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1. Jaundice Dr George Alexander Consultant Gastroenterologist and Hepatologist Columbia Asia Hospital
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6. Obstruction vs. Liver Disease AST/ALT relative to ALP PT not corrected with Vit K, Serology Predominant ALP relative to AST/ALT. PT normalizes with vit K, amylase Lab studies Stigmata of PHT, spider angioma Fever, abd tenderness, abd mass, abd scar Physical Examn Anorexia,malaise, prodrome, drugs or hepatotoxin, transfusion, family h/o Pain, Fever, Prior biliary surgery, older age History Liver Disease Biliary Obstruction
12. Aminotransferases Leakage from damage tissues Mild to moderate elevation: many types of liver disease Marked elevations : hepatitis (Viral, toxic, autoimmune, ischemic) AST/ALT > 2 suggests ALD or Cirrhosis ALT more specific than AST for hepatic injury AST : skeletal muscle, RBC, kidney, myocardium Basis of Abnormality Extrahepatic Origin Associated Liver Disease
13. Alkaline Phosphatase Overproduction and leakage into serum Moderate elevation: many types of liver disease Marked elevations : Cholestases (extra and intra hepatic, infiltration) rarely alcoholic hepatitis Bone growth or disease, placenta, intestine, tumors Basis of Abnormality Extrahepatic Origin Associated Liver Disease
14. GGTP Overproduction and leakage into serum Same as AP Induced by ethanol and drugs Kidney , spleen, pancreas, lung, brain Basis of Abnormality Extrahepatic Origin Associated Liver Disease
15. Prothrombin Time Decreased synthetic capacity Acute or chronic liver failure (PT unresponsive to Vit K) Biliary obstruction (PT responsive to Vit K) Vit K deficiency : Malabsorption, malnutrition, antibiotics Consumptive coagulopathy Basis of Abnormality Extrahepatic Origin Associated Liver Disease
16. Albumin Decreased synthesis Chronic Liver Disease Reduced in nephrotic syndrome, protein losing enteropathy, vascular leak , malnutrition, malignancy, infections, inflammation Basis of Abnormality Extrahepatic Origin Associated Liver Disease
17. Patterns in Liver Disease Usually N Usually normal Decreased in subacute, chronic Albumin Normal Prolonged, responsive Prolonged, unresponsive to Vit K PT 1-5 x 1-5 x 1-30 x 1-30 x 1-30 x 1-5 x Bilirubin 1-20 x 2-10 x 2-20 x 1-10 x 1-3 x 1-3 x ALP 1-3 x 1-5 x 1-5 x 2-5 x 5-50 x 50-100 x ALT,AST Primary, Mets, TB Hilar, PSC Ca Pancr Alc Hep HAV, HBV ACT, isch E.g.. Infiltration Partial Complete Alcohol Viral hep Toxin,isch Etiology Infiltr. Biliary Obstr. Hepatocyte Necrosis
18. Patterns in Liver Disease Usually N Usually normal Decreased in subacute, chronic Albumin Normal Prolonged, responsive Prolonged, unresponsive to Vit K PT 1-5 x 1-5 x 1-30 x 1-30 x 1-30 x 1-5 x Bilirubin 1-20 x 2-10 x 2-20 x 1-10 x 1-3 x 1-3 x ALP 1-3 x 1-5 x 1-5 x 2-5 x 5-50 x 50-100 x ALT,AST Primary, Mets, TB Hilar, PSC Ca Pancr Alc Hep HAV, HBV ACT, isch E.g.. Infiltration Partial Complete Alcohol Viral hep Toxin,isch Etiology Infiltr. Biliary Obstr. Hepatocyte Necrosis
19. Patterns in Liver Disease Usually N Usually normal Decreased in subacute, chronic Albumin Normal Prolonged, responsive Prolonged, unresponsive to Vit K PT 1-5 x 1-5 x 1-30 x 1-30 x 1-30 x 1-5 x Bilirubin 1-20 x 2-10 x 2-20 x 1-10 x 1-3 x 1-3 x ALP 1-3 x 1-5 x 1-5 x 2-5 x 5-50 x 50-100 x ALT,AST Primary, Mets, TB Hilar, PSC Ca Pancr Alc Hep HAV, HBV ACT, isch E.g.. Infiltration Partial Complete Alcohol Viral hep Toxin,isch Etiology Infiltr. Biliary Obstr. Hepatocyte Necrosis
20. Patterns in Liver Disease Usually N Usually normal Decreased in subacute, chronic Albumin Normal Prolonged, responsive Prolonged, unresponsive to Vit K PT 1-5 x 1-5 x 1-30 x 1-30 x 1-30 x 1-5 x Bilirubin 1-20 x 2-10 x 2-20 x 1-10 x 1-3 x 1-3 x ALP 1-3 x 1-5 x 1-5 x 2-5 x 5-50 x 50-100 x ALT,AST Primary, Mets, TB Hilar, PSC Ca Pancr Alc Hep HAV, HBV ACT, isch E.g.. Infiltration Partial Complete Alcohol Viral hep Toxin,isch Etiology Infiltr. Biliary Obstr. Hepatocyte Necrosis
21. Patterns in Liver Disease Usually N Usually normal Decreased in subacute, chronic Albumin Normal Prolonged, responsive Prolonged, unresponsive to Vit K PT 1-5 x 1-5 x 1-30 x 1-30 x 1-30 x 1-5 x Bilirubin 1-20 x 2-10 x 2-20 x 1-10 x 1-3 x 1-3 x ALP 1-3 x 1-5 x 1-5 x 2-5 x 5-50 x 50-100 x ALT,AST Primary, Mets, TB Hilar, PSC Ca Pancr Alc Hep HAV, HBV ACT, isch E.g.. Infiltration Partial Complete Alcohol Viral hep Toxin,isch Etiology Infiltr. Biliary Obstr. Hepatocyte Necrosis
22. Patterns in Liver Disease Usually N Usually normal Decreased in subacute, chronic Albumin Normal Prolonged, responsive Prolonged, unresponsive to Vit K PT 1-5 x 1-5 x 1-30 x 1-30 x 1-30 x 1-5 x Bilirubin 1-20 x 2-10 x 2-20 x 1-10 x 1-3 x 1-3 x ALP 1-3 x 1-5 x 1-5 x 2-5 x 5-50 x 50-100 x ALT,AST Primary, Mets, TB Hilar, PSC Ca Pancr Alc Hep HAV, HBV ACT, isch E.g.. Infiltration Partial Complete Alcohol Viral hep Toxin,isch Etiology Infiltr. Biliary Obstr. Hepatocyte Necrosis
23. Patterns in Liver Disease Usually N Usually normal Decreased in subacute, chronic Albumin Normal Prolonged, responsive Prolonged, unresponsive to Vit K PT 1-5 x 1-5 x 1-30 x 1-30 x 1-30 x 1-5 x Bilirubin 1-20 x 2-10 x 2-20 x 1-10 x 1-3 x 1-3 x ALP 1-3 x 1-5 x 1-5 x 2-5 x 5-50 x 50-100 x ALT,AST Primary, Mets, TB Hilar, PSC Ca Pancr Alc Hep HAV, HBV ACT, isch E.g.. Infiltration Partial Complete Alcohol Viral hep Toxin,isch Etiology Infiltr. Biliary Obstr. Hepatocyte Necrosis
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