Wilson's Disease: Diagnostic Tests (Nursing)

00:00 Now I want to show you some of the lab tests that might be ordered.

00:03 They'll make sense when you think about we just reviewed we're going to have problems with the liver and the brain, so doing abnormal liver enzymes, that that's going to make sense to us.

00:14 We're going to look at things like AST and ALT because we know it's a liver and brain disorder problem liver enzymes could be off.

00:24 Obviously.

00:25 We're going to be looking for elevated levels of copper.

00:28 They'll be in the blood and the urine.

00:31 But for this one we have to do a urine 24-hour test.

00:34 Now that gets a little tricky because everybody's got to work together for urine 24 hour test because how that starts is eight o'clock in the morning the patient voids and then from then on every year in has to be kept and collected in the same container for a full 24 hours.

00:51 If we miss one you have to start all over again.

00:56 And that makes a very unhappy team, all the way around and patient.

01:00 Have to keep that urine cooled in a bucket.

01:03 It's kind of a hassle but it gives us really good information about your patient.

01:08 So we can do abnormal liver enzymes that make sense because we know it involves the liver we can look for elevated copper levels that makes sense.

01:16 We're gonna look in the blood and the urine because we know that the liver is supposed to take care of that copper and make it excretable in the urine and if it's not working, both of those levels will be elevated and we can do genetic testing, we can look to see if the patient has those recessive genes for Wilson's disease.

01:34 We also watch them for low blood sugar.

01:37 That's one of the things that goes along with it.

01:39 Remember if you have liver problems, it's not that big a connection to remember low blood sugar because we know the liver helps us maintain a stable blood sugar.

01:49 Now you'll also have lower levels of, what is that word? Right.

01:53 Ceruloplasmin.

01:55 That's just a protein that carries copper through the blood and these patients will actually We have lower levels of it.

02:02 Remember it's all building up in there.

02:04 It's not being transported to be excreted the way we want it to that's why they have lower levels of ceruloplasmin.

02:13 Now some other test this is when we're getting really aggressive.

02:16 Now we're going to say hey we need we need to figure out how much damage your organs have taken from the success copper.

02:24 So we could do an MRI of the brain or the abdomen.

02:27 Why would we do that? Because we know Wilson's disease extra copper, it's going to be loaded up in the liver and in the brain.

02:36 So that's why an MRI of the brain or abdomen would be really good information.

02:41 We can also get more invasive with a liver biopsy.

02:43 Now that's not very comfortable for your patient, but will actually go in and take a piece of liver tissue out and look at it underneath a microscope, but that should make sense.

02:55 We know and Wilson's disease were live copper deposits.

02:59 And so we would look at MRI of the brain and the liver, is that will be an abdominal MRI or might actually take tissue from the liver and examine it.

03:08 Now here's another system that we use.

03:10 Again, stop.

03:12 Don't memorize this.

03:13 This is just one of many examples that are out there as a point system for kind of recognizing How likely is this patient to have Wilson's disease.

03:23 You see, you've got two points up there for Kayser Fleischer Rings.

03:25 Remember what those are? Cool! That brown circle around your eye.

03:30 What kind of mood systems do they have? What types of, do they have a hemolytic anemia? Is it Coombs negative? What's their serum ceruloplasmin level? What's their liver copper quantitative measurement? You see all the categories we have there.

03:45 You don't need to memorize these, but just for fun, check your learning.

03:50 Think through each one of those symptoms.

03:52 Remember each one of those categories in blue.

03:55 Can you see if you can tie it back to the impact in Wilson's disease.

03:59 That's a great way for you to review.