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Liver and Pancreas Lab Work

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Hepatic Function Tests Are used to asses the health, ... Interpretation Increased in: Acute, recurrent, pancreatic pseudocyst, pancreatic malignancy, ... – PowerPoint PPT presentation

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Title: Liver and Pancreas Lab Work


1
Liver and Pancreas Lab Work
  • Dr. Felix Hernandez M.D.

2
Hepatic Function Tests
  • Are used to asses the health, function and
    stability of the liver.
  • All hepatocytes contain these enzymes within them
    and they are released into circulation once the
    hepatocytes are damaged.
  • Includes Aspartate aminotransferase (AST),
    Alanine aminotransferase (ALT), Alkaline
    phosphatase, and Bilirubin

3
Aspartate aminotransferase (AST)
  • serum (AST, SGOT, GOT)
  • 035 IU/L
  • 00.58 mckat/L
  • Physiologic Basis
  • Intracellular enzyme involved in amino acid
    metabolism. Present in large concentrations in
    liver, skeletal muscle, brain, red cells, and
    heart. Released into the bloodstream when tissue
    is damaged, especially in liver injury.
  • Interpretation
  • Increased in Acute viral hepatitis (ALT gt AST),
    biliary tract obstruction (cholangitis,
    choledocholithiasis), alcoholic hepatitis and
    cirrhosis (AST gt ALT), liver abscess, metastatic
    or primary liver cancer right heart failure,
    ischemia or hypoxia, injury to liver ("shock
    liver"), extensive trauma. Drugs that cause
    cholestasis or hepatotoxicity.
  • Decreased in Pyridoxine (vitamin B6) deficiency.
  • AST/ALT ratio gt1 suggests cirrhosis in patients
    with hepatitis C.

4
Alanine aminotransferase
  • serum (ALT, SGPT, GPT)
  • 035 U/L
  • 00.58 mckat/L
  • Physiologic Basis
  • Intracellular enzyme involved in amino acid
    metabolism. Present in large concentrations in
    liver, kidney in smaller amounts, in skeletal
    muscle and heart. Released with tissue damage,
    particularly liver injury.
  • Interpretation
  • Increased in Acute viral hepatitis (ALT gt AST),
    biliary tract obstruction (cholangitis,
    choledocholithiasis), alcoholic hepatitis and
    cirrhosis (AST gt ALT), liver abscess, metastatic
    or primary liver cancer nonalcoholic
    steatohepatitis right heart failure, ischemia or
    hypoxia, injury to liver ("shock liver"),
    extensive trauma. Drugs that cause cholestasis or
    hepatotoxicity.
  • Decreased in Pyridoxine (vitamin B6) deficiency.
  • ALT is the preferred enzyme for evaluation of
    liver injury.

5
Alkaline phosphatase
  • serum
  • 41133 IU/L
  • 0.72.2 mckat/L (method- and age-dependent)
  • Physiologic Basis
  • Alkaline phosphatases are found in liver, bone,
    intestine, and placenta.
  • Interpretation
  • Increased in Obstructive hepatobiliary disease,
    bone disease (physiologic bone growth, Paget
    disease, osteomalacia, osteogenic sarcoma, bone
    metastases), hyperparathyroidism, rickets, benign
    familial hyperphosphatasemia, pregnancy (third
    trimester), GI disease (perforated ulcer or bowel
    infarct), hepatotoxic drugs.
  • Decreased in Hypophosphatasia
  • Alkaline phosphatase performs well in measuring
    the extent of bone metastases in prostate cancer.

6
Bilirubin
  • 0.11.2 mg/dL
  • 221 mcmol/L
  • Direct (conjugated to glucuronide) bilirubin
    0.10.4 mg/dL lt7 mcmol/L
  • Indirect (unconjugated) bilirubin 0.20.7 mg/dL
    lt12 mcmol/L
  • Physiologic Basis
  • Bilirubin, a product of hemoglobin metabolism, is
    conjugated in the liver to mono- and
    diglucuronides and excreted in bile.
  • Some conjugated bilirubin is bound to serum
    albumin, so-called D (delta) bilirubin.
  • Elevated serum bilirubin occurs in liver disease,
    biliary obstruction, or hemolysis.
  • Interpretation
  • Increased in Acute or chronic hepatitis,
    cirrhosis, biliary tract obstruction, toxic
    hepatitis, neonatal jaundice, congenital liver
    enzyme abnormalities (Dubin-Johnson, Rotor,
    Gilbert, Crigler-Najjar syndromes), fasting,
    hemolytic disorders. Hepatotoxic drugs.
  • Only conjugated bilirubin appears in the urine,
    and it is indicative of liver disease hemolysis
    is associated with increased unconjugated
    bilirubin.

7
Pancreatic Enzymes
  • Are used to determine the health and function of
    the pancreas and other areas of the GI system
  • You measure the native enzymes that are produced
    by and released by the pancreas.
  • They include
  • Amylase
  • Lipase

8
Amylase
  • serum
  • 20110 U/L
  • 0.331.83 mckat/L (laboratory-specific)
  • Physiologic Basis
  • Amylase hydrolyzes complex carbohydrates.
  • Serum amylase is derived primarily from pancreas
    and salivary glands and is increased with
    inflammation or obstruction of these glands.
  • Interpretation
  • Increased in Acute pancreatitis (7095),
    pancreatic pseudocyst, pancreatic duct
    obstruction (cholecystitis, choledocholithiasis,
    pancreatic carcinoma, stone, stricture, duct
    sphincter spasm), bowel obstruction and
    infarction, mumps, parotitis, diabetic
    ketoacidosis, penetrating peptic ulcer,
    peritonitis, ruptured ectopic pregnancy,
    macroamylasemia. Drugs azathioprine,
    hydrochlorothiazide.
  • Decreased in Pancreatic insufficiency, cystic
    fibrosis. Usually normal or low in chronic
    pancreatitis.
  • Serum lipase is an alternative test for acute
    pancreatitis.

9
Lipase
  • serum
  • 0160 U/L
  • 02.66 mckat/L (laboratory-specific)
  • Physiologic Basis
  • Lipases are responsible for hydrolysis of
    glycerol esters of long-chain fatty acids to
    produce fatty acids and glycerol.
  • Lipases are produced in the liver, intestine,
    tongue, stomach, and many other cells.
  • Interpretation
  • Increased in Acute, recurrent, pancreatic
    pseudocyst, pancreatic malignancy, peritonitis,
    biliary disease, hepatic disease, diabetes
    mellitus (especially diabetic ketoacidosis),
    intestinal disease, gastric malignancy or
    perforation, cystic fibrosis, inflammatory bowel
    disease (Crohn disease and ulcerative colitis).
  • Serum lipase may be a more reliable test than
    serum amylase for the initial diagnosis of acute
    pancreatitis, due to an increased sensitivity in
    acute alcoholic pancreatitis and because lipase
    remains elevated longer than amylase.

10
Lipase
  • The specificity of lipase and amylase in acute
    pancreatitis is similar, though both are poor.
    Simultaneous measurement of serum amylase and
    lipase does not improve diagnostic accuracy.
    Measurement of serum lipase does not help in
    determining the severity or etiology of acute
    pancreatitis, and daily measurements are of no
    value in assessing the patient's clinical
    progress or ultimate prognosis.
  • Test sensitivity is not very good for chronic
    pancreatitis or pancreatic cancer.

11
Calcium
  • serum (Ca2 )
  • 8.510.5 mg/dL
  • 2.12.6 mmol/L
  • Panic lt6.5 or gt13.5 mg/dL
  • Physiologic Basis
  • Serum calcium is the sum of ionized calcium plus
    complexed calcium and calcium bound to proteins
    (mostly albumin).
  • Level of ionized calcium is regulated by
    parathyroid hormone and vitamin D.
  • Interpretation
  • Increased in Hyperparathyroidism, malignancies
    secreting parathyroid hormonerelated protein
    (PTHrP) (especially squamous cell carcinoma of
    lung and renal cell carcinoma), vitamin D excess,
    milk-alkali syndrome, multiple myeloma, Paget
    disease of bone with immobilization, sarcoidosis,
    other granulomatous disorders, familial
    hypocalciuria, vitamin A intoxication,
    thyrotoxicosis, Addison disease. Drugs antacids
    (some), calcium salts, chronic diuretic use (eg,
    thiazides), lithium, others.

12
Calcium
  • Decreased in Hypoparathyroidism, vitamin D
    deficiency, renal insufficiency,
    pseudohypoparathyroidism, magnesium deficiency,
    hyperphosphatemia, massive transfusion,
    hypoalbuminemia.
  • Need to know serum albumin to interpret calcium
    level. For every decrease in albumin by 1 mg/dL,
    calcium should be corrected upward by 0.8 mg/dL.
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