المساعد الشخصي الرقمي

مشاهدة النسخة كاملة : قضية الأسبوع (3) وتحليل وظائف الكبد(تم حلها)



labspe
12-02-2008, 11:18 PM
Case Study No.3





A 30-year-old man with a long history of intravenous drug abuse and chronic hepatitis B presents with jaundice. Physical examination reveals a malnourished man with ascites (edema in the abdomen). The patient has poor concentration.

The doctor has ordered the following tests to him


Total protein, albumin, globulins, calcium, BUN, creatinine, total bilirubin, AST , ALT, CBC Coagulation profile (PT)


Q One If you were the phlebotomist who is obtaining the samples, what kind of tubes you may use

Q Two what is the function of our liver


Q Three what is liver function profile


Q Four what are the patient precaution points you may tell the nurse in order to prepare patient


Q Five If you were the lab technician or specialist who runs the samples for this patient, what are the causes make you reject the patient's specimens



After running these tests, these are the results of the patient


Total protein 8.3 g,d/L (normal, 6.O-7.8 g/dL)

albumin 2.5 g/dL (normal, 3.5.-5.5 g/dL)

globulins 5.8 g/dL(normal, 2.3-3.5 g/dL)

calcium 6.5 mg/dL (normal, 8.4-10.2 mg/dL)

BUN 5 mg/dL (normal, 7-18 mg/dL)

Creatinine 0.9 mg/dL (normal, 0.6-1.2 mg/dL)

Total bilirubin 6.0 mg/dL (normal, 0.1-1.0 mg/dL)

AST 7 U/L, (normal, 8-20 U/L)

ALT 5 U/L (normal, 8-20 U/L)

CBC: macrocytic anemia with hypersegmented neutrophils, mild neutropenia, and mild thrombocytopenla

Coagulation: prothrombin time (PT) is prolonged and does not correct with intramuscul vitamin K



Q Six If you were responsible for reviewing the patients results before releasing, to ensure the results are accurate an no errors happened


AA What are the pathological causes that lead to abnormal liver function profile


BB How do you explain the result of low transaminase enzymes although the patient has hepatitis and drug abuse


CC How do you explain abnormal tests, hypoalbuminemia, and prolonged prothrombin time that does not correct with intramuscular vitamin K


DD Why TP is high while Albumin is decreased


EE Does the patient kidney affected? Why BUN is low


FF Why Ca is abnormally low in this patient


Q Seven What is the relation between the patient diagnosis and the poor concentration symptoms


Q Eight What is the most likely cause of the macrocytic anemia in this patient


Q Nine the physican is already graduated,


Aa He forgot to write the diagnosis, what do you think the diagnosis is


Bb what do you suggest an additional test to investigate liver function


Cc what do you suggest an additional test to investigate CNS problem




الأسئلة سهلة ..بس تحتاج تركيز وبحث

بالتوفيق

($)
14-02-2008, 01:52 AM
Q1

PLAIN TUB

EDTA TUB
sodium citrait tube

Q2
Major function of liver
(
carbohydrate metabolism(gluconeogenesis, glycogen synthesis and breakdown
fat metabolism(fatty acid synthesis, cholesterol synthesis and excreation, lipoprotein synthesis, ketogenesis, bile acid synthesis and 25-hydroxylation of VD)I
PROTEIN METABOLISM (synthesis of plasma protein (including some coagulation facyors ),urea synthesis
Hormone metabolism (metabolism and excretion of steroid hormones, metabolism of polypeptide hormones)i
Metabolisme and Excretion of Drugs and foreign compounds
Metabolisme and Excretion of bilirubin
glycogen, VA, VB12 AND IRON STORGE


liver function profile

Alanine aminotransferase (ALT) – an enzyme mainly found in the liver; the best -test for detecting hepatitis
• Alkaline phosphatase (ALP) – an enzyme related to the bile ducts; often increased when they are blocked
• Aspartate aminotransferase (AST) – an enzyme found in the liver and a few other places, particularly the heart and other muscles in the body
• Bilirubin – two different tests of bilirubin often used together (especially if a person has jaundice): total bilirubin measures all the bilirubin in the blood; direct bilirubin measures a form that is conjugated (combined with another compound) in the liver
•Albumin – measures the main protein made by the liver and tells whether or not - the liver is making an adequate amount of this protein
• Total Protein - measures albumin and all other proteins in blood, including antibodies made to help fight off infections
Other tests that could be requested along with the liver panel are gamma-glutamyl transferase (GGT), lactic acid dehydrogenase (LDH), and prothrombin time (PT).

Q6

A) the pathological causes that lead to abnormal liver function profile

hepatitis, cirrhosis, cholestasis and malignancy and infiltration


B) low transaminase enzymes although the patient has hepatitis and drug abuse

due to hepatocellular destruction

CC) How do you explain abnormal tests, hypoalbuminemia, and prolonged prothrombin time that does not correct with intramuscular vitamin K synthesis of plasma protein (including some coagulation facyors and albumin are one of liver function,so hypoalbuminemia, and prolonged prothrombin time that does not correct withintramuscular vitamin K is due to hepatocellular dysfunction in chronic hepatitis


E)Does the patient kidney affected? Why BUN is low

NO,BUN is low due to urea cycle defect(urea is the end product of protein metabolism that occure in liver and due to liver damage the urea cycle will be defect then their concentration increases in blood.
FF) Ca is abnormally low in this patient blc he is malnourished man

Q7

the relation between the patient diagnosis and the poor concentration symptoms(Due to ammonia that produce due to urea cycle defect while ammonia is blood brain bariar)

Q8

cause of the macrocytic anemia in this patient(since the patient is malnourished man,so the
macrocytic anemia is aresult of folat deficincy

Q9
an additional test to investigate liver function
Alkaline phosphatase
Gamma-glutamyl transferase
Ammonia
an additional test to investigate CNS problem
Ammonia, CA

antivirus
15-02-2008, 01:38 AM
Q1-If you were the phlebotomist who is obtaining the samples, what kind of tubes you may use? -
plain tube or heparin tube for chemistry test
-EDTA tube for CBC
-sodium citrait tube for coagulation profile

Q2-what is the function of our liver?
The liver is intimately involved in many of the important functions of our body. The liver secretes vital digestive juices that help us properly digest our food and cleanses our blood of the pesticides, steroids, pharmaceuticals and additives that we absorb. With the help of our liver we naturally expel the metabolic by-products and toxins produced from the regular functioning of our bodies. The liver also has a profound effect on the hormonal system, helping to regulate and balance hormonal activity to ensure the proper functioning of our neurological system.

Q3-what is liver function profile?
Total bilirubin – measures all the yellow bilirubin pigment in the blood. Another test, direct bilirubin, measures a form made in the liver and is often requested with total bilirubin in infants with jaundice.
Albumin – measures the main protein made by the liver and tells how well the liver is making this protein


Total protein - measures albumin and all other proteins in blood, including antibodies made to help fight off infections


Alanine aminotransferase (ALT) – an enzyme mainly found in the liver; the best test for detecting hepatitis


Alkaline phosphatase (ALP) – an enzyme related to the bile ducts; often increased when they are blocked


Aspartate aminotransferase (AST) – an enzyme found in the liver and a few other places, particularly the heart and other muscles in the body



Q4-what are the patient precaution points you may tell the nurse in order to prepare patient?
I think no specail precaution to prepare patient except: Explain test purpose and blood drawing procedure for the patient.


Q5-If you were the lab technician or specialist who runs the samples for this patient, what are the causes make you reject the patient's specimens?1-Unlabeled sample
2-Mislabeled sample
3-Improperly/Incompletely Labeled
4-Corrective Action for Labeling Errors
5-Specimen collected in wrong tube, container or preservative for the test requested.
Incorrect Information—unsigned, not dated misspelled name, etc.
6-Specimen inappropriately handled with respect to temperature, timing or storage requirements.
8-Quantity not sufficient (QNS).
9-Lipemic and grossly hemolyzed specimens may be rejected for certain tests.


Q6-What are the pathological causes that lead to abnormal liver function profile?
A- hepatitis A, hepatitis B and hepatitis C cirrhosis. Jaundice , cancer ,hemochromatosis.

B-How do you explain the result of low transaminase enzymes although the patient has hepatitis and drug abuse?B- because in severe liver disease can cause false decreases in transaminase enzymes .

C-How do you explain abnormal tests, hypoalbuminemia, and prolonged prothrombin time that does not correct with intramuscular vitamin K?C- because the patient has hepatocellular dysfunction in chronic hepatitis
D-Why TP is high while Albumin is decreased?
D- it is due to incrase in globulins which lead to incrase TP

E-Does the patient kidney affected? Why BUN is low?
E-The kidney of the patient not effected. and the BUN high due to the defect in urea cycle
F-Why Ca is abnormally low in this patient?
F-The hepatits and drug abuse can cause hypocalcemia

Q8-What is the most likely cause of the macrocytic anemia in this patient ?
The main causes of macrocytic anemia for this patient are 1-liver diseases 2- B12 deficincy

Q9-what do you suggest an additional test to investigate liver function?
we must do the following test :-1- ALP 2-Serum protein electrophoresis 3-amalyse enzyme 4- GGT 5- ammonia-


what do you suggest an additional test to investigate CNS problem?

Ion selective electrode test

dr.moz
15-02-2008, 03:17 AM
This is my answer in the attached file

miss laboratory
15-02-2008, 05:03 PM
:Q1: EDTA(CBC)
Plaine for chemistry
sodium citrate(pT-PTT)

Q2: metabolism of CHO, protien, lipid and drug
synthesis of bile, caogulation profile, albumine and complement
secreation of bile salt and bilirubin

Q3: secreation the following
ALT, AST and ALp enzymes
bilirubin: yellow color substance result from break down of RBCs these substanceremove from the circulation via the liver which utilize the bilirubin to synthesis the bile which then storag in the gall blader elevation of bilirubin indecate massive break dawon of RBCs or liver disease.
Albumin:

Q4: No specific precaution

Q5: unlabelled sample
mislabelled sample
underfilled samples(espicially for PT, PTT)
sample wilthout requist
heamolyzed samples(not For all testes)
clotted samples(for cBc_ coagulation profile)
Q6: run QC before
compare the diagnosis with lab results

Q7: inflamation(hepatitis A,B,C)
cancer(hepatocellularcarcinoma)
biliary cirrhosis or obstruction

Q8: low transaminase b/c when the liver infected by the viral hepatitis there is active generation of hepatocyte due to high viral replication therefore the liver enzyme is very high in the early stage(acut) but in the late stage(chronic) almost hepatocyte become scar therefor liver enzyme back to the normal or low level

Q9: hypoalbuminemia: albumin is the protien synthesis by the liver these patient has chronic liver disease so, no proper synthesis for albumin
prolong PT b/c the coagulation profile(pT,PTT) synthese in the liver when there is liver disese no proper synthesis for PT naturaly it not corrected with intravenous K b/c these patiant not suffer from hypokalemia the defect is in the factory(liver)

Q10: total protien=albumin+globuline
in state of liver faliure no synthesis for albumin so, the body start to synthesis high level of globuline to compensate the decrease in albumin to miantian the balance therefor TP is high while albumin is low.

Q11: No, urea is low b/c in the liver disease no proper metabolism for protien so no urea secreation (end product of protien metabolism is urea)

Q12: Ca is low b/c 50% of ca in the blood is bound in albumin (in active form of ca) the other 50% called ionized calcium of free which metabolically active. total ca measure both bound and free ca when there is no albumin in liver faliure the total calcium is low also b/c these patient is malnurished.

Q13: folate deificncy (malnourished)

Q14: GGT
ALP

Q15: ammonia measurment and PH of the blood
b/c ammonia is co-factor in protien metabolism in tiver faliure no protien metabolism so, there is accumulation of ammonia which can penetrate blood brian bariar lead to CNS problem.
:sm199: miss laboratory

فطوم
15-02-2008, 06:23 PM
What is the Liver?

The liver is the largest glandular organ of the body. It weighs about 3 lb (1.36 kg). It is reddish brown in color and is divided into four lobes of unequal size and shape. The liver lies on the right side of the abdominal cavity beneath the diaphragm. Blood is carried to the liver via two large vessels called the hepatic artery and the portal vein. The heptic artery carries oxygen-rich blood from the aorta (a major vessel in the heart). The portal vein carries blood containing digested food from the small intestine. These blood vessels subdivide in the liver repeatedly, terminating in very small capillaries. Each capillary leads to a lobule. Liver tissue is composed of thousands of lobules, and each lobule is made up of hepatic cells, the basic metabolic cells of the liver.



What is its major function?

The liver has many functions. Some of the functions are: to produce substances that break down fats, convert glucose to glycogen, produce urea (the main substance of urine), make certain amino acids (the building blocks of proteins), filter harmful substances from the blood (such as alcohol), storage of vitamins and minerals (vitamins A, D, K and B12) and maintain a proper level or glucose in the blood. The liver is also responsible fore producing cholesterol. It produces about 80% of the cholesterol in your body.

Diseases of the Liver?

Several diseases states can affect the liver. Some of the diseases are Wilson's Disease, hepatitis (an inflammation of the liver), liver cancer, and cirrhosis (a chronic inflammation that progresses ultimately to organ failure). Alcohol alters the metabolism of the liver, which can have overall detrimental effects if alcohol is taken over long periods of time.

Hemochromatosis can cause liver problems.

Medications that negatively effect the liver?

Medications have side effects that may harm your liver. Some of the medications that can damage your liver are: serzone, anti-cancer drugs (tagfur, MTX, and cytoxan), and medications used to treat diabetes.

Serzone is a prescription drug manufactured by Bristol-Myers Squibb for the treatment of depression.

The possible side effects of Serzone® are: agitation, dizziness, clumsiness or unsteadiness, difficulty concentrating, memory problems, confusion, severe nausea, gastroenteritis, abdominal pain, unusually dark urine, difficult or frequent urination, fainting, skin rash or hives yellowing of the skin or whites of the eyes (jaundice) or a prolonged loss of weight or loss of appetite.

If you or a family member have suffered serious side effects or a fatal injury after taking Serzone®, you or the family member may be eligible to file a claim against the manufacturer. You should contact an attorney that specializes in class action lawsuits immediately.

To help prevent liver damage, let your doctor know about your liver condition when being treated for other conditions. Medications come in many forms and it is best to find out what is in them and what it can do to your liver.
Liver Function Tests:

Liver function tests represent a broad range of normal functions performed by the liver. The diagnosis of liver disease depends upon a complete history, complete physical examination, and evaluation of liver function tests and further invasive and noninvasive tests. Many patients become confused regarding the meaning of a liver function test. This section is designed to describe the basic liver function tests and the meaning for patients.

The hepatobiliary tree represents hepatic cells and biliary tract cells. Inflammation of the hepatic cells results in elevation in the alanine aminotransferase (ALT), aspartate aminotransferase (AST) and possibly the bilirubin. Inflammation of the biliary tract cells results predominantly in an elevation of the alkaline phosphatase. In liver disease there are crossovers between purely biliary disease and hepatocellular disease. To interpret these, the physician will look at the entire picture of the hepatocellular disease and biliary tract disease to determine which is the primary abnormality.

Alanine Aminotransferase (ALT):

ALT is the enzyme produced within the cells of the liver. The level of ALT abnormality is increased in conditions where cells of the liver have been inflamed or undergone cell death. As the cells are damaged, the ALT leaks into the bloodstream leading to a rise in the serum levels. Any form of hepatic cell damage can result in an elevation in the ALT. The ALT level may or may not correlate with the degree of cell death or inflammation. ALT is the most sensitive marker for liver cell damage.

Aspartate Aminotransferase (AST):

This enzyme also reflects damage to the hepatic cell. It is less specific for liver disease. It may be elevated and other conditions such as a myocardial infarct (heart attack). Although AST is not a specific for liver as the ALT, ratios between ALT and AST are useful to physicians in assessing the etiology of liver enzyme abnormalities.

Alkaline Phosphatase:

Alkaline phosphatase is an enzyme, which is associated with the biliary tract. It is not specific to the biliary tract. It is also found in bone and the placenta. Renal or intestinal damage can also cause the alkaline phosphatase to rise. If the alkaline phosphatase is elevated, biliary tract damage and inflammation should be considered. However, considering the above other etiologies must also be entertained. One way to assess the etiology of the alkaline phosphatase is to perform a serologic evaluation called isoenzymes. Another more common method to asses the etiology of the elevated alkaline phosphatase is to determine whether the GGT is elevated or whether other function tests are abnormal (such as bilirubin)

Alkaline phosphatase may be elevated in primary biliary cirrhosis, alcoholic hepatitis, PSC, gallstones in choledocholithiasis.

Gamma Glutamic Transpeptidase (GGT):

This enzyme is also produced by the bile ducts. However, it is not very specific to the liver or bile ducts. It is used often times to confirm that the alkaline phosphatase is of the hepatic etiology. Certain GGT levels, as an isolated finding, reflect rare forms of liver disease. Medications commonly cause GGT to be elevated. Liver toxins such as alcohol can cause increases in the GGT.

Bilirubin:

Bilirubin is a major breakdown product of hemoglobin. Hemoglobin is derived from red cells that have outlived their natural life and subsequently have been removed by the spleen. During splenic degradation of red blood cells, hemoglobin (the part of the red blood cell that carries oxygen to the tissues) is separated out from iron and cell membrane components. Hemoglobin is transferred to the liver where it undergoes further metabolism in a process called conjugation. Conjugation allows hemoglobin to become more water-soluble. The water solubility of bilirubin allows the bilirubin to be excreted into bile. Bile then is used to digest food.

As the liver becomes irritated, the total bilirubin may rise. It is then important to understand the difference between total bilirubin, which has undergone conjugation (that is hepatic cell metabolism), and at portion of bilirubin which has not been metabolized. These two components are called total bilirubin and direct bilirubin. The direct bilirubin fraction is that portion of bilirubin that has undergone metabolism by the liver. When this fraction is elevated, the cause of elevated bilirubin (hyperbilirubinemia) is usually outside the liver. These types of causes are typically gallstones. This type of abnormality is usually treated with surgery (such as a gallbladder removal or choleycystectomy).

If the direct bilirubin is low, while the total bilirubin is high, this reflects liver cell damage or bile duct damage within the liver itself.

Albumin:

Albumin is the major protein present within the blood. Albumin is synthesized by the liver. As such, it represents a major synthetic protein and is a marker for the ability of the liver to synthesize proteins. It is only one of many proteins that are synthesized by the liver. However, since it is easy to measure, it represents a reliable and inexpensive laboratory test for physicians to assess the degree of liver damage present in the in any particular patient. When the liver has been chronically damaged, the albumin may be low. This would indicate that the synthetic function of the liver has been markedly diminished. Such findings suggest a diagnosis of cirrhosis. Malnutrition can also cause low albumin (hypoalbuminemia) with no associated liver disease.

Prothrombin time (PT):

Another measure of hepatic synthetic function is the prothrombin time. Prothrombin time is affected by proteins synthesized by the liver. Particularly, these proteins are associated with the incorporation of vitamin K metabolites into a protein. This allows normal coagulation (clotting of blood). Thus, in patients who have prolonged prothrombin times, liver disease may be present. Since a prolonged PT is not a specific test for liver disease, confirmation of other abnormal liver tests is essential. This may include reviewing other liver function tests or radiology studies of the liver. Diseases such as malnutrition, in which decreased vitamin K ingestion is present, may result in a prolonged PT time. An indirect test of hepatic synthetic function includes administration of vitamin K (10mg) subcutaneously over three days. Several days later, the prothrombin time may be measured. If the prothrombin time becomes normal, then hepatic synthetic function is intact. This test does not indicate that there is no liver disease, but is suggestive that malnutrition may coexist with (or without) liver disease.

Platelet count:

Platelets are cells that form the primary mechanism in blood clots. They're also the smallest of blood cells. They derived from the bone marrow from the larger cells known as megakaryocytes. Individuals with liver disease develop a large spleen. As this process occurs platelets are trapped with in the sinusoids (small pathways within the spleen) of the spleen. While the trapping of platelets is a normal function for the spleen, in liver disease it becomes exaggerated because of the enlarged spleen (splenomegaly). Subsequently, the platelet count may become diminished.

Serum protein electrophoresis:

This is an evaluation of the types of proteins that are present with in a patient's serum. By using an electrophoretic gel, major proteins can be separated out. This results in four major types of proteins. These are 1) albumin, 2) alpha globulins, 3) beta globulins and 4) gammaglobulins. This test is useful for evaluation of patients who have abnormal liver function tests since it allows a direct quantification of multiple different serum proteins. If the gamma globulin fraction is elevated, autoimmune hepatitis may be present. In addition a deficiency in the alpha globulin fraction can result in the diagnosis, or a clinical clue, to A. alpha-1 antitrypsin deficiency. This is a simple blood test that is commonly performed by hepatologists.

manal
15-02-2008, 06:57 PM
بعدني طالبه طب سنه أولى:sm257:
أبغي أشاركم، بس ماعرف ذ1

med.tech.
15-02-2008, 11:12 PM
Q One If you were the phlebotomist who is obtaining the samples, what kind of tubes you may use
1-plain tube for ::Total protein, albumin, globulins, calcium, BUN, creatinine, total bilirubin, AST , ALT

2-EDTA tube::CBC

3-sodium citrait tube for coagulation profile

Q Two what is the function of our liver

The liver is the largest and one of the most important organs in the body. As the body's "chemical factory," it regulates the levels of most of the biomolecules found in the blood, and acts with the kidneys to clear the blood of drugs and toxic substances. The liver metabolizes these products, alters their chemical structure, makes them water soluble, and excretes them in bile. Laboratory tests for total protein, albumin, ammonia, transthyretin, and cholesterol are markers for the synthetic function of the liver. Tests for cholesterol, bilirubin, ALP, and bile salts are measures of the secretory (excretory) function of the liver. The enzymes ALT, AST, GGT, LDH, and tests for viruses are markers for liver injury.

Q Three what is liver function profile
Liver function tests, or LFTs, include tests for bilirubin, a breakdown product of hemoglobin, and ammonia, a protein byproduct that is normally converted into urea by the liver before being excreted by the kidneys. LFTs also commonly include tests to measure levels of several enzymes, which are special proteins that help the body break down and use (metabolize) other substances. Enzymes that are often measured in LFTs include gamma-glutamyl transferase (GGT); alanine aminotransferase (ALT or SGPT); aspartate aminotransferase (AST or SGOT); and alkaline phosphatase (ALP). LFTs also may include prothrombin time (PT), a measure of how long it takes for the blood to clot.


Q Four what are the patient precaution points you may tell the nurse in order to prepare patient
Patients are asked to fast and to inform clinicians of all drugs, even over-the-counter drugs, that they are taking. Many times liver function tests are done on an emergency basis and fasting and obtaining a medical history are not possible.


Q Five
1-unlebeled tube
2-unsufficient sample
3-hemolyzed sample
4-wrong tube collected
5-clotted sample for EDTA tube


Q Six
AA What are the pathological causes that lead to abnormal liver function profile

ALT: Values are significantly increased in cases of hepatitis, and moderately increased in cirrhosis, liver tumor, obstructive jaundice, and severe burns. Values are mildly increased in pancreatitis, heart attack, infectious mononucleosis, and shock. Most useful when compared with ALP levels.

AST: High levels may indicate liver cell damage, hepatitis, heart attack, heart failure, or gall stones.

ALP: Elevated levels occur in diseases that impair bile formation (cholestasis). ALP may also be elevated in many other liver disorders, as well as some lung cancers (bronchogenic carcinoma) and Hodgkin's lymphoma. However, elevated ALP levels may also occur in otherwise healthy people, especially among older people.

GGT: Increased levels are diagnostic of hepatitis, cirrhosis, liver tumor or metastasis, as well as injury from drugs toxic to the liver. GGT levels may increase with alcohol ingestion, heart attack, pancreatitis, infectious mononucleosis, and Reye's syndrome.

LDH: Elevated LDH is seen with heart attack, kidney disease, hemolysis, viral hepatitis, infectious mononucleosis, Hodgkin's disease, abdominal and lung cancers, germ cell tumors, progressive muscular dystrophy, and pulmonary embolism. LD is not normally elevated in cirrhosis.

Bilirubin: Increased indirect or total bilirubin levels can indicate various serious anemias, including hemolytic disease of the newborn and transfusion reaction. Increased direct bilirubin levels can be diagnostic of bile duct obstruction, gallstones, cirrhosis, or hepatitis. It is important to note that if total bilirubin levels in the newborn reach or exceed critical levels, exchange transfusion is necessary to avoid kernicterus, a condition that causes brain damage from bilirubin in the brain.

Ammonia: Increased levels are seen in primary liver cell disease, Reye's syndrome, severe heart failure, hemolytic disease of the newborn, and hepatic encephalopathy.

Albumin: Albumin levels are increased due to dehydration. They are decreased due to a decrease in synthesis of the protein which is seen in severe liver failure and in conditions such as burns or renal disease that cause loss of albumin from the blood.


BB How do you explain the result of low transaminase enzymes although the patient has hepatitis and drug abuse

CC How do you explain abnormal tests, hypoalbuminemia, and prolonged prothrombin time that does not correct with intramuscular vitamin K

Albumin is the protein found in the highest concentration in blood, making up over half of the protein mass. Albumin has a half-life in blood of about three weeks and decreased levels are not seen in the early stages of liver disease. A persistently low albumin in liver disease signals reduced synthetic capacity of the liver and is a sign of progressive liver failure. In the acute stages of liver disease, proteins such as transthyretin (prealbumin) with a shorter half-life may be measured to give an indication of the severity of the disease.
The liver is responsible for production of the vitamin K clotting factor.. In obstructive liver

diseases a deficiency of vitamin K-derived clotting factors results from failure to absorb vitaminK. In obstructive jaundice, intramuscular injection of vitamin K will correct the prolonged prothrombin time. In severe necrotic disease, the liver cannot synthesize factor I (fibrinogen) or factors II, VII, IX, and X from vitamin K. When attributable to hepatic necrosis, an increase in the prothrombin time by more than two seconds indicates severe liver disease.



DD Why TP is high while Albumin is decreased

fofo الحلوة
16-02-2008, 01:33 PM
للأسف
أنا كمان لسه طالبة
وماعرفت حل غير 3 أسئلة
ان شاء الله أقدر أحل المرات الجاية

الاخصائي أبوفهد
16-02-2008, 04:43 PM
بالتوفيق للجميع في القضيه وحلاها

من قال لا ادري فقد افتى

ميسرة
16-02-2008, 04:55 PM
لو سمحتم ممكن اعرف متى بالضبط توضع الاسئلة لانى اريد ان اشار ولا اجلس دائما على الكمبيوتر فاريدمعرفة الوقت حتى يتسنى لى الاجابة عليها وشكرا

labspe
16-02-2008, 08:45 PM
لو سمحتم ممكن اعرف متى بالضبط توضع الاسئلة لانى اريد ان اشار ولا اجلس دائما على الكمبيوتر فاريدمعرفة الوقت حتى يتسنى لى الاجابة عليها وشكرا

مرحبا ميسرة

لا استطيع اعطائك وقت محدد لوضع الاسئلة نحاول جعلها اسبوعيا لكن قد تطرأ تغيرات او ظروف تأخر من وضع الاسئلة والقضيا ...لكن المؤكد ان شاء الله انه حين وضع الاسئلة الجديده بالمنتدى ستصلك رساله تخبرك بالامر

بتوفيق الله ورعايته

eminile
17-02-2008, 05:49 PM
my answer in the attached file

zuhair31
17-02-2008, 10:33 PM
hearin or plain for chemistery,EDTA for CBC,and trisodium citrate for pt
2/metabolism, detoxication of wastes, storage of carbohydrates
3/total protien, albumin,bilirubin(total and direct),ALT,AST.
4/AVOID HEMOLYSIS. prolonged tourinquate applying.adequate sample volume espically for pt
5/unadquate volume for pt, hemolysis in chemistery( albumin,AST,)
6/hepatitis,druge abuse,cirhosis.
6/b/ dute the sever major cellular destruction.
6/c/ low albumine level dute the cells damage , pt abnormalities accordinge due to druge abuse which affect the liver coagulation function.
6/d/ due to high levels of globulins
6/e/the kidney not affectecd , the bun is low due to the decrease in albumin produced by the liver.
7/

NASSER TANTANI
18-02-2008, 01:19 PM
الشكر الجزيل لكافة الأخوة المشاركين ,,,

احـــمد
19-02-2008, 11:50 AM
اعتذر واسف
اذا كان الكلام من فضه فلسكوت من ذهب

محمد صالح الربيعي
19-02-2008, 12:27 PM
صباح الخير اتمنى المشاركة ولكن لازلت طالبا و سأحاول حل بعض الاسئلة وشكرا لكم[]

د/رحيم
19-02-2008, 06:13 PM
يا دكاتره لو سمحتم عايزين نكتب بايدينا مش نخش نعمل search وبس ونلصق اللي يطلع في الsearch

الكلام ده مينفعش

ابو البراء
23-02-2008, 08:35 PM
السلام عليكم ورحمه الله وبركاته
يرجى كتابة المسابقة باللغة العربية أيضاً فالموقع على ما أعتقد عربي وليس غربي ( هذ إن كان للغة القرآن احترام في هذا الزمن ) وسوف احاول اجيب على حسب فهمي للموضوع
1 - التشخيص تشمع كبد وربما يكون ورمي
2 - يفضل إجراء غاما جيتي
3 - ويفضل إجراء رحلان بروتين حتى يدعم التشخيص

labspe
25-02-2008, 08:46 PM
السلام عليكم




حل قضية رقم 3





Q One If you were the phlebotomist who is obtaining the samples, what kind of tubes you may use
Plain tubes or Serum separator tube
Sodium citrate
EDTA tube

Q Two what is the function of our liver

The various functions of the liver are carried out by the liver cells or hepatocytes.
In the first trimester fetus, the liver is the main site of red blood cell production. By the 32nd week of gestation, the bone marrow has almost completely taken over that task.


Metabolic functions: The liver is involved in the metabolism of nutrients. It receives digestive products in the form of glucose, amino acids and fatty acids and glycerol. The metabolism of carbohydrate, fat and protein takes place in the liver, although specific functions are carried out by fat depots and skeletal muscle. Metabolic end products are often stored in the liver and utilized at a later stage if required.

Gluconeogenesis (the synthesis of glucose from certain amino acids, lactate or glycerol)

Glycogenolysis (the breakdown of glycogen into glucose) (muscle tissues can also do this)

Glycogenesis (the formation of glycogen from glucose)

The breakdown of insulin and other hormones
The liver also performs several roles in lipid metabolism:
Cholesterol synthesis
The production of triglycerides (fats).
ketone bodies
Most of the body’s protein is synthesized in the liver especially Albumin and globulin where amino acids absorbed are transported to hepatocyte.
The liver produces coagulation factors I (fibrinogen), II (prothrombin), V, VII, IX, X and XI, as well as protein C, protein S and antithrombin.

Storage functionsThe liver stores a multitude of substances, including glucose in the form of glycogen, vitamin B12, iron, and copper.

Detoxification functions

Endogenous
The liver converts ammonia to urea.
The liver breaks down haemoglobin, creating metabolites that are added to bile as pigment (bilirubin and biliverdin).

Exogenous
The liver breaks down toxic substances and most medicinal products in a process called drug metabolism. This sometimes results in toxication, when the metabolite is more toxic than its precursor.

Execratory functions The liver produces and excretes bile (a greenish liquid) required for emulsifying fats. Some of the bile drains directly into the duodenum, and some is stored in the gallbladder.

The liver is responsible for immunological effects- the reticuloendothelial system of the liver contains many immunologically active cells, acting as a 'sieve' for antigens carried to it via the portal system.

The liver is responsible for the first hydroxylation step in vitamin D metabolism after its reabsorption from the small bowel

Q Three what is liver function profile

Liver function tests (LFTs or LFs), which include liver enzymes, are groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patient's liver.
This testing is performed by a medical technologist on a patient's serum or plasma sample obtained by phlebotomy. Some tests are associated with functionality (eg. Albumin); some with cellular integrity (eg. transaminase,) and some with conditions linked to the biliary tract (gamma-glutamyl transferase and alkaline phosphatase)
Albumin, TP
Alanine transaminase (ALT),
Aspartate transaminase (AST)
Alkaline phosphatase (ALP
Total bilirubin (TBIL, Direct bilirubin
Gamma glutamyl transpeptidase (GGT)
LDH
Prothrombin time PT


Q Four what are the patient precaution points you may tell the nurse in order to prepare patient


Patient must be fasting because lipimic sample cause false elevations in absorption of almost all the tests ordered through spectrophotometery

Patient must be at rest, exercise my elevate liver enzymes

Discuss with doctor if any drugs that may affect the test

Tourniquet must not prolonged than 1 minute because it will alter the contents of blood (ALB, Ca, AST)

The order of filling tubes should be as following: plain tube, sodium citrate, EDTA. Plain tube is preferred for chemistry because the doctor order pt or coagulation study, since the heparin may contaminate sodium citrate if drawn first, secondly, sodium citrate never be the first tube to draw blood in.

Transport of sample must be in a fast, cold, sun protected manner within 1 hour of drawing.


Q Five If you were the lab technician or specialist who runs the samples for this patient, what are the causes make you reject the patient's specimens


Wrong tubes
Specimen improperly collected (or suspected of IV contamination)
Quantity Not sufficient
Not properly filled tubes for sodium citrate( underline)
Specimen improperly labeled or unlabeled
In complete information on requests
Contaminated requests
Delayed specimens especially Sodium citrate more than 1 hour
Hemolysed serum
Clotted blood sample for sodium citrate and EDTA


Q Six If you were responsible for reviewing the patients results before releasing, to ensure the results are accurate an no errors happened
AA What are the pathological causes that lead to abnormal liver function profile


Albumin
Low albumin level is most often caused by acute or chronic inflammation, urinary loss, severe malnutrition or liver disease; it is sometimes caused by gastrointestinal loss (e.g., colitis or some uncommon small bowel disease). Normal values are lower in pregnancy.
Rise in bilirubin alone

Unconjugated
Haemolysis
Drugs
Gilbert's syndrome
Crigler-Najjar syndrome

Conjugated - • Dubin-Johnson syndrome
Rotor syndrome
Chronic liver disease, (usually associated with other liver function test abnormalities)

Obstructive or cholestatic pictureIntrahepatic -
primary biliary cirrhosis
drugs

Extrahepatic
Gallstone in common bile duct
Head of pancreas neoplasm
Drugs e.g. erythromycin, tricyclic antidepressants, flucloxacillin, oral contraceptive pill and anabolic steroids
Cardiac failure - improves with treatment
Primary biliary cirrhosis - commoner in women and first sign is a rise in ALP
Primary sclerosing cholangitis
Neoplasm - primary (rarely) and secondaries
Familial (benign)

Hepatitic picture i.e. rise in aminotransferases (AST and ALT)

Alcohol - fatty infiltration and acute alcoholic hepatitis (usually associated with markedly deranged liver function).
Cirrhosis of any cause - alcohol being one of the commonest.
Medications e.g. Phenytoin, carbamazepine, isoniazid, statins, methotrexate, paracetamol overdose, amiodarone. (Transaminases may be >1000 IU/l).
Chronic hepatitis B and C.
Acute viral hepatitis e.g. hepatitis A, B and C and CMV infection.
Autoimmune hepatitis.
Neoplasms - primary or secondaries.
Haemochromatosis.
Metabolic - Glycogen storage disorders, Wilson's disease.
Ischaemic liver injury e.g. severe hypotension
Fatty liver disease (mild elevation in transaminases <100 IU/l).
Non-hepatic causes: Coeliac disease, haemolysis and hyperthyroidism.

AST level greater than 500 U per L due to acetaminophen toxicity, The AST elevation is unlikely to result from alcohol intake alone. and .

Isolated rise in GGT
Ethanol intake). and aromatic medications, usually with no actual liver disease.

Isolated rise in ALP
3rd trimester of pregnancy (comes from the placenta - a normal finding)
If isolated rise in ALP consider other sources e.g. bone or kidney


BB How do you explain the result of low transaminase enzymes although the patient has hepatitis and drug abuse

The patient is having chronic hepatitis and he is a drug abuser which affect also the liver, in acute liver inflammation transaminase elevated and becomes high due to the presence of hepatocytes. But when these hepatocytes are destroyed and replaced by fibrotic tissue, these enzymes are either not elevated or slightly elevated

CC How do you explain abnormal tests, hypoalbuminemia, and prolonged prothrombin time that does not correct with intramuscular vitamin K

Low albumin, prolonged prothrombin time not corrected with intramuscular vit K, with the result of transaminase are all markers of increased severity of liver disease, since both depend on the ability of the liver to synthesize proteins (albumin and coagulation factors). Inability to correct the PT with vitamin K ********s that the liver is unable to synthesize the precursor vitamin K-dependent factors II, VII, IX, and X for (-carboxylation by vitamin K into functional coagulation factors

DD Why TP is high while Albumin is decreased

The total proteins are the sum of the serum albumin and the globulins, the latter representing (1-globulins ((1~antitrypsin), (2-globulins ((2-macroglobulin, haptoglobin), (-globulins (complement, transferrin, (-lipoproteins), and (-globulins (IgG, IgA, IgM, IgD, and IgE; Chapter 3). The total protein and serum albumin are directly measured, and the globulins are calculated by subtracting albumin from the total protein. In general, an elevated total protein is due to an increase in globulins. The increase in globulins is primarily secondary to an increase in (-globulins, particularly IgG. IgG is not only the most abundant (-globulin but also the one most often increased in chronic inflammation owing to increased synthesis by many different clones of plasma cells. Since the patient has hepatitis B, a chronic status, he most likely has an increase in IgG causing the increase in total protein. Serum protein electrophoresis would demonstrate a polyclonal gammopathy with a diffuse elevation of (-globulins due to their synthesis by many different clones of plasma cells.

EE does the patient kidney affected? Why BUN is low

No, creatinine is normal , the location of the urea cycle in the liver, the presence of liver disease seriously hampers the normal function of disposing of ammonia in the urea cycle leading to low urea resulting from the ammonia

.FF Why Ca is abnormally low in this patient

Firstly The total serum calcium (that ordered to the patient) represents the calcium that is bound to albumin (40%), other anions (13%), and free (ionized calcium; 47%). Low ionized calcium may result in tetany which is not present in this patient. Therefore, in the presence of hypoalbuminemia, the most common cause of hypocalcemia, the total calcium is decreased while the ionized calcium is normal.
Secondary The liver is responsible for the first hydroxylation step in vitamin D metabolism after its reabsorption from the small bowel. So Hypocalcemia is partly due to hypoalbuminemia and to hypovitaminosis D

Q Seven What is the relation between the patient diagnosis and the poor concentration symptoms
The patient may suffer form encephalopathy which is common found in liver failure patient
Q Eight What is the most likely cause of the macrocytic anemia in this patient?
The patient is malnourished, and the blood film shows megaloplastic changed . the patient is more likely to have megaloblastic anemia due to folic acid deficiency not Vit B 12. Vit B12 stores in liver is enough for many years to be depleted and tiny daily supply of vit b12 is sufficient.
Thrombocytopenia is may explained by the following: Individuals with liver disease develop a large spleen. As this process occurs platelets are trapped with in the sinusoids (small pathways within the spleen) of the spleen. While the trapping of platelets is a normal function for the spleen, in liver disease it becomes exaggerated because of the enlarged spleen (splenomegaly). Subsequently, the platelet count may become diminished.

Q Nine the physican is already graduated,
Aa He forgot to write the diagnosis, what do you think the diagnosis is

End-stage liver disease failure most likely, to chronic hepatitis B and drug abuse



Bb what do you suggest an additional test to investigate liver function
ALP
GGT
Glucose The liver's ability to produce glucose (gluconeogenesis) is usually the last function to be lost in the setting of fulminant liver failure.
LDH isoenzyme 5
Serum protein electrophoresis:
5' nucleotidase (5'NTD)
5' nucleotidase is another test specific for cholestasis or damage to the intra or extrahepatic biliary system, and in some laboratories, is used as a substitute for GGT for ascertaining whether an elevated ALP is of biliary or extra-biliary origin

Cc what do you suggest an additional test to investigate CNS problem
Ammonia
Blood gases and PH
Electrolytes


اعضاء مختبرات العرب الكرام .....تحيه طيبه وبعد....

اعتذر عن التأخير في وضع الحل ...

واشكر كل من شارك في الحل ....



الاخت $ ما ادري نسميكي دولار والا ايه والاخت miss laboratory

تحيه من قلبي لكم ...شرفتموني بأن تكون اول مشاركه لكم في حل القضية ...ما شاء الله اجاباتكم شبه كامله تحيه وتقدير لكم وحياكم الله في مختبرنا

ايش رايكم في القضية...سهله والا صعبه...باين انها سهله لان ماشاء الله الاغلبيه جاوب


الاخ ابو البراء ....الترجمة تحتاج وقت ..القضية الاولى ترجمناها بس بعد كدا ..والله جدا مشغولين...ان شاء الله في المرات الجايه نترجم...



نأتي للفائز.....




والذي لطالما أفادنا بعلمه وخبرته...:more19:



الدكتور


:more54:




الفاضل




:sm170:




dr Moz




جزاك الله كل خير على كل ماتعلمناه منك ...ولك منا الدعاء بالتوفيق والسداد ...


وهذي ورده لكل من شارك ... :rose:...يعطيكم الف عافيه ...




وننتظركم في القضية الرابعة....

ابن دوام
04-03-2008, 10:59 PM
Liver function tests represent a broad range of normal functions performed by the liver. اختبارات وظائف الكبد وتمثل مجموعة واسعة من الوظائف العاديه التي يؤديها الكبد. The diagnosis of liver disease depends upon a complete history, complete physical examination, and evaluation of liver function tests and further invasive and noninvasive tests. تشخيص أمراض الكبد يتوقف كاملة تاريخ اتمام الفحص البدني ، وتقييم وظيفة الكبد التجارب والغازية وnoninvasive مزيد من الاختبارات. Many patients become confused regarding the meaning of a liver function test. كثير من المرضى يصبح الخلط فيما يتعلق بتحديد معنى للاختبار وظيفة الكبد. This section is designed to describe the basic liver function tests and the meaning for patients. هذا القسم مصمم لوصف الاساسية اختبارات وظائف الكبد ومعنى للمرضى.

The hepatobiliary tree represents hepatic cells and biliary tract cells. فان hepatobiliary شجرة تمثل خلايا الكبد والخلايا biliary المسالك. Inflammation of the hepatic cells results in elevation in the alanine aminotransferase (ALT), aspartate aminotransferase (AST) and possibly the bilirubin. التهاب الكبد من خلايا النتائج في الارتفاع في alanine aminotransferase (بديلة) ، aspartate aminotransferase (AST) ، وربما bilirubin. Inflammation of the biliary tract cells results predominantly in an elevation of the alkaline phosphatase. التهاب المسالك biliary من خلايا النتائج في الغالب في الارتفاع من القلويه Phosphatase. In liver disease there are crossovers between purely biliary disease and hepatocellular disease. في مرض الكبد وهناك عمليات الانتقال بين بحتة biliary المرض وhepatocellular المرض. To interpret these, the physician will look at the entire picture of the hepatocellular disease and biliary tract disease to determine which is the primary abnormality. لتفسير هذه ، والطبيب سوف ننظر في الصورة بأكملها من hepatocellular المرض وbiliary المسالك لتحديد المرض الذي يعد العامل الرئيسي في الشذوذ.

Alanine Aminotransferase (ALT): Alanine aminotransferase (بديلة) :

ALT is the enzyme produced within the cells of the liver. البديل هو الانزيم التي تصدر داخل خلايا الكبد. The level of ALT abnormality is increased in conditions where cells of the liver have been inflamed or undergone cell death. مستوى الشذوذ البديل هو زيادة في ظروف فيها خلايا الكبد وقد خضعت الملتهبه او موت الخلية. As the cells are damaged, the ALT leaks into the bloodstream leading to a rise in the serum levels. لأن الخلايا التالفه ، والتسريبات التي آلت الى مجرى الدم مما يؤدي الى ارتفاع في مستويات المصل. Any form of hepatic cell damage can result in an elevation in the ALT. اي شكل من اشكال الكبدي خلية يمكن ان يؤدي الى اضرار في الارتفاع في صيغة بديلة. The ALT level may or may not correlate with the degree of cell death or inflammation. المستوى فان البديل قد يكون او قد لا تتطابق مع درجة زنزانة الموت او التهاب. ALT is the most sensitive marker for liver cell damage. البديل هو العلامه الاكثر حساسيه للخلية الكبد اضرار.

Aspartate Aminotransferase (AST): Aspartate aminotransferase (AST) :

This enzyme also reflects damage to the hepatic cell. كما يعكس هذا الانزيم الضرر الواقع على كبدي الخلية. It is less specific for liver disease. ومن أقل محددة لامراض الكبد. It may be elevated and other conditions such as a myocardial infarct (heart attack). قد يكون مترفعه والشروط الاخرى مثل infarct متعلق بعضلة القلب (قلبية). Although AST is not a specific for liver as the ALT, ratios between ALT and AST are useful to physicians in assessing the etiology of liver enzyme abnormalities. ورغم ان AST ليست محددة لالكبد كما نص بديل ، والبديل النسب بين AST مفيدة للاطباء في تقييم المسببات : انزيمات الكبد من العيوب.

Alkaline Phosphatase: Phosphatase القلويه :

Alkaline phosphatase is an enzyme, which is associated with the biliary tract. Phosphatase القلويه هو انزيم ، وهو أمر يرتبط مع biliary المسالك. It is not specific to the biliary tract. انها ليست محددة الى biliary المسالك. It is also found in bone and the placenta. كما انه وجد في العظام والمشيمه. Renal or intestinal damage can also cause the alkaline phosphatase to rise. Intestinal الكلوي او ضرر يمكن ايضا ان تسبب قلوية Phosphatase الى الارتفاع. If the alkaline phosphatase is elevated, biliary tract damage and inflammation should be considered. اذا القلويه Phosphatase هو مترفعه ، biliary الضرر والتهاب المسالك ينبغي النظر. However, considering the above other etiologies must also be entertained. ولكن بالنظر الى اعلاه اخرى etiologies كما يجب مطلقا. One way to assess the etiology of the alkaline phosphatase is to perform a serologic evaluation called isoenzymes. احدى الطرق لتقييم المسببات : من القلويه Phosphatase هو ان يؤدوا serologic التقييم دعا isoenzymes. Another more common method to asses the etiology of the elevated alkaline phosphatase is to determine whether the GGT is elevated or whether other function tests are abnormal (such as bilirubin) آخر اكثر طريقه شاءعه لتقويم المسببات : من ارتقى القلويه Phosphatase هو تحديد ما اذا كانت ggt هو مترفعه وظيفة اخرى او ما اذا كانت الاختبارات غير طبيعية (مثل bilirubin)

Alkaline phosphatase may be elevated in primary biliary cirrhosis, alcoholic hepatitis, PSC, gallstones in choledocholithiasis. القلويه Phosphatase قد تكون مرتفعة في الابتدائي biliary التليف الكبدي ، التهاب الكبد الكحولي ، والقبة السماوية ، والحصاه في choledocholithiasis.

Gamma Glutamic Transpeptidase (GGT): غاما جلتاميت transpeptidase (ggt) :

This enzyme is also produced by the bile ducts. هذا الانزيم هو ايضا تنتجها قنوات الصفراء. However, it is not very specific to the liver or bile ducts. بيد أنه ليس من غاية محددة الى الكبد او القنوات الصفراء. It is used often times to confirm that the alkaline phosphatase is of the hepatic etiology. فهو يستخدم في كثير من الاحيان مرات للتاكد من ان القلويه Phosphatase هو من المسببات : كبدي. Certain GGT levels, as an isolated finding, reflect rare forms of liver disease. Ggt مستويات معينة ، كما ايجاد معزول ، وتعكس الاشكال النادرة من مرض الكبد. Medications commonly cause GGT to be elevated. الادوية عموما تسبب ggt الى ان ترفع. Liver toxins such as alcohol can cause increases in the GGT. الكبد السموم مثل الكحول يمكن ان يؤدي الى زيادات في ggt.

Bilirubin: Bilirubin :

Bilirubin is a major breakdown product of hemoglobin. Bilirubin رئيسي هو نتاج انهيار خضاب الدم. Hemoglobin is derived from red cells that have outlived their natural life and subsequently have been removed by the spleen. خضاب الدم الاحمر يشتق من الخلايا التي لم تعد الحياة الطبيعيه وازيلت لاحقا من قبل الطحال. During splenic degradation of red blood cells, hemoglobin (the part of the red blood cell that carries oxygen to the tissues) is separated out from iron and cell membrane components. خلال طحالي تدهور خلايا الدم الحمراء ، خضاب الدم (جزء من خلايا الدم الحمراء التي تحمل الاوكسجين الى الانسجه) هو ينفصلا الحديد ومكونات غشاء الخلية. Hemoglobin is transferred to the liver where it undergoes further metabolism in a process called conjugation. الهيموغلوبين يتم نقله الى الكبد حيث انها تعبر كذلك الايض في عملية تسمى الاقتران. Conjugation allows hemoglobin to become more water-soluble. الاقتران يسمح خضاب الدم لتصبح اكثر ذوبان في الماء. The water solubility of bilirubin allows the bilirubin to be excreted into bile. الماء للذوبان من bilirubin يسمح bilirubin لتفرز في الصفراء. Bile then is used to digest food. ثم الصفراء تستخدم لهضم الغذاء.

As the liver becomes irritated, the total bilirubin may rise. كما يصبح مغضب الكبد ، ويمكن ان يرتفع اجمالي bilirubin. It is then important to understand the difference between total bilirubin, which has undergone conjugation (that is hepatic cell metabolism), and at portion of bilirubin which has not been metabolized. ومن ثم من المهم ان نفهم الفرق بين مجموع bilirubin ، التي مرت اقتران (إن هو الكبدي خلية الأيض) ، وعلى جزء من bilirubin الذي لم مءيض. These two components are called total bilirubin and direct bilirubin. وهذان العنصران يسمى مجموع bilirubin والمباشره bilirubin. The direct bilirubin fraction is that portion of bilirubin that has undergone metabolism by the liver. المباشره هي ان bilirubin كسر جزء من bilirubin التي مرت بها الايض في الكبد. When this fraction is elevated, the cause of elevated bilirubin (hyperbilirubinemia) is usually outside the liver. هذا هو جزء بسيط عندما ارتقى ، ان سبب ارتفاع bilirubin (hyperbilirubinemia) هي عادة خارج الكبد. These types of causes are typically gallstones. هذه الانواع من الأسباب عادة ما تكون الحصاه. This type of abnormality is usually treated with surgery (such as a gallbladder removal or choleycystectomy). هذا النوع من الشذوذ هو عادة تعامل مع الجراحه (مثل ازالة المراره او choleycystectomy).

If the direct bilirubin is low, while the total bilirubin is high, this reflects liver cell damage or bile duct damage within the liver itself. اذا المباشره bilirubin منخفضه ، في حين بلغ اجمالي bilirubin مرتفع ، وهذا يعبر عن خلية الكبد او التلف او الضرر قناة الصفراء داخل الكبد نفسها.

Albumin: زلال :

Albumin is the major protein present within the blood. الزلال هو البروتين الرئيسى الحالى داخل الدم. Albumin is synthesized by the liver. الزلال هو توليفها من قبل الكبد. As such, it represents a major synthetic protein and is a marker for the ability of the liver to synthesize proteins. على هذا النحو ، فهو يمثل الرئيسية الاصطناعيه والبروتين هو علامة للقدرة الكبد على تجميع البروتينات. It is only one of many proteins that are synthesized by the liver. انها ليست سوى واحدة من العديد من البروتينات التي هي توليفها من قبل الكبد. However, since it is easy to measure, it represents a reliable and inexpensive laboratory test for physicians to assess the degree of liver damage present in the in any particular patient. ولكن ، نظرا لأنه من السهل قياس ، وهو يمثل موثوقه وغير مكلفه لاختبار مختبر الاطباء لتقييم درجة الضرر الكبد فى هذا بوجه خاص في أي مريض. When the liver has been chronically damaged, the albumin may be low. عندما الكبد المزمن قد تضررت ، والزلال قد تكون منخفضه. This would indicate that the synthetic function of the liver has been markedly diminished. وهذا من شأنه ان يبين أن الاصطناعيه وظيفة الكبد قد تضاءل بشكل ملحوظ. Such findings suggest a diagnosis of cirrhosis. هذه النتائج تشير الى تشخيص التليف الكبدي. Malnutrition can also cause low albumin (hypoalbuminemia) with no associated liver disease. سوء التغذيه يمكن ان يتسبب ايضا فى حدوث انخفاض الزلال (hypoalbuminemia) مع هذا المرض لا يرتبط الكبد.

Prothrombin time (PT): Prothrombin الوقت (PT) :

Another measure of hepatic synthetic function is the prothrombin time. وهناك تدبير اخر من كبدي الاصطناعيه وتتمثل المهمة prothrombin الوقت. Prothrombin time is affected by proteins synthesized by the liver. Prothrombin الوقت يتأثر بها توليفها البروتينات في الكبد. Particularly, these proteins are associated with the incorporation of vitamin K metabolites into a protein. لا سيما ، تلك البروتينات المرتبطه ادراج فيتامين ك ناتج او محصلة عملية التمثيل الغذائي في البروتينات. This allows normal coagulation (clotting of blood). ويتيح هذا طبيعي التخثر (تخثر الدم). Thus, in patients who have prolonged prothrombin times, liver disease may be present. وهكذا ، في المرضى الذين prothrombin أوقات طويلة ، ومرض الكبد قد تكون موجودة. Since a prolonged PT is not a specific test for liver disease, confirmation of other abnormal liver tests is essential. منذ مطولة PT يست محددة لاختبار مرض الكبد ، وتأكيد اختبارات الكبد غير طبيعية اخرى امر ضروري. This may include reviewing other liver function tests or radiology studies of the liver. ويمكن ان يشمل ذلك اعادة النظر في وظيفة الكبد التجارب الاخرى او الاشعه دراسات الكبد. Diseases such as malnutrition, in which decreased vitamin K ingestion is present, may result in a prolonged PT time. الأمراض مثل سوء التغذيه ، والتي انخفضت في فيتامين ك الابتلاع هو الحاضر ، قد يؤدي الى جعل المطول PT الوقت. An indirect test of hepatic synthetic function includes administration of vitamin K (10mg) subcutaneously over three days. غير مباشرة لاختبار وظيفة الكبد الاصطناعيه تشمل الادارة من فيتامين ك (10mg) تحت الجلد على مدى ثلاثة ايام. Several days later, the prothrombin time may be measured. وبعد بضعة ايام ، prothrombin الوقت يمكن ان يقاس. If the prothrombin time becomes normal, then hepatic synthetic function is intact. اذا prothrombin الوقت تصبح عادية ، ثم الكبد التركيبيه الوظيفة سليم. This test does not indicate that there is no liver disease, but is suggestive that malnutrition may coexist with (or without) liver disease. هذا الاختبار لا يبين انه لا توجد أمراض الكبد ، وانما هي توحي ان سوء التغذيه قد يتعايش مع (أو دون) الكبده المرض.

Platelet count: تعداد الصفيحات :

Platelets are cells that form the primary mechanism in blood clots. الصفائح هي الخلايا التي تشكل الاليه الاساسية في الجلطات الدمويه. They're also the smallest of blood cells. يبحثون أيضا أصغر من خلايا الدم. They derived from the bone marrow from the larger cells known as megakaryocytes. انها مستمده من نخاع العظم من اكبر الخلايا المعروفة باسم megakaryocytes. Individuals with liver disease develop a large spleen. الافراد مع مرض الكبد والطحال تطوير كبير. As this process occurs platelets are trapped with in the sinusoids (small pathways within the spleen) of the spleen. حيث ان هذه العملية تحدث مع الصفائح محاصرون في sinusoids (الصغيرة الممرات داخل الطحال) من الطحال. While the trapping of platelets is a normal function for the spleen, in liver disease it becomes exaggerated because of the enlarged spleen (splenomegaly). وفي حين حصر من الصفائح هي الوظيفة العاديه للالطحال ، وأمراض الكبد في ان يصبح مبالغا فيها بسبب الموسع الطحال (splenomegaly). Subsequently, the platelet count may become diminished. وفي وقت لاحق ، الصفيحات الفرز قد اصبحت تتضاءل.

Serum protein electrophoresis: بروتين المصل الكهربي :

This is an evaluation of the types of proteins that are present with in a patient's serum. هذا هو تقييم لأنواع من البروتينات التي هي في الحاضر مع المريض المصل. By using an electrophoretic gel, major proteins can be separated out. باستخدام electrophoretic هلام ، كبرى البروتينات يمكن فصل. This results in four major types of proteins. وهذا يؤدي الى اربعة انواع رئيسية من البروتينات. These are 1) albumin, 2) alpha globulins, 3) beta globulins and 4) gammaglobulins. هذه هي 1) الزلال ، 2) ألفا جلوبيولين ، 3) بيتا جلوبيولين و4) gammaglobulins. This test is useful for evaluation of patients who have abnormal liver function tests since it allows a direct quantification of multiple different serum proteins. هذا الاختبار هو مفيد لتقييم المرضى الذين الشاذ اختبارات وظائف الكبد حيث انه يتيح المباشر لكمية البروتينات في المصل متعددة مختلفة. If the gamma globulin fraction is elevated, autoimmune hepatitis may be present. اذا غاما الجلوبيولين هي جزء مترفعه ، والتهاب الكبد الذاتية قد يكون موجودا. In addition a deficiency in the alpha globulin fraction can result in the diagnosis, or a clinical clue, to A. alpha-1 antitrypsin deficiency. وبالاضافة الى وجود عجز في الجلوبيولين الفا يمكن ان يؤدي الى كسر في التشخيص السريري او فكرة ، لألف ألفا - 1 antitrypsin نقص. This is a simple blood test that is commonly performed by hepatologists. هذا هو اختبار دم بسيط هو ان يؤديها hepatologists عموما

sauod
16-03-2008, 05:55 PM
للاااااااااااااااسف اللغه عني زيرووووووووو بس الله يعينني والمهم اذاااا بغيت اظرح مووضووع باللغة العربيه عاااادي ولاااا لاااااا
ومشكووووووووووور ع الافاده

labspe
16-03-2008, 06:17 PM
الاخ سعود

ان شاء الله بتتحسن اللغة

واذا بغيت تطرح اي موضوع او تساؤل اطرحه عادي بأي لغه ...

بالتوفيق للكل

الوداد
18-03-2008, 05:40 PM
الان اقرأ وارد الجواب الاكيد

زهرة اللوتس
16-05-2008, 12:03 PM
http://sco77.com/up/uploads/16a35eba4f.jpg

زهرة اللوتس
16-05-2008, 12:16 PM
:step of collection sample
The first step is always to identify the patient. Outpatient phlebotomy, as shown here, should take place with the patient seated-
The requisition form should be completely filled out, and the requisition must indicate the tests ordered.

Here is the equipment for performing phlebotomy.
Barrier protection for the phlebotomist consists of the latex gloves

The tourniquet is applied and the phlebotomist palpates for a suitable vein for drawing blood.
The area of skin is cleaned with a disinfectant, here an alcohol swab
The vein is anchored and the needle is inserted

The vacutainer tube is depressed into the needle to begin drawing blood.

When the final tube is being drawn, release the tourniquet.
Then remove the tube,
and remove the needle.

After the needle is removed from the vein,
apply firm pressure over the site
to achieve hemostasis

Apply a bandage to the area
Label the tubes, checking the requisition for the proper identification.[/I][/I]

زهرة اللوتس
16-05-2008, 12:26 PM
liver function test
AST ,ALT GGT, ALP ,LDH,OCT, Tptal protein Albumin PT,(Prothrombin time), PTT.Activated partial thrombin time,protein electrophoresis, biliurbin total and direct.

Hasanessobky
23-12-2008, 04:49 PM
أفادكم الله

ايمن عون
05-01-2009, 09:31 AM
1-الاحتبار التشحيصى للكبد