumbuh memerlukan '1"
9 serum '1" osteoblast-rapid growth,penyembuhan fraktur, keganasan tulang, Paget!s
disease, riketsia "lasenta '1"
in>ammatory bo@el disease kolitis ulserativa!'1"9
ENIM GAMMA GLUTAMCL
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ENIM GAMMA GLUTAMCLTRANSFERASE
%%# sintesis glutation tripeptida
%%# hati, ginjal, pankreas, sel intestin,dan kelenjar prostat
D
alkoholik kronis, kelainan pankreas, infarkmiokard, gagal ginjal, penyakit paru obstruktifkronis ""FK!, (
"enyakit hati %%# 9 '1"
"enyakit hati alkoholik %%# 9 jumlahalkohol yang dikonsumsi
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'(' "M#';U'';V
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Thank You