Gg Hepatobilier

8/17/2019 Gg Hepatobilier

1/47

PEMERIKSAANLABORATORIUM SISTEM

GASTRO INTESTINAL

Indriani SilviaFK UNSWAGATI

26 April 2016


2/47

LEARNING OBJECTIVES

mamp m!n"!la#$and!%ni#i dan &"an

p!m!ri$#aanla'(ra&(rim #i#&!m

)a#&r( in&!#&inal

Mamp m!n"!la#$an&ip! dan prin#ip

p!m!ri$#aanla'(ra&(rim #i#&!m

)a#&r( in&!#&inal

M!ma*ami in&!rpr!&a#i*a#il p!m!ri$#aan

la'(ra&(rim

#i#&!m )a#&r( in&!#&inal


3/47

ANATOMI +ATI


4/47


5/47

FUNGSI +EPAR

Hepar organ berukuran terbesar

organ interna paling kompleks

Seluruh darah dari intestin dan pankreas heparmelalui sistem vena porta

Hepar organ multifungsi banyak fungsi tubuh

1, Fn)#i M!&a'(li$

karbohidrat, lemak, protein, mineral dan vitamin

2, Fn)#i E$#$r!#i

pigmen empedu, garam empedu, kolesterolekskresi [pigmen empedu] intestin


6/47

-, Fn)#i pr(&!$&i. dan /!&($#i%$a#i

Sel Kupfer hepar fagositosis benda asing

Contoh amonia didetoksikasi menjadibentuk urea dan dimetabolisme xenobiotikdetoksikasi!

klirens hormon insulin, hormon paratiroid

"#H!, estrogen, kortisol

, Fn)#i +!ma&(l()i dan Sin&!#i#

•. pembentukan sel darah saat embrio!•. sintesis of protein plasma albumin, protrombin!,

hormon seperti angiotensinogen, insulin-likegrowth factor $%&! dan triiodotironin

•. destruksi eritrosit Bilir'in!


7/47

, Fn)#i p!nimpanan

glikogen, vitamins ', ( dan )*+

6, En3im #!rm penanda kerusakan hepar


8/47

Hepatic uptake of bilirubin

and production of bile


9/47

TES FUNGSI

+EPATOBILIER in&!rpr!&a#i ri#i$( .a$&(r4 )!"ala $lini#4 .a$&(rp!n!r&a4 p!m!ri$#aan %#i$

m!n))am'ar$an adana )an))an *!pa&('ili!r&, $r(ni#

*ar# dii$&i !vala#i5m(ni&(rin)

&iap la'(ra&(rim nilai n(rmal '!r'!da


10/47

.

Roberts E A , Sarkar B Am J Clin Nutr 2008;88:851S85!S©2008 by American Society for Nutrition


11/47

S&r$&r S'#!ll!r +!par


12/47

BILIRUBIN

N(rmal $adar 'ilir'in #!rm

#otal bilirubin - . */ µmol01

Conjugated bilirubin0direk0glukuronida

2 . - µmol01

3n4onjugated bilirubin0indirek0kompleks bilirubin 5 albumin0bilirubin

hingga *+ µmol01


13/47

BILIRUBIN SERUM /INILAIMENGGUNAKAN REAKSI AN/EN BERG+

"rinsip pemeriksaan

asam sulfanilat dalam HCl dan sodium nitrat 6 bilirubin

a7obilirubin n)!


14/47

BILIRUBIN SERUM METO/E AN/EN BERG+

Conjugated bilirubin segera n) van den )ergh positif

Unconjugated bilirubin 6 alkohol n)

p(#i&i. indir!$ )ila kadar conjugated 8 unconjugated bilirubin9 segera n)

6 'lkohol intensitas n) 9 bifasik


15/47

Pr(d$#i 'ilir'in


16/47

$!)naan• sensitif, metode

noninvasif untukskrining disfungsi hati

• menggambarkanadanya jenis gangguanhati

• menilai keparahandisfungsi hati

• dilakukan setelah

ditentukan dugaanetiologi penyakit hati

$!$ran)an• sensitivitas :

;ilai normal pada

kelainan hati yang

berat

• tidak spesik untukdisfungsi hati

• jarangmenggambarkandiagnosis spesik

TES FUNGSI +ATI


17/47

TES FUNGSI +ATILiv!r 7*!mi#&r&!#&

8lini7al impli7a&i(n (. a'n(rmali&

ALT +!pa&(7!lllar dama)!

AST +!pa&(7!lllar dama)!

Bilir'in 8*(l!#&a#i#4 impair 7(n")a&i(n4 (r 'iliar('#&r7&i(n

ALP 8*(l!#&a#i#4 in%l&ra&iv! di#!a#!4 (r 'iliar('#&r7&i(n

PT Sn&*!&i7 .n7&i(n

Al'min Sn&*!&i7 .n7&i(n

GGT 8*(l!#&a#i# (r 'iliar ('#&r7&i(n

Bil! a7id# 8*(l!#&a#i# (r 'iliar ('#&r7&i(n

9:n7l!(&ida#! 8*(l!#&a#i# (r 'iliar ('#&r7&i(n

L/+ +!pa&(7!lllar dama)!4 n(& #p!7i%7


18/47

TES FUNGSI +ATI"il#

$times%

"o#erate

$times%

"arke#

$times%

AS& '2( 2( to 20 )20

A*& '2( 2( to 20 )20

A*+ '1.52 1.52 to 5 )5

& '2( 2( to 10 )10


19/47

TES FUNGSI +ATI

$la#i%$a#i.n)#i #in&!#i# al'min4 PT

$!r#a$an #!l ; "arin)an *!pa&i$AST4 ALT

$(l!#&a#i# 'ilir'in4 ALP4 GGT

protro!bin ti!e4al'min4 'ilir'in

Pr()n(#i#


20/47

ALBUMIN dip!n)ar*in&ri#i4 #&a&# v(lm!4 in&!)ri&a# va#$lar4$a&a'(li#m!4 *(rm(n4 !$#$r!#i rin ; .!#!#

&ida$ #p!#i%$ n&$ $!lainan *a&i

& 152 1?:21 *ari B$an indi$a&(r '!rma$na n&$ $!lainan *a&i an) a$&


21/47

PEMERIKSAAN BILIRUBIN URIN 3rin bilirubin

)ilirubin oksidasi 6 3< biliverdin

A,P!r7('aan B#a

= ml urin segar dalam tabung di4ampurgerakan

kuat! bilirubin 6 kuningbilirubin 5 putih0kuning muda

6 palsu[urobilin] :

akri>avin, piridium


22/47

PEMERIKSAAN BILIRUBIN URIN

B P!r7('aan +arri#(n

"rinsip pemeriksaan

bilirubin 6 barium klorida *2? 6 &ou4het

@arna hijau bilirubin

8ara $!r"a

•= ml urin dalam tabung di4ampur kuatA

•6 = ml lar barium klorida *2? saringA

•'ngkat kertas saring dari 4orong, dibukalipatannya, ditaruh mendatar, biarkan keringA

•6 + . B tetes reagen &ou4het di atas presipitat kertassaring *i"a



23/47


8 M(di%$a#i p!r7('aan +arri#(n d!n)an

p(&(n)an $!r&a# #arin)

kertas saring tebal uk *2x* 4m S4hlei4her danSnull no -2! direndam di dalam lar barium kloridabeberapa lama hingga diserap kertas saring

keringkan di lemari panas digunakan

8ara K!r"a

"otongan kertas saring dipegang dan sebelah lain

dimasukkan ke dalam urin hingga *0B B2D . +E

Kertas diangkat biarkan hingga kering

6 * tetes &ou4het +i"a bilirubin 6!


24/47

)ilirubin 7at lain kuning tua, kuning4ampur hijau, 4oklat

)ilirubin glukorinida oksidasi63< biliverdinhijau!

bilisianin biru!

koletelinkuning!

In&!rpr!&a#i Kadar rendah 6

Kadar tinggi 66



25/47


8 8ara d!n)an 7ari$ 7!lp

bilirubin 6 senya@a dia7o pada 4arik 4elup

8a&a&an

3rin segar3rin tidak segar hidrolisi atau oksidasi


26/47

TES FUNGSI +ATI

mendeteksi abnormalitas dan meluasnya

kerusakan sel hati 1ebih sensitif dari gejala klinis #es fungsi hati terdiri atas

5 T(&al pr(&!in yaitu 'lbumin and globulin

Prothrombin Time, "#, masa protrombin!

#ransaminases 'S# 8 '1#!

'lkaline "F-ase )ilirubin, biasanya dalam bentuk fraksi

Gamma Glutamyl Transpeptidase %%#!


27/47

TOTAL PROTEIN

N(& a v!r #!.l m!a#r!4 n(n:#p!7i%7@(nl pr(vid!# in.(rma&i(n (nG!n!ral n&ri&i(nal #&a&#S!v!r! (r)an di#!a#!

l(#in) d5#>Fra7&i(na&!d val!# (. )r!a&!r #!

M!&*(d# (. m!a#r!m!n&

El!7&r(p*(r!#i# .(ll(=!d '4Pr!7ipi&a&i(n4 .(ll(=!d '48(lmn #!para&i(n,Ni&r()!n 7(n&!n& i# #al m!&*(d ina&(ma&i(n


28/47

TOTAL PROTEIN

$ngatG "enilaian protein dalam serum

hindari pengen4eran protein dengan antikoagulan

"re4ipitation is used to fra4tionate proteins into albumin andglobulin 6 ;aSF-, ;a sulte, 'mmonium SF-, methanol

globulin mengendap

asio '0% I serum protein abnormal "erubahan kadar albumin

"erubahan kadar globulin

Sintesis 9 kadar 9


29/47

TOTAL PROTEIN

$ndeks refratif bermakna bila I +,=g0d1! "anjang gelombang 3< +J2nm etode turbidimetrik

kolorimetrik L metode biuret otomatis


30/47

ALBUMIN /AN

GLOBULINAl'min)iasanya protein abundant dalamserum *+2 mg0kg0hari!

:albuminKerusakan sintesis malnutrisi,malabsorpsi, disfungsi hepatik, sirosishati!

kekurangan asites, protein losing-nephropathy , enteropathy !

Mdeme perifer albumin :

Hingga +=? albumin padah er likemia men adi likosilasi


31/47

ALBUMIN /AN

GLOBULINAl'min↑albumin #idak spesik L dapat terjadi padadehidrasi atau artefak akibat penggunaantorniket

Tip! )l('linα*5antitripsin ''#!α+5makroglobulinhaptoglobin

transferrin


32/47

1:ANTITRIPSIN

• I abundant α 1-globulin• menghambat kerja tripsin

• terdiri atas beberapa variasi genetik

• ''#↑ emsema and neonatal jaundice


33/47

2

:MAKROGLOBULIN

non5immunoglobulin protein plasma

jumlah terbanyak

↑ sindrom nefrotik


34/47

+APTOGLOBIN

• 'nother major α+ protein• &un4tion L to 4ombine @ith Hb released by

)C lysis to preserve &e and protein stores

•

Cir4ulating half5life approx - days• ↑ in stress, infe4tion, a4ute in>amm, tissue

ne4rosis

• : post haemolyti4 episode

• 3seful to monitor slo@ rate of haemolysisiAeA fm me4hani4al valves, exer4iseasso4iated trauma, haemoglobinopathies


35/47

8ERULOPLASMIN

Cu 4ontaining en7yme ferroxidase! in serum : in NilsonEs d0s

'sso4iated @ith 4hroni4 hepatitis o44 a4ute!

and may have neurologi40 psy4hiatri4

seOuelae


36/47

:FETOPROTEIN Fne of the major plasma proteins in foetal life

&un4tion not kno@n, similar stru4ture to albumin

&alls thru5out gestation P*2,222 ng0m1 at birth!and by age one yr Q*2 ng0m1 L adult levels!

$n a4ute hepati4 injury '&" ↑ *2 L +2R upper reflimits

'bt *2? pt @ith viral hepatitis have ↑ '&"

&ibrosis post 4hroni4 liver d0s, '&" ↑ 3sed to s4reen and diagnose HCC 8hepatoblastoma


37/47

PROT+ROMBIN TIME

ost 4oag fa4tors made in liver parti4ularly thoseasso4 @ith vitamin K! Hen4e in liver d0s, 4oagulopathies are 4ommon

Commonly "# is used for dete4ting liver asso44oagulopathies

)est "# method not 4lear

"# $; is useful for monitoring oral anti54oagtherapy, not very useful for liver disease

'n indire4t test of hepati4 syntheti4 fun4tion

in4ludes administration of vitamin K *2mg!sub4utaneously over three daysA Several days later,the prothrombin time may be measuredA $f theprothrombin time be4omes normal, then hepati4syntheti4 fun4tion is inta4tA #his test does notindi4ate that there is no liver disease, but issuggestive that malnutrition may 4oexist @ith or


38/47

#';S'$;'SM [S%F#

S%"#]

#ests of liver injury

Hepato4ytes 4ontain high levels ofen7ymes that 4an leak into theplasma @hen there is liver injury

Mn7ymes found in hepato4ytesareCytoplasmi4 1(H, 'S#, '1#

ito4hondrial 'S#m


39/47

ALANINE AMINOTRANSFERASE5SGPT

"rimer penyakit hati, monitoring terapi hepatitis,active postnecrotic cirrhosis 8 efek terapi

9 in>amasi, nekrosis

Sel rusak '1# dilepaskan ke sirkulasi darah

"erubahan kadar '1# kadang tidak spesik

#api '1# sensitif untuk kerusakan hepatosit

'1# dapat dibedakan antara hemolytic jaundice 8

jaundice


40/47

ALANINEAMINOTRANSFERASE

$n4reased '1# levels are found in thefollo@ing 4onditions

- Hepato4ellular disease

- '4tive 4irrhosis mild in4rease!

- etastati4 liver tumor

- Fbstru4tive jaundi4e or billiary obstru4tionmild to moderate in4rease!

- viral, infe4tious or toxi4 hepatitis B25=2xnormal!

-


41/47

ASPARTATE AMINOTRANSFERASE5SGOT

'lso re>e4ts damage to the hepati4 4ell $t is less spe4i4 for liver disease

$t may be elevated and other 4onditions su4h as amyo4ardial infar4t and mus4le disease

'lthough 'S# is not a spe4i4 for liver as the '1#, ra&i(# '!&=!!n ALT and AST are useful tophysi4ians in assessing the aetiology of liver en7ymeabnormalities


42/47

MEASUREMENT 3ses 4oupled en7ymati4 rea4tions @ithni4otinamide adenine dinu4leotide

;'(H! as nal rea4tion produ4tmeasured

eagents @ith ;H-6 should be avoided

as it may arti4ially ↑ the 'S#0'1#values


43/47

SPESIMEN

Stabil dalam whole blood selama +- jam lalu ↑karena dieksresikan dari)C! 'S#0'1# stabil pada -oC hingga Bminggu

'S# stabil dengan dibekukan freeed! '1# dapat: dengan free7ing sesuaibuTer yang digunakan


44/47

ALKALIN FOSFATASE Sumber hati, tulang, plasenta dan intestin

9 '1" pada kelainan hati sintesis sel dikanalikuli bilier 9 kolestasis intra atau ekstrahepatik!

'1" 9 +x nilai normal kolestasis

'1" 9 kelainan hati inltratif spaceoccupying lesions SF1! tumor

#ulang yang sedang tumbuh memerlukan '1"

9 serum '1" osteoblast-rapid growth,penyembuhan fraktur, keganasan tulang, Paget!s

disease, riketsia "lasenta '1"

in>ammatory bo@el disease kolitis ulserativa!'1"9

ENIM GAMMA GLUTAMCL


45/47

ENIM GAMMA GLUTAMCLTRANSFERASE

%%# sintesis glutation tripeptida

%%# hati, ginjal, pankreas, sel intestin,dan kelenjar prostat

D

alkoholik kronis, kelainan pankreas, infarkmiokard, gagal ginjal, penyakit paru obstruktifkronis ""FK!, (

"enyakit hati %%# 9 '1"

"enyakit hati alkoholik %%# 9 jumlahalkohol yang dikonsumsi


46/47

'(' "M#';U'';V


47/47

Thank You

Documents

Gg Hepatobilier