1. 2011/11/14 6 Introduction I. II. III. IV. V V V V V V Biochemistry assessmentI. Hepatocellular injuryII. Obstruction of biliary treeIII. InflammationIV. Malignancy tumor marker Biochemistry assessmentI. Synthetic capacitiesII. Excretory functionsIII. Metabolic functions---------------------------------- --------------------------------- -AST/ALT/ALP/GGTI. Aspartate aminotransferase AST; GOTII. Alanine aminotransferase ALT; GPTIII. Alkaline phosphatase ALPIV. Gemma-glutamyl transferase GGTV. 1. AST/ALT 2. ASTALTGGT 3. parameter -BilirubinI. Bilirubin II. Bilirubin

2. III. Bilirubin 1. bilirubin 2. direct bilirubin non-specific bilirubinIV. Jaundice a. Hyperbilirubinemia b. Bilirubin in urine c. Urinary urobilinogen -ALB//I. Albumin ALBII. III. Childs classificationalpha-fetoprotein cancer Notices in interpreting liver function tests parameter case report case SummaryTO >ALT Alcoholic liver diseaseCirrhosisChronic activehepatitis HCC 3. AST>>ALT AMI 4. AST0.4 mg/dl e. Urinary urobilinogen 1. 2. cholestasis biliary tree obstruction -ALB//I. Albumin ALB a. b. 20 ALB c. 1. 2. 12. II. a. Tissue factor VIII Endothelium Liver b. Prothrombin time PT1. Vitamin K dependent clotting factors 2. i International normalized ratioINRii INR = [patient PT / Normal mean PT]ISIiii ISI=international sensitivity Index of thromboplastin3. Factor VII Fulminating hepatitis ALB c. Protein CProteinSIII. 13. Notices in interpreting liver function testsI. II. Sensitivity and specificityliver function tests a. 25% ~ 50%AST ALT ASTALT b. AST ALP c. ASTALT ALP III. I. II. III. a. Acute hepatitis PT b. Acute hepatitis ALB c. Chronic hepatitis PT d. Albumin/Gamma-Globulin ratio Chronic hepatitis e. Malignancy ALP AFP tumormarker 14. 15. I. Case 1 a. 22-year-old boy student b. Flu-like, loss of appetite, RUQ painfor 1 week c. Jaundice and tea color urine for 2 days d. Liver tender, palpable e. Stool: paleBilirubinASTALT Bilirubin AST ALT II. Case 2 a. A 27 year-old woman b. Malaise, fever, loss of appetite,icterus frustrated for 2 months c. Markedjaundice, mild pale,hepatomegaly 2 finger widthBilirubin Albumin AST/ALT AST ALTIcterus: Jaundice 16. III. Case 3a. A 60 year-old manb. Abdominal fullness and loss of appetite for 2 monthsc. An acute episode of hepatitis was noted 15 years ago, admitted for 1 month, abnormal liver function tests when discharged. BP 144/90 mmHge. PR 72 / minf. Paleg. Spider angiomatah. Hepatomegaly 4 finger width, tenderedi. Splenomegaly 2 finger widtha. Ascites Ascitis Spanish b. Pitting edema on low legsASTALT AST ALT PT IV. Case 4a. A 50 year-old womanb. ATH 2 months old with PRBC transfusion C c. Nausea, loss of appetite for 1 weekd. Jaundice, hepatomegaly 2 finger width -------------------------------------------------------e. Admitted due to acute episode of hepatitis 17. f. Auditory hallucination g. Disorientation h. Flapping tremor i. Hepatomegaly - HBV HCV B Case BilirubinASTALT ASTALT Bilirubin Case 4 ASTALT