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Difference between revisions of "Medical liver disease"
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Liver neoplasms are dealt with in the ''[[liver neoplasms]]'' article. | Liver neoplasms are dealt with in the ''[[liver neoplasms]]'' article. | ||
=Review of liver blood work= | |||
===Inflammation activity=== | |||
*ALT. | |||
*AST. | |||
===Cholestatic markers=== | |||
*ALP. | |||
*GGT - used to assess whether the ALP is an "honest" value, elevated in cirrhosis. | |||
===Cirrhosis/decompensation=== | |||
*PLT - low is suggestive of dysfunction. | |||
*INR - high is bad, unless anticoagulated. | |||
===Other=== | |||
*Bilirubin. | |||
**Direct (AKA conjugated). | |||
**Indirect (AKA unconjugated). | |||
A short DDx of elevated:<ref>{{Ref PCPBoD8|441}}</ref> | |||
*Indirect: | |||
**[[Gilbert syndrome]]. | |||
**Crigler-Najjar syndrome type 1. | |||
**Crigler-Najjar syndrome type 2. | |||
*Direct: | |||
**Rotor syndrome. | |||
**Dubin-Johnson syndomre. | |||
===Viral hepatitis=== | |||
*HBV DNA. | |||
*HCV RNA. | |||
*HBs Ag, HBs Ab, HBe Ag, HBe Ab. | |||
*HCV Ab. | |||
Others: | |||
*[[Epstein-Barr virus]] (EBV). | |||
*[[Cytomegalovirus]] (CMV) - especially in the immune incompetent. | |||
====Hepatitis B==== | |||
Meaning & utility of the various [[Hepatitis B]] tests:<ref>URL: [http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/hepatitis-B/ http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/hepatitis-B/]. Accessed on: 16 May 2011.</ref><ref name=lto_hepb>URL: [http://www.labtestsonline.org/understanding/analytes/hepatitis_b/test.html http://www.labtestsonline.org/understanding/analytes/hepatitis_b/test.html]. Accessed on: 16 May 2011.</ref> | |||
{| class="wikitable sortable" border="1" | |||
! Test name | |||
! Location | |||
! Positive test | |||
! Negative test | |||
! Usual question | |||
|- | |||
| HBs Ag||Surface||Virus active||No active infection||Active infection? | |||
|- | |||
| HBs Ab||Surface||Exposed OR vaccinated||No exposure OR no vaccine OR loss of Ab||Immunization status? | |||
|- | |||
| HBe Ag||Virus core||Infect. w/ viral replication||No active infection||Active infect. w/ viral replication? | |||
|- | |||
| HBe Ab||Virus core||Exposed to virus||Infect. w/o antibody response OR not exposed||Immune response to infection? | |||
|- | |||
| HBV DNA||-||Active||Not active/no exposure||Viral load/how active? | |||
|- | |||
| HBc Ab||Virus core||Virus active/previous exposure||No exposure||Early active infection? | |||
|} | |||
Notes: | |||
*''HBc Ab'' may test for acute (IgM) or chronic infection - dependent on specific antibody test; it is often used to look for early infection.<ref name=lto_hepb>URL: [http://www.labtestsonline.org/understanding/analytes/hepatitis_b/test.html http://www.labtestsonline.org/understanding/analytes/hepatitis_b/test.html]. Accessed on: 16 May 2011.</ref> | |||
*''Carriers of hepatitis B'': HBs Ag +ve, HBs Ab -ve, HBc Ag -ve, HBc Ab +ve, HBe Ag -ve, HBe Ab +ve.<ref>URL: [http://labtestsonline.org/understanding/analytes/hepatitis-b/tab/test http://labtestsonline.org/understanding/analytes/hepatitis-b/tab/test]. Accessed on: 3 May 2012.</ref> | |||
===Markers for rare liver diseases=== | |||
*Ceruloplasm - low think ''[[Wilson's disease]]''; typical value for Wilson's ~ 0.12 g/L. | |||
**<0.20 g/L is a criteria for Wilson's disease.<ref name=pmid18556333>Diagnostic accuracy of serum ceruloplasmin in Wilson disease: determination of sensitivity and specificity by ROC curve analysis among ATP7B-genotyped subjects. Mak CM, Lam CW, Tam S. Clin Chem. 2008 Aug;54(8):1356-62. Epub 2008 Jun 12. PMID 18556333. URL: [http://www.clinchem.org/cgi/reprint/54/8/1356.pdf http://www.clinchem.org/cgi/reprint/54/8/1356.pdf]. Accessed on: 28 September 2009.</ref> | |||
*Alpha-1 antitrypsin - if low think ''deficiency''. | |||
===Hemosiderosis=== | |||
*Ferritin - high. | |||
*Iron saturation - high. | |||
Causes: | |||
*Hemochromatosis. | |||
*Hemolysis, chronic. | |||
*Cirrhosis. | |||
=Medical imaging= | |||
Blood flow:<ref>URL: [http://insidesurgery.com/2010/12/hepatopedal-hepatofugal-flow/ http://insidesurgery.com/2010/12/hepatopedal-hepatofugal-flow/]. Accessed on: 2 December 2011.</ref> | |||
*Hepatopedal flow = normal portal vein flow. | |||
*Hepatofugal flow = reversed portal vein flow. | |||
==Interventional measurements== | |||
Wedged to free hepatic venous pressure:<ref name=pmid1864548>{{Cite journal | last1 = Bion | first1 = E. | last2 = Brenard | first2 = R. | last3 = Pariente | first3 = EA. | last4 = Lebrec | first4 = D. | last5 = Degott | first5 = C. | last6 = Maitre | first6 = F. | last7 = Benhamou | first7 = JP. | title = Sinusoidal portal hypertension in hepatic amyloidosis. | journal = Gut | volume = 32 | issue = 2 | pages = 227-30 | month = Feb | year = 1991 | doi = | PMID = 1864548 | PMC = 1378815 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1378815/?tool=pubmed }}</ref> | |||
*Normal = 1-4 mmHg. | |||
**Elevated in [[portal hypertension]]. | |||
=Viral hepatitis= | =Viral hepatitis= | ||