Tietze Chapter 5 (GI)

2 mg/dL.

A patient is generally visibly jaundiced if the bilirubin level is higher than

Total bilirubin - (direct + indirect bilirubin)

Delta bilirubin formula

Alkaline phosphatase

It is elevated in biliary cirrhosis, cirrhosis, and intrahepatic bile duct disease.

• 0-35 units/L

• Serum

Biliary system

• Alanine aminotransferase RR

• 30-120 units/L

• Serum

Biliary system

• Alkaline phosphatase RR

• 10-80 mcg/dL

• Plasma

Biliary system

• Ammonia RR

• 0-35 units/L

• Serum

Biliary system

• Aspartate aminotransferase RR

Direct Bilirubin

It is water-soluble conjugated posthepatic bilirubin. It is increased in biliary disease (e.g., extrahepatic bile duct obstruction, physical impairment of bile flow, impaired bile transport) and some liver disease (e.g., hepatitis, cirrhosis, hepatic neoplasm

Delta Bilirubin

It is albumin-bound conjugated bilirubin. The level of delta bilirubin is a calculated value It is metabolically inactive and is cleared slowly from the body. Its level is increased in biliary obstruction and some liver disease.

Indirect bilirubin

It is unconjugated bilirubin. Its level is increased in hemolytic anemia (rapid, severe hemolysis) and some liver disease

Total Bilirubin

It is the sum of all three forms of bilirubin (direct bilirubin, indirect bilirubin, and delta bilirubin). It is increased in hepatic and hemolytic diseases.

• 0.3-1 mg/dL

• Serum

Bilirubin

• Total RR

• 0.1-0.3 mg/dL

• Serum

Bilirubin

• Direct RR

• 0.2-7 mg/dL

• Serum

Bilirubin

• Indirect RR

Ammonia

The liver synthesizes urea from ammonia. Serum — level is increased if the liver is damaged or if blood flow is compromised.

Hepatic Encephalopathy

Although serum ammonia level is not used as a routine screening test, it is sometimes performed to confirm a diagnosis of —.

Albumin

The liver manufactures many different proteins. The serum levels of - and the vitamin K–dependent clotting factors are commonly used to assess hepatic synthetic function.

serum Protein

Although circulating albumin takes several weeks to clear from the body, a rapidly declining — level indicates greatly impaired hepatic synthetic function.

serum Protein

Longstanding liver disease is associated with very low - concentrations.

vitamin K– dependent clotting factors

Lack of production of the __ prolongs the prothrombin time (PT) and activated partial thromboplastin time (aPTT). The PT is prolonged earlier than the aPTT and often is used as an early indicator of impaired hepatic synthetic function.

PT and aPTT

Both the -are prolonged in longstanding severe hepatic dysfunction.

• 3.5-5.5 g/dL

• Serum

Protein

• Albumin RR

• 2.0-3.5 g/dL

• Serum

Protein

• Globulin RR

• 5.5-8.0 g/dL

• Serum

Protein

• Total RR

• 11-13 sec

• Plasma

Prothrombin Time PT RR

• 22-35 sec

• Plasma

Activate partial thromboplastin time aPTT RR

Alanine aminotransferase (ALT

—) is found in high concentrations in hepatocytes and is considered a specific marker of hepatocellular damage.

Aspartate aminotransferase (AST)

It is found in hepatocytes, myocardial muscles, skeletal muscle, the brain, and the kidneys. It is used as a nonspecific marker of hepatocellular damage.

Gamma glutamyl transpeptidase.

It is elevated in most hepatocellular and hepatobiliary disease, although elevations correlate better with obstructive disease than with pure hepatocellular damage.

Lactate dehydrogenase.

Elevations occur during shock syndrome (marked changes in circulation) and in diseases associated with hepatocellular damage (hepatitis, cirrhosis, inflammatory disease, and infiltrative disease).

• 1-94 units/L

• Serum

Gamma Gultamyl Transpeptidase GGT RR

• 100-190 units/L

• Serum

LDH RR

• 1-7 g/day

• Stool

Stool fat RR

Black

What stools may indicate upper gastrointestinal tract bleeding; however, iron therapy may produce a similar color.

Gray stools

What stools are generally associated with steatorrhea;

Light gray

What stools may indicate bile duct obstruction.

Watery stools

What stools are indicative of rapid gastrointestinal tract transit and malabsorption syndromes.

Hard stools

What stools may indicate dehydration.

Blood

The presence of obvious — in the stool indicates colonic bleeding.

Occult blood

—, present in both upper and lower gastrointestinal tract bleeding, may be detected for several weeks after gastrointestinal tract bleeding.

WBC

The presence of it in stool is associated with a variety of infectious processes and inflammatory bowel disease.

Carcinoembryonic antigen

It is 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.

Alpha fetoprotein

It 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.