Course 6 Module IIC
Prof. Jiří Horák
Seminar 17
Interpretation of basic laboratory tests in hepatogastroenterology
Serum gastrin concentration
normal values: 0 – 200 pg/ml
normal values – healthy persons, peptic ulcer
high to very high – pernicious anemia
very high – Zollinger- Ellison syndrome
Cholecystokinin – secretin test
gold standard in diagnostics of chronic pancreatitis
normal values:
volume 95 – 235 ml/hr
bicarbonate concentration 74 – 121 mmol/l
amylase output 87.000 – 267.000 mg
PABA (bentiromid) test
500 mg benmtiromid taken per os after an overnight fast, liberated PABA is excreted in urine
normal values: >50% PABA excreted in urine over 6 hrs
Xylose tolerance test
25 g of D-xylose in water taken per os, urine collection for 5 hrs
normal value: > 4 g/5 hrs
malabsorption: < 4 g/5 hrs
Serum carotene concentration
indicator of malabsorption
normal values
70 - 290 µg/dl
mild decrease
30 – 70 µg/dl
severe malabsorption
< 30 µg/dl
Fecal fat excretion
gold standard for the diagnosis of malabsorption
normal value
< 7 g/24 hr on 60 – 100 g fat a day
< 5 g/24 hr on a diet with < 50 g fat a day
Serum bilirubin concentration
cf seminar on icterus
Serum enzymes
ALT, AST
indicator enzymes showing hepatocellular damage; increase in hepatitis
- viral, drug, toxic including alcoholic, autoimmune, also in cholestasis
(less than excretory enzymes)
AST > ALT typical for alcoholic liver disease but also found in other conditions
GMT
isolated elevation is typical for alcoholic liver disease
together with ALP increased in cholestasis
ALP
elevated in cholestasis, liver tumours, TBC, sarcoidosis, amyloidosis,
bone diseases, in children and adolescents
it cannot differentiate intrahepatic cholestasis from extrahepatic obstruction
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Course 6 Module IIC
Prof. Jiří Horák
Constellation: AST > ALT + GMT elevation + macrocytosis is strongly suggestive of
alcoholic liver disease
Serum amylase
increase in acute pancreatitis (up to 40times the upper limit of normal), acute exacerbation of
chronic pancreatitis, pancreatic duct obstruction, diseases of the salivary glands and in a
number of malignant tumours
Macroamylasemia – lasting serum amylase elevation without a clear cause, urine amylase is
normal
Serum lipase
similar to amylase but elevation in acute pancreatitis lasts longer and is more specific
Protein electrophoresis
hypalbuminemia – chronic hepatitis, liver cirrhosis, malnutrition, nephrotic syndrome
low alpha-1 globulin – alpha-l antitrypsin defficiency
hypergammaglobulinemia – chronic hepatitis, cirrhosis, myeloma
Serum ceruloplasmin concentration
normal value > 0,2 g/l
decreased in Wilson‘s disease
Copper concentration in liver tissue
normal value < 250 µg/g dry weight
increased in Wilson‘s disease, cholestatic liver diseases
combination low ceruloplasmin + high liver content is typical for Wilson‘s disease
Antimitochondrial antibody
positive in primary biliary cirrhosis, to a lesser extent also in autoimmune hepatitis
Tumour markers
AFP (alpha-fetoprotein)
CEA (carcinoembryonic
antigen)
Ca 19-9
Ca 15-3
Ca 125
Ca 72-4
PSA (prostatic specific
antigen)
NSE (neuron-specific
enolase)
tumour
hepatocellular carcinoma, germinal tumours
slight increase: cirrhosis, hepatitis
gastrointestinal tract, stomach, lungs, pancreas, breast, kidney,
urogenital tract, medullary thyroid carcinoma
nonmalignant increase: pneumonia, hepatitis, GIT infection,
strong smokers
tumours of pancreas, biliary tree, stomach, large intestine,
ovaries
tumours of breast, bronchogenic carcinoma, ovary, pancreas,
prostate, colon
nonmalignant: cirrhosis, hepatitis, mastopathy, fibroadenoma
nonmucinous ovarial tumours, uterus, breast, lungs, GIT
nonmalignant: cirrhosis, pancreatitis, endometriosis
carcinoma of the stomach, ovary and non-small-cell
bronchogenic
prostatic carcinoma
marker of neuroblastoma and small-cell bronchogenic carcinoma
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Course 6 Module IIC
Prof. Jiří Horák
CYF-21 (cytokeratin
fragment)
TPA (tissue polypeptide
antigen)
beta-HCG (human
chorionic gonadotropin)
BMG (beta-2-microglobulin)
marker for diagnosis, prognosis and monitoring of non-small-cell
bronchogenic carcinoma, squamous-cell carcinoma,
undifferentiated carcinoma of cervix, urinary bladder, head and
neck
general marker of tumour proliferation or necrosis
germinal tumours of ovary and testes, choriocarcinoma and
embryocarcinoma, mola hydatidosa
malignancies of B-lymphocyte origin, myeloma, lymphoma,
M. Hodgkin
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