leverproever-unormale (LH Indholdsside)

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      <HtmlField Name="PageContent"><![CDATA[<h2>Definition</h2>
<ul>
    <li>Kliniske biokemiske analyser som anvendes i forbindelse med diagnostik, kontrol og overv&aring;gning, stadieindeling, prognose eller behandlingsvalg ved leversygdom&nbsp;<a href=" " data-type="journal-reference" data-value="Kwo PY, Cohen SM, Lim JK, ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol 2017;112: 18-35" data-value-piped="Kwo PY, Cohen SM, Lim JK|ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries.|Am J Gastroenterol|2017|112|18-35|27995906" data-url="reference-link" data-pubmedid="27995906" title="Kwo PY, Cohen SM, Lim JK, ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol 2017;112: 18-35">1</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="European Association for Study of Liver., Asociacion Latinoamericana para el Estudio del Higado., EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015;63: 237-64" data-value-piped="European Association for Study of Liver., Asociacion Latinoamericana para el Estudio del Higado.|EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis.|J Hepatol|2015|63|237-64|25911335" data-url="reference-link" data-pubmedid="25911335" title="European Association for Study of Liver., Asociacion Latinoamericana para el Estudio del Higado., EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015;63: 237-64">2</a></li>
    <li>Analyserne indg&aring;r ogs&aring; hyppigt i diverse "rutineblodpr&oslash;ver til unders&oslash;gelse af leverfunktionen," f.eks. i forbindelse med:
    <ul>
        <li>Udredning af &aring;rsager til uspecifikke symptomer</li>
        <li>Akut indl&aelig;ggelse, ved alvorlig sygdom<a href=" " data-type="book-reference" data-value="ahlerup JF, Boesgaard S, Bonde J, et al. Den akut svært syge patient. I: Schaffalitzky de Muckadell O, Haunsø S, Vilstrup H, red. Medicinsk Kompendium. 17 utg. København: Nyt Nordisk Forlag Arnold Busck A/S; 2009. p. 185-211" data-value-piped="ahlerup JF, Boesgaard S, Bonde J, et al.|Den akut svært syge patient. I: Schaffalitzky de Muckadell O, Haunsø S, Vilstrup H, red. Medicinsk Kompendium. 17 utg.|København|Nyt Nordisk Forlag Arnold Busck A/S|2009. p. 185-211" data-url="reference-link" title="ahlerup JF, Boesgaard S, Bonde J, et al. Den akut svært syge patient. I: Schaffalitzky de Muckadell O, Haunsø S, Vilstrup H, red. Medicinsk Kompendium. 17 utg. København: Nyt Nordisk Forlag Arnold Busck A/S; 2009. p. 185-211">3</a></li>
        <li>Behandling med potentielt levertoksiske medikamenter</li>
        <li>Deltagelse i kliniske videnskabelige unders&oslash;gelser</li>
        <li>Forsikringssager</li>
    </ul>
    </li>
</ul>
<h3>Bem&aelig;rkninger</h3>
<ul>
    <li>Oversigten nedenfor omfatter <em>ikke</em> specifikke diagnostiske unders&oslash;gelser for infekti&oslash;s hepatit, autoimmun sygdom, forgiftning etc. </li>
    <li>Det er stor forskel p&aring; analysernes "leverspecificitet," dvs. at abnorme v&aelig;rdier kan skyldes andet end leversygdom (se nedenfor), og at flere analyser ogs&aring; kan anvendes til andre form&aring;l
    <ul>
        <li>Brugen af ASAT og LDH som leverpr&oslash;ver er omdiskuteret, da analyserne ikke antages at give mere information end den, som ALAT giver, da forh&oslash;jede v&aelig;rdier kan skyldes meget andet end leverp&aring;virkning&nbsp;<a href=" " data-type="journal-reference" data-value="Green RM, Flamm S, AGA technical review on the evaluation of liver chemistry tests. Gastroenterology 2002;123: 1367-84" data-value-piped="Green RM, Flamm S|AGA technical review on the evaluation of liver chemistry tests.|Gastroenterology|2002|123|1367-84|12360498" data-url="reference-link" data-pubmedid="12360498" title="Green RM, Flamm S, AGA technical review on the evaluation of liver chemistry tests. Gastroenterology 2002;123: 1367-84">4</a></li>
    </ul>
    </li>
    <li>Det er vigtig at fortolke resultaterne i sammenh&aelig;ng med anamnesen, den kliniske unders&oslash;gelse og resultater af andre parakliniske unders&oslash;gelser (UL, CT, mfl)</li>
    <li>Bortset fra gamma-GT, er almindelige leverpr&oslash;ver ikke s&aelig;rlig velegnede til p&aring;visning af et h&oslash;jt alkoholforbrug eller misbrug (medmindre det har medf&oslash;rt leverskade), og de kan tilsvarende heller ikke bruges til at udelukke dette. Analysen <a href="~/link.aspx?_id=694A607A43284884BEE2853E44F7C0C5&amp;_z=z">carbohydrate-deficient transferrin (CDT)</a>&nbsp;er bedre</li>
</ul>
<h2>&Aring;rsager og fejlkilder til let forh&oslash;jede v&aelig;rdier hos asymptomatiske patienter</h2>
<ul>
    <li>H&oslash;j fysisk aktivitet i dagene f&oslash;r pr&oslash;vetagning eller nylig overst&aring;et st&oslash;rre operation (LDH, ASAT, ALAT)</li>
    <li>Protein- eller fedtrigt m&aring;ltid i timerne f&oslash;r pr&oslash;vetagning (ASAT, alkalisk fosfatase)</li>
    <li>Vanskelig/ langvarig pr&oslash;vetagning (ASAT, LDH)</li>
    <li>Rekonvalesens efter fraktur (alkalisk fosfatase)</li>
    <li>Graviditet (ASAT, LDH, alkalisk fosfatase)</li>
</ul>
<h2>Gruppering af analyserne</h2>
<ul>
    <li>Analyserne kan placeres i 4 grupper, der svarer til det som resultaterne afspejler<a href=" " data-type="journal-reference" data-value="American Gastroenterological Association., American Gastroenterological Association medical position statement: evaluation of liver chemistry tests. Gastroenterology 2002;123: 1364-6" data-value-piped="American Gastroenterological Association.|American Gastroenterological Association medical position statement: evaluation of liver chemistry tests.|Gastroenterology|2002|123|1364-6|12360497" data-url="reference-link" data-pubmedid="12360497" title="American Gastroenterological Association., American Gastroenterological Association medical position statement: evaluation of liver chemistry tests. Gastroenterology 2002;123: 1364-6">5</a>
    <ul>
        <li>Hepatocytskade/nekrose ses ved akut hepatitis</li>
        <li>Nedsat ekskretorisk funktion, ses ved tilstande med intra- eller ekstrahepatisk kolestase</li>
        <li>Reduceret proteinsyntese, ses ved cirrhose</li>
        <li>Global leverfunktion</li>
    </ul>
    </li>
    <li>Grupperingerne kan benyttes som en tommelfingerregel, men b&oslash;r ikke benyttes kategorisk, da graden af abnorme analysesvar overlapper mellem de forskellige sygdomme, s&aelig;rlig ved alvorlig leverp&aring;virkning</li>
</ul>
<h3>Hepatocytskade (parenkymat&oslash;se nekroser)<a href="EditorPage.aspx?da=core&amp;id=%7B5D890786-85E8-461F-ACB4-D848DDE0C3C2%7D&amp;ed=FIELD2715188292&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H2715188356&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Kalas MA, Chavez L, Leon M, Taweesedt PT, Surani S, Abnormal liver enzymes: A review for clinicians. World J Hepatol 2021;13: 1688-1698" data-value-piped="Kalas MA, Chavez L, Leon M, Taweesedt PT, Surani S|Abnormal liver enzymes: A review for clinicians.|World J Hepatol|2021|13|1688-1698|34904038" data-url="reference-link" data-pubmedid="34904038" title="Kalas MA, Chavez L, Leon M, Taweesedt PT, Surani S, Abnormal liver enzymes: A review for clinicians. World J Hepatol 2021;13: 1688-1698">6</a></h3>
<ul>
    <li><a href="~/link.aspx?_id=CAEF0A174B334B75805EB18D6A266EE1&amp;_z=z">Alanin-aminotransferase (ALAT)</a>
    <ul>
        <li>Findes prim&aelig;rt i leveren og er derfor mere specifik for leverskader end ASAT. Findes dog ogs&aring; i mindre grad i hjerte, nyre og muskelv&aelig;v</li>
    </ul>
    </li>
    <li><a href="~/link.aspx?_id=1EC226C28A704C08985C187EE58092BF&amp;_z=z">Aspartat-aminotransferase (ASAT)</a>
    <ul>
        <li>Findes b&aring;de i lever, skeletmuskulatur, hjerte, hjerne og erytrocytter</li>
        <li>Indg&aring;r i&nbsp;<a href="~/link.aspx?_id=75EB2C747EE04008BCAE16072A7C2C82&amp;_z=z">FIB-4</a>&nbsp;algoritmen sammen ALAT, alder og trombocyttal&nbsp;til udredning af <a href="~/link.aspx?_id=4E1B675D7D3B4AC489863CDE6C79BA04&amp;_z=z">ikke-alkoholisk fedtleversygdom</a>&nbsp;</li>
    </ul>
    </li>
    <li><a href="~/link.aspx?_id=80F720F94C384D84B04F6F054CB5D960&amp;_z=z">Laktat dehydrogenase (LD)</a>&nbsp;- regnes ikke konsekvent som leverparameter. Findes udbredt i hele kroppen</li>
    <li>Hepatocellul&aelig;r skade frig&oslash;r ALAT og ASAT til blodbanen<a href=" " data-type="journal-reference" data-value="Oh RC, Hustead TR, Causes and evaluation of mildly elevated liver transaminase levels. Am Fam Physician 2011;84: 1003-8" data-value-piped="Oh RC, Hustead TR|Causes and evaluation of mildly elevated liver transaminase levels.|Am Fam Physician|2011|84|1003-8|22046940" data-url="reference-link" data-pubmedid="22046940" title="Oh RC, Hustead TR, Causes and evaluation of mildly elevated liver transaminase levels. Am Fam Physician 2011;84: 1003-8">7</a></li>
    <li>ASAT/ALAT ratio
    <ul>
        <li>&lt; 1 tyder p&aring;&nbsp;<a href="~/link.aspx?_id=4E1B675D7D3B4AC489863CDE6C79BA04&amp;_z=z">ikke-alkoholisk fedtleversygdom</a></li>
        <li>&gt; 2 tyder p&aring; alkoholisk leversygdom&nbsp;<a href="EditorPage.aspx?da=core&amp;id=%7B5D890786-85E8-461F-ACB4-D848DDE0C3C2%7D&amp;ed=FIELD2715188292&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H2715188356&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Kalas MA, Chavez L, Leon M, Taweesedt PT, Surani S, Abnormal liver enzymes: A review for clinicians. World J Hepatol 2021;13: 1688-1698" data-value-piped="Kalas MA, Chavez L, Leon M, Taweesedt PT, Surani S|Abnormal liver enzymes: A review for clinicians.|World J Hepatol|2021|13|1688-1698|34904038" data-url="reference-link" data-pubmedid="34904038" title="Kalas MA, Chavez L, Leon M, Taweesedt PT, Surani S, Abnormal liver enzymes: A review for clinicians. World J Hepatol 2021;13: 1688-1698">6</a></li>
        <li>&gt; 4 tyder p&aring; <a href="~/link.aspx?_id=313DC3D9E392403FB022A7E75CB8FD63&amp;_z=z">Wilsons sygdom</a><a href=" " data-type="journal-reference" data-value="Krier M, Ahmed A, The asymptomatic outpatient with abnormal liver function tests. Clin Liver Dis 2009;13: 167-77" data-value-piped="Krier M, Ahmed A|The asymptomatic outpatient with abnormal liver function tests.|Clin Liver Dis|2009|13|167-77|19442912" data-url="reference-link" data-pubmedid="19442912" title="Krier M, Ahmed A, The asymptomatic outpatient with abnormal liver function tests. Clin Liver Dis 2009;13: 167-77">8</a></li>
    </ul>
    </li>
</ul>
<h4>&Aring;rsager til forh&oslash;jede transaminaser</h4>
<ul>
    <li>Alkoholrelateret
    <ul>
        <li>Sammenh&aelig;ng med overdrevent alkoholforbrug</li>
        <li>Relevante test er ASAT og ALAT (ratio), gamma-GT</li>
    </ul>
    </li>
    <li><a href="~/link.aspx?_id=DCC02894FB4B47298BC6094780800A34&amp;_z=z">H&aelig;mokromatose</a>&nbsp; &nbsp; &nbsp;&nbsp;
    <ul>
        <li>Unders&oslash;g familieanamnese, is&aelig;r for leversygdom&nbsp;</li>
        <li>Suppl&eacute;r med <a href="~/link.aspx?_id=84F24B5ECB9C48AE9BC4A1DCB7ED5C3F&amp;_z=z">Jern</a>, transferrin, <a href="~/link.aspx?_id=B347096E158D41C58AFFF43E52829778&amp;_z=z">Ferritin</a>, TIBC og HFE genotype</li>
    </ul>
    </li>
    <li><a href="~/link.aspx?_id=4D630BBD45DC4733B9F1B100C9A40985&amp;_z=z">Hepatitis B</a>
    <ul>
        <li>Risikopatienter er indvandrere fra lande hvor hepatitis findes endemisk, promiskuitet, intraven&oslash;s stofmisbrug</li>
        <li>Supplere med HBsAg</li>
    </ul>
    </li>
    <li><a href="~/link.aspx?_id=167256D2AFAE46B08CFEFD608010732C&amp;_z=z">Hepatit C</a>
    <ul>
        <li>Risikoadf&aelig;rd er spr&oslash;jtebrug, HIV, blodtransfusion f&oslash;r 1992</li>
        <li>Tjek HCV antistof</li>
    </ul>
    </li>
    <li>Medikamenter
    <ul>
        <li>Polyfarmaci, visse urtepr&aelig;parater</li>
        <li>Mange medikamenter kan give forh&oslash;jede transaminaser, men de mest relevante er paracetamol og statiner</li>
        <li>Kortl&aelig;g medikamentforbrug + alternativ medicin</li>
    </ul>
    </li>
    <li><a href="~/link.aspx?_id=4E1B675D7D3B4AC489863CDE6C79BA04&amp;_z=z">Ikke-alkoholisk fedtleversygdom</a>
    <ul>
        <li>Tegn p&aring; metabolisk syndrom - h&oslash;je triglycerider, lavt HDL, &oslash;get abdominalomfang, forh&oslash;jet glukose</li>
        <li>Tjek lipider, glukose, vurder ultralyd af leveren</li>
    </ul>
    </li>
    <li><a href="~/link.aspx?_id=B88F95BE9B02476692AD8A1A8D21AA2F&amp;_z=z">Alfa1-antitrypsin mangel</a>
    <ul>
        <li>Familiehistorie. Tidlig debut af emfysem</li>
        <li>M&aring;l&nbsp;<a href="~/link.aspx?_id=B88F95BE9B02476692AD8A1A8D21AA2F&amp;_z=z">alfa1-antitrypsin</a></li>
    </ul>
    </li>
    <li><a href="~/link.aspx?_id=A66FE392D12A45619D44C32ACE4ACCFF&amp;_z=z">Autoimmun hepatit</a>
    <ul>
        <li>Kvinder med autoimmune forstyrrelser</li>
        <li>Tjek proteinelektroforese, antistoffer mod lever/nyre mikrosomalt antistof type 1, ANF og glat-muskel antistof</li>
    </ul>
    </li>
    <li><a href="~/link.aspx?_id=313DC3D9E392403FB022A7E75CB8FD63&amp;_z=z">Wilsons sygdom</a>
    <ul>
        <li>Yngre end 40 &aring;r, neuropsykiatriske symptomer, Kayser-Fleischer ringer</li>
        <li>Tjek ceruloplasmin</li>
    </ul>
    </li>
    <li><a href="~/link.aspx?_id=935A845E8C8643229D937C40DCE2A30F&amp;_z=z">C&oslash;liaki</a>
    <ul>
        <li>Diarr&eacute;, mavesmerter, malabsorption</li>
        <li>Tjek <a href="~/link.aspx?_id=5D6888EC431A49EFA6596EA3EA84FB89&amp;_z=z">anti-vevstransglutaminase</a>&nbsp;antistof, anti-tTG </li>
    </ul>
    </li>
    <li>H&aelig;molyse
    <ul>
        <li>Glukose-6-fosfat dehydrogenase mangel, seglcellean&aelig;mi, infektion</li>
        <li>Tjek LD, haptoglobin, retikulocytter</li>
    </ul>
    </li>
    <li>Muskelsygdom
    <ul>
        <li>Muskelsvaghed og smerte, ekstreme fysiske belastninger</li>
        <li>Tjek kreatinkinase og aldolase</li>
    </ul>
    </li>
    <li>Thyreoideaforstyrrelse
    <ul>
        <li>Tegn p&aring; <a href="~/link.aspx?_id=A6F030DC72254F5FA59D5924937494D0&amp;_z=z">hypo</a>- eller&nbsp;<a href="~/link.aspx?_id=6F8C67265AD4418CBB1BA4514AE6EA53&amp;_z=z">hypertyreose</a></li>
        <li>Tjek TSH</li>
    </ul>
    </li>
</ul>
<h3>Kompromitteret ekskretorisk funktion (kolestase, infiltrerende sygdom, reduceret konjugering)</h3>
<ul>
    <li><a href="~/link.aspx?_id=E72732DC66DF48C7850DBED1D6B403A8&amp;_z=z">Alkalisk fosfatase (ALP)</a>. Findes lever/galdeveje, knogler, placenta og tarme</li>
    <li><a href="~/link.aspx?_id=CA07BA3BD6584718AEAC06C13D518FA0&amp;_z=z">Bilirubin</a>. Findes i lever og blodbanen. Findes i ukonjugeret&nbsp;og konjugeret form, der stiger is&aelig;r ved kolestase</li>
    <li><a href="~/link.aspx?_id=4CC97C026E3E45DCA81505D8F09F2FE1&amp;_z=z">Gamma-Glutamyltransferase (GT)</a></li>
</ul>
<h3>Reduceret proteinsyntese</h3>
<ul>
    <li><a href="~/link.aspx?_id=F115F1A4BE8648D5B5D0AB79A07629DD&amp;_z=z">P-Albumin</a></li>
    <li><a href="~/link.aspx?_id=15300C99C97B46359BD98CA055FC9DD8&amp;_z=z">P-Koagulationsfaktor II, VII og X (PT-INR)</a></li>
</ul>
<h3>Global leverfunktion</h3>
<ul>
    <li><a href="~/link.aspx?_id=E1A8F49BE2B944B69B1A920EAB975F54&amp;_z=z">P-Ammoniak</a></li>
    <li>Pt-Galaktose eliminationskapacitet til estimering af resterende levermasse&nbsp;</li>
    <li>Pt-MELD-score til estimering af prognose og operationsrisiko hos patienter med fremskreden leversygdom. Score beregnes ud fra P-Bililrubin, PT-INR, P-Kreatinin og (eventuelt) P-Natrium<a href=" " data-type="journal-reference" data-value="Jepsen P, Sørensen HT, Vilstrup H, Ott P, [Surgical risk for patients with liver disease]. Ugeskr Laeger 2006;168: 4299-302" data-value-piped="Jepsen P, Sørensen HT, Vilstrup H, Ott P|[Surgical risk for patients with liver disease].|Ugeskr Laeger|2006|168|4299-302|17164057" data-url="reference-link" data-pubmedid="17164057" title="Jepsen P, Sørensen HT, Vilstrup H, Ott P, [Surgical risk for patients with liver disease]. Ugeskr Laeger 2006;168: 4299-302">9</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Kamath PS, Kim WR, Advanced Liver Disease Study Group., The model for end-stage liver disease (MELD). Hepatology 2007;45: 797-805" data-value-piped="Kamath PS, Kim WR, Advanced Liver Disease Study Group.|The model for end-stage liver disease (MELD).|Hepatology|2007|45|797-805|17326206" data-url="reference-link" data-pubmedid="17326206" title="Kamath PS, Kim WR, Advanced Liver Disease Study Group., The model for end-stage liver disease (MELD). Hepatology 2007;45: 797-805">10</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Ytrebø LM, Klepstad P, [Intensive care of patients with acute liver failure]. Tidsskr Nor Laegeforen 2010;130: 1609-13" data-value-piped="Ytrebø LM, Klepstad P|[Intensive care of patients with acute liver failure].|Tidsskr Nor Laegeforen|2010|130|1609-13|20805858" data-url="reference-link" data-pubmedid="20805858" title="Ytrebø LM, Klepstad P, [Intensive care of patients with acute liver failure]. Tidsskr Nor Laegeforen 2010;130: 1609-13">11</a></li>
</ul>
<h2>Hvis det ikke er leveren, hvad kan det v&aelig;re?</h2>
<ul>
    <li>Forh&oslash;jet ALAT: Muskelv&aelig;v?</li>
    <li>Forh&oslash;jet ASAT: Muskelv&aelig;v eller erytrocytter?</li>
    <li>Forh&oslash;jet LDH: Muskelv&aelig;v, erytrocytter, lungev&aelig;v, nyrer, milt, lymfeknuder, endokrine kirtler, testiscancer, lymfom?</li>
    <li>Forh&oslash;jet Basisk fosfatase: knogle, tarm eller placenta?</li>
    <li>Forh&oslash;jet Bilirubin: H&aelig;molytisk tilstand?</li>
    <li>Forh&oslash;jet gamma-GT: Pancreas?</li>
    <li>Forh&oslash;jet INR: &Oslash;get forbrug af koagulationsfaktorer? K-vitamin mangel?</li>
    <li>Nedsat Albumin: D&aring;rlig ern&aelig;ring, &oslash;get tab, forskydning eller overhydrering?</li>
</ul>]]></HtmlField>
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    <Medias />
  </Item>
</Provider>

20.803 characters