Hepatology
陳醫師
data異常一定要去看病人
Hyperglycemia->
可能是從D5W IV側抽血造成的
------------
AST
- 80% mitochondria
- Half-life 17 hrs
- Acute >10x
ALT
- Chronic
- Half-life 47 hrs
- Acute >10x
- Viral (>2000IU is very dangerous)
- Jaundice 70% HAV(good prognosis), 35%HBV, 25%HCV
- Mild fever通常是HAV，糞便要用lysol消毒，vaccination兩劑撐廿年，incubation 1mo，症狀出現之前糞便就有病毒
- HBV分八種genotype，華人常見BC, C outcome很差，不過genotype在biofunction沒有甚麼實際差異。疫苗要>10IU/ml才有保護力。Anti-Hbe spontaneous seroconversion 10-20% annually. Adult得的<5% 變carrier
HBsAg
|
HBsAb
|
HBeAg
|
HBcAb
|
HBV DNA
|
|
Acute
|
+
|
-
|
+
|
IgM
|
+
|
Clerared
infection
|
-
|
+
|
-
|
IgG
|
-
|
vaccinated
|
-
|
+
|
-
|
-
|
-
|
Inactivated
carrier
|
+
|
-
|
-
|
IgG
|
<2000IU/ml
|
Chronic
infection with active replication
|
+
|
-
|
+/-
|
IgG
|
>2000IU/ml
|
- HCV 80%會變成carrier, asymptomatic,
- HEV: High risk for pregnancy->fulminant hepatic failure. Window period 6-8 weeks.
- Ischemia
- Toxin/drug (3000IU是正常的，排除underlying就OK) Ex: statin (2.5% population)
- Autoimmune
- Type 1
- ANA (Cytoplasmic); anti nuclear antibody
- ASMA; anti smooth muscle antibody
- AAA; anti actin antibody
- Type 2
- ALKM1; anti liver kidney microsomal I antibody
- ALCM; anti liver cytosol 1 antibody
Ref.周貝倫 自體免疫性肝炎 - Taiwan Society of Internal Medicine http://www.tsim.org.tw/journal/jour20-3/03.PDF
- Early phase of obstruction (jaundice & pain)
- PBC; Primary Biliary Cirrhosis: AMA
- PSC; Primary Sclerosing Cholangitis
- Gallstones, CBD stones, pancreatic cancers
- AST/ALT 3-5X
- NASH; non-alcoholic steatohepatitis
- 不一定fat有關，可能跟biofilm有關
- 可能變成HCC
- Asymptomatic
- Gilbert syndrome
- 2-10% population
- Unconjugated bilirubin levels fluctuate
- No risk of kernicterus to the fetus (不用浪費錢驗bilirubin)
- R/o hemolysis
- Wilson's disease
- Low Ceruloplasmin (homozygous 65-95%, heterozygous 20%)
Factors
- BMI
- Exercise: Independent AST↑
- Hemolysis: AST↑ ALT↑ Red urine, Occult blood, pale face, dizziness
- Rhabdomyolysis: AST↑ ALT↑ Red urine, Occult blood(-), pale face(-)
------------
Gamma GT
- Confirm ALP↑ due to hepatic source
- Alcohol
- Drugs: statin
- BMI
- steatohepatitis (一般視為正常人)
ALP
- Liver and bone
- BMI, pregnancy
- Marker of cholestasis
- Half-life 1 week
- 可以用ALP isoenzyme (很貴), 5-NT, gamma GT 驗證
Conjugation
Bilirubin
- Exercise
- Hemolysis
- Hemolytic anemia
INR
Thrombocytopenia
- Liver fibrosis
Albumin
- Half-life 19-21 days
- Nephrotic syndrome
- Burns
- Enteropathy
- SIRS
------------
ALP
|
AST
|
ALT
|
GGT
|
T-bil
|
TP
|
Albumin
|
|
Hepatocellular
pattern
|
-
|
↑
|
↑
|
-
|
|||
Cholestatic
pattern
|
↑
|
-
|
-
|
↑
|
|||
Mixed
pattern
|
↑
|
↑
|
↑
|
↑
|
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對於無症狀的人，做預防醫學
抽Anti-Hbs IgG, anti-HCV, Anti-HAV IgG
------------
對於 RUQ pain, jaundice, fever, AST/ALT>1000 U/L
抽Anti-Hbc IgM, HbsAg, Anti-HAV IgM, anti-HCV (rare acute onset)
抽Anti-Hbc IgM, HbsAg, Anti-HAV IgM, anti-HCV (rare acute onset)
