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ARTIKEL CME IDI

Managing the Patient with an Abnormal Liver -Test: Persistent Aminotransferase ElevationsMengelola 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.

Mengidentifiasi penyebab gigih, aminotransferase tanpa ge!ala

elevasi dapat menantang. "iagnosis luas

dan berisar dari ondisi yang cuup !ina untu penyait yang mengancam !iwa

di mana diagnosis dini sangat penting. #e!arah menyeluruh adalah penting

dan harus menun!uan yang investigasi tambahan yang diperluan untu

mencapai diagnosis.

$iver function test %$&T' abnormalities are common incidental findings in patients who show no othersigns of hepatobiliary disease. They may also be found in patients who present with vaguecomplaints, such as fatigue. The differential diagnosis of $&T elevations is extensive and ranges fromfairly 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 thisarticle, we discuss what to cover when taing the history of a patient with a persistentaminotransferase elevation. (e also indicate when additional testing is needed ) and which tests toorder ) to achieve a diagnosis. (hen to *valuate A$T+A#T *levations(hen a level of alanine aminotransferase %A$T' or aspartate aminotransferase %A#T' greater than theupper limit of normal is first noticed in an asymptomatic patient, or one with only vague symptoms, thetest should always be repeated before proceeding with evaluation of any ind. The most commonnon-specific symptom in a patient with chronic liver disease is fatigue. If a second test establishesthat the elevation is persistent, and if the value is greater than three times the normal,evaluation iswarranted. 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 confrmed ater the missed menstrual period, a ew weeks ater the conception. Inearly pregnancy, the embryo is susceptible to teratogens. Furthermore, the health o the pregnant womanmay not be optimally suited to pregnancy. Thereore,it seems logical that care should begin beoreconception. Most women do not isit the obstetricians beore pregnancy has been confrmed. Familydoctors or other primary health care proiders are in a better position to proide preconception care. !ome

o the preconception care can een be introduced in the community and in schools, in the orm o healtheducation and public health measures. "lthough the impact o preconception care or women withsignifcant pre#e$isting health problem, such as diabetes, may be more obious than or women without,preconception care should not be confned to the ormer group o women. %&ering preconception care,such as olic acid supplementation to preent neural tube deect, to all women may hae a signifcantimpact on the whole population. The eidence or the e&ectieness o commonly practiced preconceptioncare will be e$amined in this article. " practical checklist or preconception care in the primary health caresetting will also be proided.

%'()CTI*)! %F P+)C%C)PTI% C"+) The ob-ecties o preconception care are to improe the physical and psychological health o the motherdecrease maternal mortality and morbidity/ and the ather, and to improe the health o the o&springdecrease perinatal morbidityand mortality/. The ma-or causes o perinatal morbidity and mortality are low birth weight and congenital

abnormalities. Thereore, preconception interention strategies are targeted at reducing these.

P0")1 P"+)T2%%1Family planning is an important part o preconception care. In deeloping countries maternal deaths areassociated

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with high multiparity and closely spaced pregnancies.3 In deeloped countries, especially in metropolitancities, delayedparenthood, single parenthood and lack o support rom the e$tended amily may pose special problems.For e$ample, postpartum depression occurs more oten in unplanned pregnancies, while subertility andmiscarriages occur more oten with older maternal age.4 5omen and their partners should be gieninormation on contraception, and they should also be encouraged to discuss when it is best or them tohae children.

1I)T"+6 "1 *IT"MI !7PP0)M)T"TI%Folic acid supplement use beore concep