ALT AST ALP hepatocytes disruption cholestatic hepatocytes membrans

ALT / AST ALP hepatocytes disruption cholestatic hepatocytes membrans damage GTP bilirubin prothrombin time (index, INR) albumins toxic impaired detoxication or canaliculo-vascular reflux severe impairment of synthetic capabilities chronic impairment of synthetic capabilities

jaundice ALT <1000 U/l mild hepatocytes injury ALP >300 U/l USG dilatated (wide) extrahepatic cholestasis <300 U/l cholestasis bile ducts intrahepatic cholestasis + + HBe. Ag & HBV-DNA HCV-RNA CT MRI + ? surgical or endoscopic intervention _ Elastography • AIH Genotype • PBC • metabolic diseases • others liver biopsy HBs. Ag anti-HCV normal + Elastography ALT chronic hepatitis treatment

jaundice ALT 1000 -3000 U/l moderate hepatocytes injury HBs. Ag HBe. Ag anti-HBc-Ig. M + acute viral hepatitis B _ + anti-HCV _ _ + anti-HAV-Ig. M HCV RNA _ + acute viral hepatitis A + anti-CMV anti-EBV _ + acute viral hepatitis C GGTP CMV hepatitis or infectious mononucleosis >300 U/l toxic liver injury <300 U/l _ • AIH • PBC • metabolic diseases • other

jaundice ALT >3000 U/l massive (severe, heavy) hepatocytes injury OK PI prothrombin index - PI (prothrombin time, INR) PI<50% ALT monitor PI>50% • fulminant hepatitis (mostly HBV) • mushroom poisoning (death cap) • drug hepatotoxicity ALT PI HBs. Ag, anti-HBs life threatening detoxication brain decompression hepatoprotection liver transplantation examination of stomach or gut washings