Laboratory Diagnosis of Liver diseases Flashcards
(12 cards)
A 61 year-old man lost 8 kg during the last 4 months. He complains of pruritus and
frequently occurring dull epigastric pain. He has noted dark-colored urine, but lightcolored
stools lately. He has jaundice. The gall bladder is palpable, but non-tender.
Laboratory results:
serum bilirubin: 310 µmol/l, mostly direct
urine Ubg: negative
ASAT: 82 U/l
ALAT: 91 U/l
alkaline phosphatase: 540 U/l
prothrombin time: INR = 2.6
What is the cause of his jaundice? What further tests do you consider?
Clinical Findings:
>Significant W.L : cancer/DM/Malabsorption
>Pruitus (itching) : usually bililary salt deposition in skin
>Courvoisser Triad: enlarged but not painful g.b/jaundice
Lab findings:
>Bilirubin is high (less than 17) -> complete bililar block
>ALP -> bililary block
>negative UBG -> as no bilirubin is into intestine
>ASAT/ALAT -> elevated (parenchymal damage)
>INR indicates coag takes longer (as no bile so no vit k absorption so less ysnthesis of coag factor -> check by administrating vit k and if it changes
Conclusion:
- Pancreatic cancer (weight loss and malabsorption)
- urine dark: as cB inside of it
- stool light as no bilirubin in gut.
Normal liver paramets: Direct bili Indirect bili total bili ASAT + ALAT LDH Hematocrit hyperbil ggt mcv inr Albumin
direct <5
indirect <12
total bili <17
ASAT AND ALAT: 45
LDH: 160 U/L
Ht: 0.4 - 0.54(m)
0.37-0.47 (f)
hyperbili >50uM
GGT <60
MCV 80-95
INR: 0.8-1.2
albumin: 35-50An icteric woman has the following laboratory parameters: serum indirect bilirubin: 54 µmol/l serum direct bilirubin: 5,1 µmol/l urine bilirubin: negative ASAT: 19 U/l ALAT: 22 U/l LDH: 720 U/l Ht: 0.33 l/l plasma haptoglobin and hemopexin concentrations are significantly decreased What is the cause of her jaundice?
Clinical findings:
>itcteric -> Hyperbilirubinemia
Lab findings: >Direct is good, indirect is very high > Urine bilirubin is -ve -> normal >ASAT and ALAT normal >LDH very high (indicate hemolysis) >Ht is low (indicates decrease rbc) >Haptoglobin: binds free hemoglobin >Hemotexin: binds free heme
Conclusion: >hemolytic jaundice with indirect hyperbilirubinemia >can occur: 1) autoimmune on RBC 2) sickle cell 3) corpuscular anemia 4) Incompatible transufsion
A 38 year-old man, who regularly drinks alcohol. He has never been ill before, but he
has grown icteric in the last couple of days. He has a temperature, and is a little anemic.
His liver is palpable an inch below the ribs, it is slightly tender. Laboratory results:
urine color: dark brown
serum total bilirubin: 150 µmol/l
ASAT: 160 U/l
ALAT: 60 U/l
GGT: 490 U/l
MCV: 103 fl
What is the cause of his jaundice?
Clinical findings:
>alcohol -> alchoholic hepatitis (also indicated by palpable liver)
>Jaundice: Indicate hyperbilirubinemia
>Dark Urine: cB in urine
Lab findings:
>serum bilirubin too high (jaundice)
>ASAT is higher than ALAT indicating alchoholic hepatitis
>GGT greater than 60 -> bililary obstruction/Drug or alchohol toxicity
>MCV is higher (Bone marrow depression effect of chronic alcholism)
Conclusion:
> ACUTE alchoholic hepatitis
A 47 year-old man, who has been on hemodialysis for 5 years before he got his kidney
transplantation. He has little body hair, a large, protruding belly, slim extremities and gynecomastia.
Laboratory results:
ASAT: 85 U/l
ALAT: 76 U/l
prothrombin time: INR = 2.7; it does not change after vitamin K administration
albumin: 28 g/l
K+: 3.3 mmol/l
Ht: 0.36
What is the most likely diagnosis?
Clinical findings:
>large protruding belly -> ascites (cirrohosis)
>tits -> liver damage (dirsupted testerone synthesis due to alchohol or improper metabolism of estrogen due to cirrohosis)
Lab Findings:
>ASAT and ALAT are madly high -> parenchymal damage
> INR: liver damage
>Albumin: has decreased (due to decrease liver synthesis)
>K+: low due ascites as fluid leaves blood, decrease circ volume –> RAAS –> incr Aldosterone (LOW K+)
Conclusion:
- Cirrohosis
- either due to alchohol or hemodialysis (prone to HBV, HCV)
A 38 year-old woman complains of recurrent, sharp pain in the right upper quadrant of
her abdomen. She has been vomiting, has fever and jaundice.
Laboratory results:
serum bilirubin: 50 µmol/l, mostly direct
Ubg: negative
ASAT: 180 U/l
alkaline phosphatase: 640 U/l
What is the cause of her symptoms, and how can you prove the diagnosis?
Clinical findings: >sharp pain -> bililar obstruction >fever -> inflmm >jaundice -> hyperbilirubinemia all together -> CHOLANGITIS
Lab findings:
- Serum bilirubin high -> indicates biliary obstruction
- UBG -ve: no excretion cB into intestine
- ASAT -> parenchymal damage
- ALP high -> obstructive jaundice
Conclusion:
- clinical-> cholangitis
- lab -> bililar obstruction
Test:
-US TO SEE GALL STONES
A 25 year-old man has been icteric for a few days. His laboratory values: serum indirect bilirubin: 47 µmol/l serum direct bilirubin: 4 µmol/l ASAT: 18 U/l ALAT: 23 U/l alkaline phosphatase: 66 U/l Ht: 0.48 Hb: 162 g/l What is the cause of his jaundice? What further tests are necessary?
clinical:
>Icteric -> hyperbilirubinemia
Lab:
-indirect very high and direct is normal (so indicates problem with conjugation -> unconjugated bilirubinemia)
>ASAT AND ALAT GOOD
>ALP (150) so is normal
Conclusion:
mild jaundice and increasing uCB indicates conjugation problem.
Gilberts Diseases (defect in UGT)
Hemoglobin
m: 135-170
f: 120 - 170
. A 32 year-old man has been complaining of fatigue, malaise and a temperature for a
week. His liver is palpable ¾ of an inch below the ribs, it is a bit tender. His laboratory
results:
serum indirect bilirubin: 28 µmol/l
serum direct bilirubin: 24 µmol/l
Ubg: increased
ASAT: 870 U/l
ALAT: 1180 U/l
alkaline phosphatase: 310 U/l
What is the most likely diagnosis, and how can you prove it? What further tests are
necessary?
Clinical:
>palpable -> hepatomegaly
>Fatigue/malaise -> inflammation
Lab:
>nCB + CB is very high but total is not above 50 so mild jaundice
>UBG increased ->Indicates hepatocellular damage as liver takes up less
>ASAT AND ALAT incr -> acute hepatitis
>ALP increaed - indicates liver damage too (always present with acute hepatitis)
Conclusion:
acute liver damage (mushrooms, viral hepatitis)
Test:
> ab against Hep A /B
>PCR for Hep C
A 28 year-old woman. She is complaining of fatigue, malaise and nausia. Her laboratory results: serum total bilirubin: 45 µmol/l ALAT: 220 U/l alkaline phosphatase: 200 U/l γ-globulins: 33 g/l (↑) RF and ANA: positive What is the most likely diagnosis, and what tests should be done?
Clinical findings:
-malaise,fatigue,nausea -> inflammation
Lab Findings: >total bili = subiteric > ALAT incr ->Parenchymal damage >ALP incr -> parenchymal damage >gamma-globulins -> increased >ANA and RG -> autoimmune
Conclusion:
>autoimmune hepatitis
>also Hep B/C could be cause of appearance of autoABS
A 30 year-old woman, who is 164 cm tall, her body weight is 81 kg. She saw her doctor,
because she had noted a yellow discoloration of her skin accompanied by itching.
She mentions she has had unpleasant gastrointestinal symptoms after meals for a long time:
feeling full, having nausea. Physical examination reveals: yellow skin and sclera, spleen
is not palpable, liver enlarged by an inch. The right upper quadrant of her abdomen is
clearly sensitive on palpation. Laboratory findings:
serum bilirubin: 150 µmol/l
urine bilirubin: positive
Ubg: decreased
ASAT: 53 U/
alkaline phosphatase: 710 U/l
GGT: 390 U/l
What is the most likely diagnosis?
Clinical Findings:
>jaundice/itching/pain -> extrahepatic bililary obstruction
Lab findings:
>serum bilirubin very high: accompanied by bilirubinemia indicating obstructive/hepatocellular jaundice.
>urine bilirubin goes down: obstructive jaundice (as no CB get into intestine)
>ALP + GGT elevated -> indicates obstructive jaundice
>ASAT MODERATE
>OBESE
Conclusion:
high ALP and GGT is (OBSTRUCTIVE JAUNDICE DUE TO EXTRAHEPATIC BIL OBSTRUCTION)
cause:
1) Gall stones (esp cuz fat)
2) Tumour
Test:
US
A newborn baby is admitted to the hospital with a complaint of increasing jaundice.
The serum bilirubin is 160 µmol/l.
What can be the cause of the jaundice if this bilirubin is mainly:
1. direct, or
2. indirect reacting?
Clinical Findings:
>serum bilirubin is high -> Jaundice
Direct (conjugated) bilirubinemia:
1) Bililary Atresia: no hole in bile duct -> ob. jaundice
2) Hepatitis + Sepsis: esp in mums who has STD
3) Major Infxns -> also affect
Indirect (unconjugated) bilirubinemia:
1) Physiological: -breakdown of fetal rbc to replace with adult or IMMATURE liver (low conjugating capacity)
2) Impaired Conjugation: crigler najar (I: no congating, II: reduced expression of conjugating enzyme)
3) Erythroblastasis Foetalis:
