MindMap Gallery Biochemical tests for hepatobiliary diseases
Examine clinical biochemistry testing techniques and summarize the hepatobiliary, Liver Fibrosis, Hepatobiliary structure, damage to hepatobiliary structure test items, hepatobiliary function, etc.
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Chapter 12 Biochemical Testing of Hepatobiliary Diseases
Liver and gallbladder
substance metabolism center
The liver plays an important role in digestion, absorption, excretion, biotransformation, and metabolism of various substances.
largest solid organ
Liver Fibrosis
Four items of liver fiber
①Procollagen type III (PCIII)
②Type IV collagen (IV-C)
③Laminin (LN)
④Hyaluronic acid (HA)
Monoamine oxidase MAO
Serum bile acids (TBA)
Hepatobiliary structure
dual blood supply
Requires a lot of raw materials and consumes a lot of energy
Dual output
The two channels are mixed and transported to increase efficiency, and waste excretion products are transported externally.
cellular level
Hepatobiliary structural damage test items
related enzymes
aspartate aminotransferase AST
Alanine aminotransferase ALT
transaminase
Concept: Transaminase is a group of enzymes that can catalyze the transfer of amino groups between amino acids and a-keto acids, and participates in the synthesis of various non-essential amino acids in the body.
project
Aspartate aminotransferase AST Intracellular enzyme (mitochondria) Heart > Liver
Alanine aminotransferase ALT intracellular enzyme (cytoplasm) liver > heart
Transaminase evaluation of liver cell damage
Clinical significance: AST is an indicator that reflects liver cell necrosis, and ALT is a sensitive indicator that reflects liver cell damage.
Calculate the AST/ALT ratio, which can be used to diagnose and differentially diagnose the degree of liver damage.
In hepatitis, AST/ALT<2
In cirrhosis, AST/ALT≥2
In liver cancer, AST/ALT≥3
Transaminase test
Detection method: mostly using continuous monitoring method
Specimen requirements: serum, avoid hemolysis, no need to fast
Reference value: AST<40U/L ALT<50U/L
If the AST and ALT values are within the normal range, it means there is no liver function damage, and the ratio is meaningless.
Lactate dehydrogenase LD
Serum bile acid TBA
Bilirubin (TBIL, DBIL)
Hepatobiliary function
Substance metabolism disorder
protein metabolism
1. Synthesis and secretion of plasma proteins
Total protein TP-albumin ALB albumin/globulin (A/G)=1.5~2.5:1
Decreased white blood cells
Elevated globulin
Decreased albumin and increased globulin
Prealbumin PA
Serum cholinesterase PChE
prothrombin time PT
2. Convert and decompose amino acids
3. Synthesis of urea ammonia lyase
Ammonia is a decomposition product of amino acids and amines and is neurotoxic. It is converted into urea by the ornithine cycle in the liver. Excretion by the kidneys.
Blood ammonia: direct determination of glutamate dehydrogenase
serum urea
Urinary urea
Glucose metabolism
fat metabolism
Hormone Metabolism: Estrogen
Vitamin Metabolism: Vitamin D3
Biotransformation
Ammonia, amines, hormones
Bilirubin (excretion)
Source of bilirubin
Senescent red blood cells (RBCs) are destroyed and degraded
Mainstream bilirubin (80%)
Ineffective erythropoiesis
Decomposition of non-hemoglobin heme proteins (cytochrome, peroxidase, myoglobin, etc.)
Shunt bilirubin (20%)
The production process of bilirubin
Properties of free bilirubin: lipophilic and hydrophobic, toxic to cells
Bilirubin transport
Transport temporary form of bilirubin
Bilirubin-albumin complex (unconjugated bilirubin)
significance
Increase the solubility of bilirubin in plasma to facilitate transport
Restricting the free passage of bilirubin through biofilms produces toxic effects
ingest
Specific receptors on the liver cell membrane take up bilirubin from the liver sinusoidal blood and transport it to the liver cells.
Transformation of bilirubin in liver cells
Conversion---Generation of conjugated bilirubin
Excretion of bilirubin
active transport in bile canaliculi
Excretion---conjugated bilirubin enters the intestine with bile
Test items
Abnormal bilirubin production
Hemolytic jaundice: free bilirubin enters the tissue and causes yellow staining of the tissue
hepatocellular jaundice
Damage to liver cells and reduced transformation function
Swelling of liver cells and poor bilirubin excretion
obstructive jaundice
drugs, poisons
Secretion and excretion
bile acid
Bilirubin
γ-glutamine transpeptidase (GGT/γ-GT)
Liver tumors