How is dx of WD?

Cu and Ceruloplasmin measure (normal Cu 10-22, Wilson's high in liver >250micg/g on biopsy and serum ceruloplasmin low (below 200-600)) LFT (depends if we have hemolytic anemia ->AST elevated, if cirrhosis (ALP and Bi elevated, progress to liver failure Prothrombin time elevated) Urinary Cu (24-hour excretion >40 micromol) Challenge w/penicillamine (increase Cu in urine after 24-hour 200-500mg) Slit-lamp exam of eye (See KF rings, nearly always present and associated w/neuro presentation, absence doesn't exclude the disease) Liver biopsy (definitive wide section (not diffuse Cu accumulation), Cu>250 micg/g diagnostic)