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ARTIKEL CME IDI

Managing the Patient with an Abnormal Liver -Test: Persistent Aminotransferase Elevations
Mengelola Pasien dengan Hati Abnormal -Test: Persistent aminotransferase Ketinggian
Identifying the cause of a persistent, asymptomatic aminotransferase
elevation can be challenging. The differential diagnosis is extensive
and ranges from fairly benign conditions to life-threatening disease
in which early diagnosis is critical. A thorough history is essential
and should indicate which additional investigations are required to
achieve the diagnosis.
Mengidentifikasi penyebab gigih, aminotransferase tanpa gejala
elevasi dapat menantang. Diagnosis luas
dan berkisar dari kondisi yang cukup jinak untuk penyakit yang mengancam jiwa
di mana diagnosis dini sangat penting. Sejarah menyeluruh adalah penting
dan harus menunjukkan yang investigasi tambahan yang diperlukan untuk
mencapai diagnosis.
Liver function test (LFT) abnormalities are common incidental findings in patients who show no other
signs of hepatobiliary disease. They may also be found in patients who present with vague
complaints, such as fatigue. The differential diagnosis of LFT elevations is extensive and ranges from
fairly benign conditions to life-threatening disease in which early diagnosis is critical.
A focused and detailed medical history can usually help narrow the differential considerably. In this
article, we discuss what to cover when taking the history of a patient with a persistent
aminotransferase elevation. We also indicate when additional testing is needed and which tests to
order to achieve a diagnosis. When to Evaluate ALT/AST Elevations
When a level of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) greater than the
upper limit of normal is first noticed in an asymptomatic patient, or one with only vague symptoms, the
test should always be repeated before proceeding with evaluation of any kind. The most common
non-specific symptom in a patient with chronic liver disease is fatigue. If a second test establishes
that the elevation is persistent, and if the value is greater than three times the normal,evaluation is
warranted. If the value is less than this, monitor the patient; if it remains elevated, no matter how
slightly, initiate evaluation.

Preconception Care
Pregnancy is usually confirmed after the missed menstrual period, a few weeks after the conception. In
early pregnancy, the embryo is susceptible to teratogens. Furthermore, the health of the pregnant woman
may not be optimally suited to pregnancy. Therefore,it seems logical that care should begin before
conception. Most women do not visit the obstetricians before pregnancy has been confirmed. Family
doctors or other primary health care providers are in a better position to provide preconception care. Some
of the preconception care can even be introduced in the community and in schools, in the form of health
education and public health measures. Although the impact of preconception care for women with
significant pre-existing health problem, such as diabetes, may be more obvious than for women without,
preconception care should not be confined to the former group of women. Offering preconception care,
such as folic acid supplementation to prevent neural tube defect, to all women may have a significant
impact on the whole population. The evidence for the effectiveness of commonly practiced preconception
care will be examined in this article. A practical checklist for preconception care in the primary health care
setting will also be provided.

OBJECTIVES OF PRECONCEPTION CARE


The objectives of preconception care are to improve the physical and psychological health of the mother
(decrease maternal mortality and morbidity) and the father, and to improve the health of the offspring
(decrease perinatal morbidity
and mortality). The major causes of perinatal morbidity and mortality are low birth weight and congenital
abnormalities.
Therefore, preconception intervention strategies are targeted at reducing these.

PLANNED PARENTHOOD
Family planning is an important part of preconception care. In developing countries maternal deaths are
associated

with high multiparity and closely spaced pregnancies.1 In developed countries, especially in metropolitan
cities, delayed
parenthood, single parenthood and lack of support from the extended family may pose special problems.
For example, postpartum depression occurs more often in unplanned pregnancies, while subfertility and
miscarriages occur more often with older maternal age.2 Women and their partners should be given
information on contraception, and they should also be encouraged to discuss when it is best for them to
have children.

DIETARY AND VITAMIN SUPPLEMENTATION


Folic acid supplement use before concep