scholarly journals Diagnostic strategies and test algorithms in liver disease

1997 ◽  
Vol 43 (8) ◽  
pp. 1555-1560 ◽  
Author(s):  
Edgar R Black
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Diagnostic Tests ◽  
Clinical Decision Making ◽  
Serum Alkaline Phosphatase ◽  
Clinical Decision ◽  
Aminotransferase Activity ◽  
Hepatocellular Injury ◽  
Serum Aminotransferase ◽  
Diagnostic Strategies

Abstract As clinicians evaluate patients, they first develop problem lists based on the history, physical examination, and basic laboratory studies. Synthesis and analysis result in a differential diagnosis with associated disease probabilities. Experienced clinicians then selectively use diagnostic tests to rule in or rule out these possibilities. For example, in a patient presenting with jaundice, anorexia, fever, and abdominal pain, the relative increases of the serum aminotransferase activity and the serum alkaline phosphatase will help to guide the subsequent evaluation. If the aminotransferase activity is markedly increased, then the subsequent evaluation will be targeted toward identifying an etiology for hepatocellular injury. In contrast, if the alkaline phosphatase is markedly increased, then the evaluation would be targeted toward identifying an etiology for obstructive jaundice. This paper reviews clinical decision making, discusses characteristics of diagnostic tests, and presents examples of how basic clinical information can guide the use of the laboratory in evaluating patients with suspected liver disease.

scholarly journals Multiparametric MR mapping in clinical decision-making for diffuse liver disease

2020 ◽  
Vol 45 (11) ◽  
pp. 3507-3522 ◽  
Author(s):  
Helena B. Thomaides-Brears ◽  
Rita Lepe ◽  
Rajarshi Banerjee ◽  
Carlos Duncker
Keyword(s):  
Liver Disease ◽  
Liver Diseases ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Clinical Decision ◽  
Chronic Liver ◽  
Diffuse Liver Disease ◽  
Treatment Pathway ◽  
Recent Developments ◽  
Potential Applications

Abstract Accurate diagnosis, monitoring and treatment decisions in patients with chronic liver disease currently rely on biopsy as the diagnostic gold standard, and this has constrained early detection and management of diseases that are both varied and can be concurrent. Recent developments in multiparametric magnetic resonance imaging (mpMRI) suggest real potential to bridge the diagnostic gap between non-specific blood-based biomarkers and invasive and variable histological diagnosis. This has implications for the clinical care and treatment pathway in a number of chronic liver diseases, such as haemochromatosis, steatohepatitis and autoimmune or viral hepatitis. Here we review the relevant MRI techniques in clinical use and their limitations and describe recent potential applications in various liver diseases. We exemplify case studies that highlight how these techniques can improve clinical practice. These techniques could allow clinicians to increase their arsenals available to utilise on patients and direct appropriate treatments.

Serum Gamma-Glutamyl Transpeptidase Activity as an Indicator of Disease of Liver, Pancreas, or Bone

1972 ◽  
Vol 18 (4) ◽  
pp. 358-362 ◽  
Author(s):  
Gifford Lum ◽  
S Raymond Gambino
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Viral Hepatitis ◽  
Bone Disease ◽  
Leucine Aminopeptidase ◽  
Serum Alkaline Phosphatase ◽  
Metastatic Carcinoma ◽  
Gamma Glutamyl Transpeptidase ◽  
Serum Alkaline Phosphatase Activity ◽  
Glutamyl Transpeptidase

Abstract Serum γ-glutamyl transpeptidase (GGT), leucine aminopeptidase, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase activities were assayed in controls and in patients with liver, pancreatic, or bone disease. GGT activity was above normal in all forms of liver disease studied (viral hepatitis, cirrhosis, cholecystitis, metastatic carcinoma to liver, pancreatic carcinoma, liver granuloma, and acute pancreatitis). GGT more sensitively indicated hepatic disease than did alkaline phosphatase, much more so than did leucine aminopeptidase. GGT was disproportionately more active in relation to the transaminases in cases of intraor extrahepatic biliary obstruction; the reverse was true in cases of viral hepatitis. GGT activity was normal in children, adolescents, and pregnant women, and in cases of bone disease and renal failure. Kinetic measurement of GGT activity offers a simple, sensitive, and direct means for distinguishing whether bone or liver is the source of increased serum alkaline phosphatase activity. Activity was highest in obstructive liver disease.

Evaluating Diagnostic Tests

1993 ◽  
Vol 7 (2) ◽  
pp. 66-69 ◽  
Author(s):  
C.W. Douglass
Keyword(s):  
Predictive Value ◽  
Diagnostic Tests ◽  
Clinical Decision Making ◽  
New Technologies ◽  
Clinical Decision ◽  
Future Research ◽  
Scientific Support ◽  
Body Of Knowledge ◽  
Efficacy Parameters ◽  
Sensitivity Specificity

The presentations at this conference will discuss new technologies and rapid scientific developments that have resulted in new diagnostic tests for periodontal disease, musculoskeletal imaging, temporomandibular joint dysfunctions, and incipient coronal and root dental caries. However, for many of these claims, there has been insufficient scientific support regarding the sensitivity and specificity of the tests, or their ability to predict the percent of cases in which the disease or condition progresses to the next state of development. Research is needed that will yield the basic diagnostic parameters of new diagnostic tests, i.e., their accuracy, precision, sensitivity, specificity, positive predictive value, and negative predictive value. The purpose and methods for calculating each of these measures are described in this paper. Five questions are then presented that will need to be addressed in future research regarding new diagnostic tests: (1) Does the scientific theory of the test fit with our current body of knowledge? (2) Have the efficacy parameters of the test been reliably determined? (3) How does the test affect clinical decision-making? (4) Does using the test improve the patient's health? and (5) Is the added expense of the test justified by increased effectiveness or by avoiding other health expenditures?

Medication prescribing in liver dysfunction

2014 ◽  
Vol 4 (3) ◽  
pp. 131-137
Author(s):  
Kristen N. Gardner ◽  
Jolene R. Bostwick
Keyword(s):  
Decision Making ◽  
Liver Disease ◽  
Solubility Product ◽  
Clinical Decision Making ◽  
Bleeding Risk ◽  
Clinical Decision ◽  
Pharmacokinetic Parameters ◽  
Decision Making Process ◽  
Product Formulation ◽  
Medication Prescribing

Patients with mental illness often have co-occurring substance abuse which increases the risk for developing cirrhosis, particularly with common etiologies such as hepatitis and alcoholic liver disease. As such, knowledge of how the disease may impact medication prescribing is important. Unfortunately, there is a paucity of data to guide medication prescribing in these patients. Product labeling information should be used in the clinical decision making process. Additionally, clinicians should consider the etiology of disease, adverse effect profile, and pharmacokinetic parameters including solubility, product formulation, protein binding, hydrophilicity, metabolism, bioavailability, extraction ratios, excretion route, and half-life. Thoughtful consideration should be given when prescribing potentially hepatotoxic medications, and those which may increase bleeding risk in patients with coagulopathy. It is essential to ensure every medication has an appropriate indication and carefully evaluate the need for each medication. Overall, more research is necessary to support clinical decision-making with outcomes based research in patients with chronic liver disease.

Alcoholic liver disease presenting with marked elevation of serum alkaline phosphatase

1978 ◽  
Vol 23 (12) ◽  
pp. 1061-1066 ◽  
Author(s):  
Robert P. Perrillo ◽  
Ronald Griffin ◽  
Katherine DeSchryver-Kecskemeti ◽  
Jerrold J. Lander ◽  
Gary R. Zuckerman
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Alcoholic Liver Disease ◽  
Serum Alkaline Phosphatase ◽  
Marked Elevation

Clinical Epidemiology

2016 ◽  
pp. 285-290
Author(s):  
Scott C. Litin ◽  
John B. Bundrick
Keyword(s):  
Diagnostic Test ◽  
Diagnostic Tests ◽  
Clinical Decision Making ◽  
Clinical Epidemiology ◽  
Clinical Decision ◽  
Test Results ◽  
Specific Patient ◽  
Predictive Values ◽  
Test Sensitivity ◽  
Sensitivity Specificity

Diagnostic tests are tools that either increase or decrease the likelihood of disease. The sensitivity, specificity, and predictive values of normal and abnormal test results can be calculated with even a limited amount of information. Some physicians prefer interpreting diagnostic test results by using the likelihood ratio. This ratio takes properties of a diagnostic test (sensitivity and specificity) and makes them more helpful in clinical decision making. It helps the clinician determine the probability of disease in a specific patient after a diagnostic test has been performed.

Primary biliary cholangitis

2020 ◽  
pp. 3127-3135
Author(s):  
Jessica K. Dyson ◽  
David E.J. Jones
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Serum Alkaline Phosphatase ◽  
Disease Diagnosis ◽  
Immunosuppressive Drug ◽  
Primary Biliary Cholangitis ◽  
Line Treatment ◽  
Antimitochondrial Antibodies ◽  
First Line ◽  
Intrahepatic Bile Ducts

Primary biliary cholangitis (PBC), previously known as primary biliary cirrhosis, is a chronic, cholestatic liver disease in which the biliary epithelial cells lining the small intrahepatic bile ducts are the target for immune-mediated damage, leading to progressive ductopenia and cholestasis. The cause is unknown but presumed to be autoimmune. The disorder affects women (>90% of cases) and usually has an insidious onset in middle age. Younger patients are less common but have a more aggressive disease course. Fatigue and pruritus are the most common presenting symptoms. Findings on examination vary widely, ranging from no abnormality to jaundice with hyperpigmentation, scratch marks, and rarely the features of advanced liver disease. Diagnosis of PBC is based on three criteria: (1) cholestatic liver function tests, with increases in serum alkaline phosphatase and γ‎-glutamyl transferase, (2) presence of serum antimitochondrial antibodies (found in more than 95% of cases), and (3) compatible liver histology. Many asymptomatic patients are recognized following the incidental discovery of antimitochondrial antibodies or elevated levels of serum alkaline phosphatase. First-line treatment is with ursodeoxycholic acid which can lead to significant improvement in liver biochemical values. Second-line treatment is with obeticholic acid. No immunosuppressive drug regimen has been proven effective. Progression may be slow, but eventually patients can develop cirrhosis. Cholestyramine is used as first line to treat pruritus. There is no recognized treatment for fatigue. Liver transplantation is indicated in some cases.

Establishment of Reference Intervals for Alkaline Phosphatase in Pakistani Children Using a Data Mining Approach

2019 ◽  
Vol 51 (5) ◽  
pp. 484-490 ◽  
Author(s):  
Sibtain Ahmed ◽  
Jakob Zierk ◽  
Aysha Habib Khan
Keyword(s):  
Data Mining ◽  
Alkaline Phosphatase ◽  
Clinical Decision Making ◽  
Clinical Chemistry ◽  
Age Groups ◽  
Clinical Decision ◽  
German Society ◽  
Reference Intervals ◽  
Photometric Method ◽  
Data Mining Approach

Abstract Objective To establish reference intervals (RIs) for alkaline phosphatase (ALP) levels in Pakistani children using an indirect data mining approach. Methods ALP levels analyzed on a Siemens Advia 1800 analyzer using the International Federation of Clinical Chemistry’s photometric method for both inpatients and outpatients aged 1 to 17 years between January 2013 and December 2017, including patients from intensive care units and specialty units, were retrieved. RIs were calculated using a previously validated indirect algorithm developed by the German Society of Clinical Chemistry and Laboratory Medicine’s Working Group on Guide Limits. Results From a total of 108,845 results, after the exclusion of patients with multiple specimens, RIs were calculated for 24,628 males and 18,083 females with stratification into fine-grained age groups. These RIs demonstrate the complex age- and sex-related ALP dynamics occurring during physiological development. Conclusion The population-specific RIs serve to allow an accurate understanding of the fluctuations in analyte activity with increasing age and to support clinical decision making.

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