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قضية الأسبوع (3) وتحليل وظائف الكبد(تم حلها)

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  • #16
    اعتذر واسف
    اذا كان الكلام من فضه فلسكوت من ذهب

    تعليق


    • #17
      صباح الخير اتمنى المشاركة ولكن لازلت طالبا و سأحاول حل بعض الاسئلة وشكرا لكم[]

      تعليق


      • #18
        يا دكاتره لو سمحتم عايزين نكتب بايدينا مش نخش نعمل search وبس ونلصق اللي يطلع في الsearch

        الكلام ده مينفعش

        تعليق


        • #19
          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

          تعليق


          • #20
            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....
            sigpic

            قال صلى الله عليه وسلم:
            (ثلاث كفارات وثلاث درجات وثلاث منجيات وثلاث مهلكات فأما الكفارات فإسباغ الوضوء في السبرات وانتظار الصلوات بعد الصلوات ونقل الأقدام إلى الجماعات وأما الدرجات فإطعام الطعام وإفشاء السلام والصلاة بالليل والناس نيام وأما المنجيات فالعدل في الغضب والرضا والقصد في الفقر والغنى وخشية الله في السر والعلانية وأما المهلكات فشح مطاع وهوى متبع وإعجاب المرء بنفسه)

            تعليق


            • #21
              اختبارات وظائف الكبد


              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
              http://up105.arabsh.com/my/c847ba2.jpg

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              • #22
                للاااااااااااااااسف اللغه عني زيرووووووووو بس الله يعينني والمهم اذاااا بغيت اظرح مووضووع باللغة العربيه عاااادي ولاااا لاااااا
                ومشكووووووووووور ع الافاده

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                • #23
                  الاخ سعود

                  ان شاء الله بتتحسن اللغة

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

                  بالتوفيق للكل
                  sigpic

                  قال صلى الله عليه وسلم:
                  (ثلاث كفارات وثلاث درجات وثلاث منجيات وثلاث مهلكات فأما الكفارات فإسباغ الوضوء في السبرات وانتظار الصلوات بعد الصلوات ونقل الأقدام إلى الجماعات وأما الدرجات فإطعام الطعام وإفشاء السلام والصلاة بالليل والناس نيام وأما المنجيات فالعدل في الغضب والرضا والقصد في الفقر والغنى وخشية الله في السر والعلانية وأما المهلكات فشح مطاع وهوى متبع وإعجاب المرء بنفسه)

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                  • #24
                    الان اقرأ وارد الجواب الاكيد

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                    • #25

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                      • #26
                        :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]

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                        • #27
                          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.

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                          • #28
                            أفادكم الله

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                            • #29
                              1-الاحتبار التشحيصى للكبد

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