Laboratory examination of liver · Urobilin Stercobilin Increased non-conjugated bilirubin in blood...
Transcript of Laboratory examination of liver · Urobilin Stercobilin Increased non-conjugated bilirubin in blood...
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
LaboratoryLaboratory examinationexamination ofof liverliver
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
BilirubinBilirubin
Hem
Biliverdin
Bilirubinnon-conjugated
Bilirubinconjugated
UrobilinogenStercobilinogen
Urobilin
Stercobilin
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
IcterusIcterus
�� PrePre--hepatichepatic
–– HemolysisHemolysis
�� HepatocellularHepatocellular
–– LiverLiver damagedamage
�� PostPost--hepatichepatic
–– ObstructionObstruction ofof biliarybiliary tracttract
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
PrePre--hepatichepatic icterusicterus
Hem
Biliverdin
Bilirubinnon-conjugated
Bilirubinconjugated
UrobilinogenStercobilinogen
Urobilin
Stercobilin
Increased non-
conjugatedbilirubin in blood
Increasedurobilinogen
in urine
Dark faeces
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
HepatocellularHepatocellular icterusicterus
Hem
Biliverdin
Bilirubinnon-conjugated
Bilirubinconjugated
UrobilinogenStercobilinogen
Urobilin
Stercobilin
××
×
Increased non-conjugated bilirubin in
blood
Increasedconjugatedbilirubin in
blood
Increasedurobilinogen
in urine
Bilirubin in
urine, darkurine
Pale faeces
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
PostPost--hepatichepatic icterusicterus
Hem
Biliverdin
Bilirubinnon-conjugated
Bilirubinconjugated
UrobilinogenStercobilinogen
Urobilin
Stercobilin
×
Bilirubin in urine, dark
urine
Acholicfaeces
Increasedconjugated
bilirubin in blood
No urobilinogen
in urine
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
IcterusIcterus
NonNon
conjconj. .
SS--BiBiConjConj. .
SS--BiBi UU--BiBi UU--UBGUBG UrineUrine FaecesFaeces
PrePre--hepatichepatic ↑↑↑↑ ●● ●● ↑↑
HepatocellularHepatocellular ↑↑↑↑ ↑↑↑↑ ↑↑↑↑ ↑↑
PostPost--hepatichepatic ((↑↑)) ↑↑↑↑ ↑↑↑↑ --
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
BloodBlood markersmarkers ofof liverliver damagedamage
�� Bilirubin (Bilirubin (conjconj., ., nonnon--conjconj.).)
�� TransaminasesTransaminases
–– AlanineAlanine aminotransferaseaminotransferase (ALT)(ALT)
–– AspartateAspartate aminotransferaseaminotransferase (AST)(AST)
�� ObstructiveObstructive enzymesenzymes
–– AlkalineAlkaline phosphatasephosphatase (ALP)(ALP)
–– γγ--glutamylglutamyl transferasetransferase (GGT)(GGT)
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
ALT & ASTALT & AST
�� ALT: in ALT: in cytoplasmcytoplasm
�� AST: AST: cytoplasmcytoplasm, , mitochondriamitochondria
�� AST > ALT AST > ALT …… necrosisnecrosis ofof
hepatocyteshepatocytes
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
ALT & ASTALT & AST
�� AlsoAlso in in otherother organsorgans
–– AST: AST: heartheart!!
–– MuscleMuscle
–– LungsLungs
–– KidneyKidney
–– ……
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
EstimationEstimation ofof ALT ALT andand ASTAST
�� IndirectIndirect WarburgWarburg opticaloptical testtest
�� ALT: ALT: coupledcoupled withwith
lactatelactate dehydrogenasedehydrogenase
�� AST: AST: coupledcoupled withwith
malatemalate dehydrogenasedehydrogenase
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
EstimationEstimation ofof ALTALT
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
EstimationEstimation ofof ASTAST
NH2
CH COOHH2C
O
C COOHH2C
H2CHOOC
2-oxoglutarate
Ast
NH2
CH COOHH2C
H2CHOOC
oxaloacetate
Glu
NADH + H+ NAD+
HOOC
O
C COOHH2CHOOC
oxaloacetate
O
C COOHH2CHOOC
malate
OH
CH COOHH2CHOOC
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
AlkalineAlkaline phosphatasephosphatase (ALP)(ALP)
�� BiliaryBiliary obstructionobstruction
�� OtherOther isoformsisoforms
–– BonesBones
–– PlacentaPlacenta
–– IntestineIntestine
�� IncreasedIncreased alsoalso in in somesome tumorstumors
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
γγ--glutamylglutamyl transferasetransferase (GGT)(GGT)
�� BiliaryBiliary obstructionobstruction
�� ToxicToxic injuryinjury
–– AlcoholAlcohol
–– CytostaticsCytostatics, , antimicrobialantimicrobial drugsdrugs etc.etc.
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
GeneralGeneral signssigns ofof liverliver damagedamage
�� JaundiceJaundice
�� DisordersDisorders ofof bloodblood coagulationcoagulation
–– ExcessiveExcessive bleedingbleeding
–– ThromboticThrombotic disordersdisorders
�� HypoproteinemiaHypoproteinemia
–– SwellingsSwellings
–– AscitesAscites
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
ExaminationExamination ofof liverliver functionfunction
�� „„Liver testsLiver tests““
–– BilirubinsBilirubins, ALT, AST, ALP, G, ALT, AST, ALP, GGGTT
�� Urine Urine –– bilirubin, bilirubin, urobilinogenurobilinogen
�� CoagulationCoagulation parametersparameters
�� BloodBlood proteinsproteins
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
CholineCholine esterase (esterase (ChSChS))
�� Degrades esters of Degrades esters of cholinecholine
�� HepatocytesHepatocytes →→ bloodblood
�� ↓↓ ChSChS = = ↓↓ proteosynthesisproteosynthesis
–– hepatopathyhepatopathy
–– starvationstarvation, , malnutritionmalnutrition
–– …… ((intoxicationintoxication withwith organophosphatesorganophosphates……))
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
CarbohydrateCarbohydrate defficientdefficienttransferrintransferrin (CDT)(CDT)
�� TransferrinTransferrin
–– glycoproteinglycoprotein
–– 4 to 6 4 to 6 residuesresidues ofof sialicsialic acidacid
�� AlcoholAlcohol abuse:abuse:
increasedincreased proportionproportion ofof lessless glycatedglycated
transferrintransferrin = CDT (> 6 %)= CDT (> 6 %)
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
CasuistryCasuistry 11
BiBi tottot.. 55.455.4 TotalTotal proteinprotein 6868
BiBi conjconj.. 19.119.1 AlbumineAlbumine 2121
ALTALT 2.192.19
ASTAST 1.681.68
GGGGTT 29.5929.59
ALPALP 1.191.19
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
CasuistryCasuistry 22
BiBi tottot.. 28.328.3 HbHb 5757
BiBi conjconj.. 1.71.7
ALTALT 0.130.13
ASTAST 0.410.41
GGGGTT 0.390.39
ALPALP 1.181.18
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
CasuistryCasuistry 33
BiBi tottot.. 79.679.6 UU--BiBi pospos..
BiBi conjconj.. 66.266.2 UU--UbgUbg negneg..
ALTALT 2.132.13
ASTAST 1.761.76
GGGGTT 24.624.6
ALPALP 18.418.4
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
CasuistryCasuistry 44
BiBi tottot.. 36.836.8
BiBi conjconj.. 2.82.8
ALTALT 0.760.76
ASTAST 0.540.54
GGGGTT 3.123.12
ALPALP 1.161.16
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
ExaminationExamination ofof pancreaspancreas
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
BiochemicalBiochemical examinationexamination ofofpancreaspancreas
�� LysisLysis ofof pancreaticpancreatic cellscells
((αα--amylase, lipase)amylase, lipase)
�� EndocrineEndocrine functionfunction
�� ExocrineExocrine functionfunction
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
αα--amylase (AMS)amylase (AMS)
�� PancreasPancreas
–– PP--isoenzymeisoenzyme
�� SalivarySalivary glandgland
–– SS--isoenzymeisoenzyme
�� BothBoth isoenzymesisoenzymes cancan bebedistinguisheddistinguished by by immunochemicalimmunochemicaltechniquestechniques
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
αα--amylase (AMS)amylase (AMS)
�� SmallSmall protein (MW = 50 000)protein (MW = 50 000)
�� ElevationElevation
–– damagedamage to to producingproducing glandsglands
–– impairedimpaired eliminationelimination by by kidneyskidneys
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
αα--amylase (AMS)amylase (AMS)
�� in in serumserum (S(S--AMS)AMS)
–– shortshort halfhalf--lifelife (6 (6 –– 12 h)12 h)
–– returnsreturns to to normalnormal in 3 in 3 daysdays
�� in urinein urine
–– laterlater
–– higherhigher activityactivity
�� in in asciticascitic fluidfluid
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
αα--amylase (AMS)amylase (AMS)
↑ S-AMS
↑ U-AMS
↓ U-AMS
P-isoenzyme – damage to pancreas
S-isoenzyme – damage to salivarygland
renal insufficiency
macroamylasemia
Racek J
. et
al.: K
linic
ká
bio
chem
ie. 2
nd
Ed., G
alé
n, P
raha 2
006
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
PancreaticPancreatic lipaselipase
��SpecificSpecific forfor pancreaspancreas
��More sensitive More sensitive thanthan AMSAMS
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
OtherOther markersmarkers ofof acuteacute pancreatitispancreatitis
�� ↓↓ SS--CaCa
Pancreatic lipase
Release of fatty acids
Fatty acids bind Ca
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MUDr. Martin Vejražka
Ústav lékařské biochemie 1. LF UK
ExaminationExamination ofof exocrineexocrinepancreaticpancreatic functionfunction
�� DuodenalDuodenal juicejuice afterafter stimulationstimulation withwith
secretinsecretin & & cholecystokinincholecystokinin
–– volume, volume, pHpH, HCO, HCO33--, amylase, lipase, , amylase, lipase,
trypsintrypsin
�� ChymotrypsinChymotrypsin andand elastase in elastase in faecesfaeces
�� BreathBreath teststests withwith 1313CC--triglyceridestriglycerides