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PEMERIKSAAN

LABORATORIUM
FAAL HATI

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ANATOMI HEPAR

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This organ plays a major role in metabolism and has a number of
functions in the body :
glycogen storage,
decomposition of red blood cells,
plasma protein synthesis,
hormone production, and
detoxification.

It produces bile, an alkaline compound (which aids in digestion,


via the emulsification of lipids.

synthesis and breakdown of small and complex molecules


(many of which are necessary for normal vital functions.[2]

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SYNTHESIS FUNCTION

amino acid synthesis

several roles in carbohydrate metabolism:


Gluconeogenesis (the synthesis of glucose from certain amino
acids, lactate or glycerol)
Glycogenolysis (the breakdown of glycogen into glucose)
Glycogenesis (the formation of glycogen from glucose)(muscle
tissues can also do this)

protein metabolism, synthesis as well as degradation

several roles in lipid metabolism:


Cholesterol synthesis
Lipogenesis, the production of triglycerides (fats).

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Cont….

produces coagulation factors I (fibrinogen), II (prothrombin), V, VII,


IX, X and XI, as well as protein C, protein S and antithrombin.

produces and excretes bile (a greenish liquid) required for emulsifying fats.

produces insulin-like growth factor 1 (IGF-1),


a polypeptide protein hormone
(that plays an important role in childhood growth and continues
to have anabolic effects in adults)

a major site of thrombopoietin production. (thrombopoietin is a glycoprotein


hormone that regulates the production of platelets by the bone marrow

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BREAKDOWN FUNCTION

The breakdown of insulin and other hormones

The liver breaks down hemoglobin, creating metabolites that are added
to bile as pigment (bilirubin and biliverdin).

The liver breaks down or modifies toxic substances (eg. methylation) and
most medicinal products in a process called drug metabolism. This
sometimes results in toxication, when the metabolite is more toxic than
its precursor. Preferably, the toxins are conjugated to avail excretion in
bile or urine.

The liver converts ammonia to urea.

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OTHER FUNCTIONS

The liver stores a multitude of substances


glucose (in the form of glycogen),
vitamin A (1–2 years' supply),
vitamin D (1–4 months' supply),
vitamin B12,
iron, and copper.
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 produces albumin, the major osmolar component of blood serum.

The liver synthesizes angiotensinogen, a hormone that is responsible for raising


the blood pressure when activated by renin, a kidney enzyme that is released
when the juxtaglomerular apparatus senses low blood pressur

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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.

Some tests are associated with :


 functionality (eg. albumin);

 cellular integrity (eg. transaminase)

 conditions linked to the biliary tract


(gamma-glutamyl transferase and alkaline phosphatase).

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Several biochemical tests are useful in the evaluation and
management of patients with hepatic dysfunction.
These tests can be used to :

(1) detect the presence of liver disease,

(2) distinguish among different types of liver disorders,

(3) gauge the extent of known liver damage, and

(4) follow the response to treatment.

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Pemeriksaan Laboratorium
untuk penyakit hati, bertujuan :

1. Skrining
2. Diagnosis
3. Monitoring
4. Prognosis

 Faal Hati :
1. Fungsi ekskresi : bilirubin, bile acids
2. Fungsi sintesa : protein, albumin, Fx Koagulasi
Cholinesterase (CHE)
3. Fungsi metabolik
 Kerusakan Hati : ensim-ensim hati (SGOT, SGPT)
 Obstruksi Hati : bilirubin, ALP, GGT
 Keganasan Hati : AFT

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ENSIM – ENSIM HATI

Penyakit hati
kadar serum ensim sel hati:
- sitosolik
- mitokondrial
- membran >>>
SGOT / AST (aspartate aminotransferase)
SGPT / ALT ( alanine aminotransferase)
ALP (akaline phosphatase)
GGT (γ-glutamyltransferase)
CHE ( cholinesterase)
G-LDH (LDH) (Lactic-dehydrogenase)

Pemeriksaan kombinasi beberapa ensim : dapat dilakukan


untuk skrining

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AMINOTRANSFERASE
AST / SGOT
ensim mitokondrial & sitoplasmik
distribusi : jantung, hati, otot skeletal, ginjal
ALT / SGPT
ensim membran hepatosit & sitoplasmik
distribusi : hati, ginjal

ALKALINE PHOSPHATASE (ALP)


terlibat pada transpor metabolit melewati membran sel
distribusi : plasenta, ginjal, tulang, hati
>>> :
Penyakit hati :
Cholestasis : menstimulasi hepatosit mensintesa ALP
Garam empedu : meningkatkan pelepasan ALP
non hati :
hamil, anak-anak, penyakit tulang,
tumor yg memproduksi ALP
dibedakan dg pemeriksaan GGT
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GGT (GAMMA-GLUTAMYL TRANSFERASE)
ensim yg terikat pd membran hepatosit
>>>> :
- obat : carbamazepine, cimetidin, furosemid, heparin
isotretinoin, methotrexate, oral contraceptives,
phenobarbital, phenitoin, valproic acid
- alkohol

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JAUNDIS / IKTERIK

Tanda fisik berupa warna kekuningan pada kulit & sklera


Akibat deposisi pigmen empedu

Bilirubin serum > 2-3 mg/dl

Penyebab :
 Penyakit Hati
 bukan penyakit hati :
- Hemolisis
- gangguan metabolisme bilirubin
Bilirubin yg diperiksa :
 bilirubin total
 bilirubin direk : conjugated bilirubin & δ bilirubin
 bilirubin indirek (unconjugated) = total - direk

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KLASIFIKASI HIPERBILIRUBINEMIA INDIREK
/UNCONJUGATED
Produksi dari heme >>> : Penurunan pengangkutan ke hati :
- hemolisis - congestive heart failure
- eritropoisis inefektif - portacaval shunt

Penurunan Uptake membran : Penurunan penyimpanan di sel :


- inhibisi kompetitif - inhibisi kompetitif
(obat) - febris
- Gilbert syndrome
- sepsis
- fasting

Penurunan biotransformasi (konjugasi) :


- neonatal jaundice (fisiologik)
- inhibisi (obat)
- herediter (Crigler Najjar)
- disfungsi hepatoseluler
- Gilberst syndrome ?
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KLASIFIKASI HIPERBILIRUBINEMIA CONJUGATED

Penurunan sekresi ke kanalikuli :


- Penyakit hepatoseluler :
Hepatitis
Cholestasis (intahepatik)
- Dubin-Johnson & Rotor syndromes
- Obat (estradiol)

Penurunan drainase :
- Obstruksi ekstrahepatik:
batu striktur
carcinoma atresia
- Sclerosing cholangitis
- Obstruksi intrahepatik :
obat primary biliary cirrhosis
granuloma bile duct paucity
tumor

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ALBUMIN

Protein yg disintesa terbanyak oleh hepatosit

Kecepatan produksi dipengaruhi oleh :


- suplai asam amino
- tekanan onkotik plasma
- kadar sitokon inhibitor ( IL-6)
- jumlah sel hepatosit yg berfungsi baik

Penyebab penurunan kadar albumin plasma :


- protein loss (nephrotic syndrome, burns, protein losing
entropathy)
- albumin turn over >> (catabolic state, glucocrticoid)
- penurunan protein intake (malnutrisi)
- PENYAKIT HATI

Pada Hepatitis kronik yg progresif menjadi cirrhosis Albumin <<


(petanda dekompensasi & prognosis)
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TES PEMBEKUAN DARAH

Hati mensintesa Faktor pembekuan darah :


I, II, V, VII, IX, X

F. II , VII, X diaktifkan oleh ensim yg tergantung Vit. K

Dekompensasi hati menyebabkan pemanjangan


Semua tes pembekuan darah :

aPTT activated partial thromboplastin time


( Pembekuan darah jalur intrinsik)

PPT plasma prothrombin time


( Pembekuan darah jalur ekstrinsik)

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TES FUNGSI HATI

TES FUNGSI
Bilirubin Diagnosa jaundis, berkorelasi dg keparahan
ALP Diagnosa kolestasis & space occupying lesions
Fraksi bilirubin Diagnosa gangguan metabolisme & jaundice of the new
born
AST (SGOT) Tes yg sensitif untuk penyakit hepatoseluler,
SGOT > SGPT pada penyakit alkohol & penyakit hati kronik
berat
ALT (SGPT) Tes yg sensitif & lebih spesifik untuk penyakit
hepatoseluler
Albumin Indikator kronisitas & keparahan
Prothrombin time Indikator keparahan & kolestasis
(PT)

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