45. Choice and assessment of clinical laboratory parameters in hepatic and bile diseases · Clinical Laboratory · MU Plovdiv

Choice and evaluation of clinical laboratory parameters in hepatic and bile diseases.

Hematology (reticulocytes, PT, fibrinogen)
Serum (total protein, albumin, electrophoresis of serum proteins, glucose, enzymes, Iron, Cu, cholesterol, electrolytes.

ammonia concertation in plasma;
individual proteins of the acute phase – haptoglobin, transferrin, ceruloplasmin; ferritin; lipoproteins;
enzymes – isoenzymes of LDH and AP; clotting factors – II, V, VII; bile acids.
Specific markers in serum – HbsAg, HBeAg, PSR for HCV- RNA;
tumor markers (АFP, СЕА,), protocollagen III, collagen III, collagen I.

GGT and AP – in cholestasis, high activity of GGT only- drug or alcohol induction. CHE- decreased in disturbance in the protein synthesis in hepatocytes.
АSАТ and АLАТ – give information about the severity of the disease, the degree of exacerbation and the stage of the chronic illness.
GIDH– for evaluation of the severity and the damage of the hepatocytes in the differential diagnosis of icterus
AP and GGT- in differential diagnosis of cholestasis and toxic damages.
LDH – metastases in liver and in hemolysis.
CHE –for evaluation of synthesis capacity of hepatocytes in acute and chronic processes.

Viral hepatitis: Mild hepatitis only cASAT, ALAT and LDH elevated, In Sever damage AP, GGT mASAT is elevated and CHE is decreased
Acute Alcohol damage: GGT is increased more than 10 times over the reference range. AP is not high, ALAT and ASAT moderately elevated
Bile Duct disease: in first days ASAT and ALAT elevated at the start, GIDH very high, Ratio of ASAT:ALAT is less than 1. On third day ASAT and ALAT reduces and back to normal on 5-6 day. AP and GGT continues to increase.

Chronic liver disease: hypoalbuminemia with hypergammaglobulinemia and hyperproteinaemia

Acute viral hepatitis: prealbumin↓, factors of coagulation ↓ II, V, VII, IX, X, CHE ↓