720 North Tustin Avenue
Suite 104
Santa Ana, CA 92705-3606
Phone: (714) 565-1032
Fax: (714) 565-1035

Jeremy E. Kaslow, MD, FACP, FACAAI Physician and Surgeon
Board Certified Internal Medicine

NOTICE TO CONSUMERS
Medical Doctors are licensed and regulated by the Medical Board of California
(800) 633-2322
www.mbc.ca.gov

The first sign that you may have hepatitis is from your blood work since liver dysfunction is often without symptoms.   The term hepatitis implies that you have inflammation of the liver.  Commonly, an abnormal blood test is the first indication that you have a virus that is causing the hepatitis.  While Hepatitis A is rather acute in symptoms, it never persists and once you have gotten through the acute stage, you will not have ongoing liver inflammation.  This is very different than viral Hepatitis B and Viral Hepatitis C, both of which can persist and cause persistent liver inflammation, cirrhosis and even liver cancer (hepatocellular carcinoma).  Persistently elevated liver enzyme levels can indicate a number of possibilities that are not due to viral infection and it is very important to follow up with appropriate testing.  Many liver enzyme markers can be increased significantly after drinking alcohol (and for days thereafter) or as a result of using certain drugs. These are collectively known as liver function tests (LFTs).  They are rather non-specific and any abnormalities must be carefully assessed.

 

SGOT/AST (Aspartate Aminotransferase)

Optimal Range: 20-30 U/L

Causes of Increased

  • Liver Inflammation (hepatitis, infectious mononucleosis, cholestasis, alcoholism, drug toxicity)
  • Heart muscle damage (acute myocardial infarction, acute myocarditis, trauma, CHF)
  • Other tissues (Skeletal muscle damage, lung infarct, pancreatitis, renal infarct, burns, seizures, eclampsia)
  • Red Blood Cells (severe hemolytic anemia, megaloblastic anemia)
  • Malignancy
  • Drugs (oral contraceptives, acetaminophen, aspirin, isoniazid, codeine, cortisone, heparin)

*AST is widespread in tissues and therefore elevations may represent non-specific tissue damage. Clinically is primarily related to liver dysfunction.

Causes of Decreased

  • Vitamin B6 deficiency
  • Chronic kidney dialysis
  • Gonadal deficiency

Discussion:  This enzyme is released into circulation following the injury or death of cells. The focus is on cellular damage, particularly liver, muscle, and highly metabolic cells.  Aspartate aminotransferase also reportedly reflects gonadal function and the amount of oxygen available to membranes. Aside from liver, heart, or muscle damage, elevations in AST can indicate a deficiency of certain hormones and vitamin E.  When the AST is greater than ALT, it may indicate mononucleosis, cirrhosis or alcohol-related damage.

SGPT/ALT (Alanine Aminotransferase)

Optimal Range: 20-30 U/L

Causes of Increased

  • Hepatic inflammation (including infectious mononucleosis, pancreatitis, alcohol, viral hepatitis)
  • CHF and acute myocardial infarction
  • Acute renal infarction
  • Skeletal muscle injury
  • Heparin therapy

*As with SGOT but predominate sources are liver and kidney. Therefore the SGPT/ALT is a much more specific indicator of liver dysfunction.

Causes of Decreased

  • Vitamin B6 deficiency

Discussion:  SGPT/SGOT is an enzyme associated with liver function and glucose conversion and is most often found in the mitochondria of the liver cell.   The ALT is perhaps the most important indicator of HCV activity.  Usually, if it is twice or more than the AST value, this indicates HCV-associated liver damage.   Two to ten times normal may indicate infectious mononucleosis (Epstein-Barr, CMV), chronic active hepatitis (viruses B, C, or D; Wilson's disease, autoimmune I, II, or III, many alpha1-protease inhibitor deficiency) or chronic persistent hepatitis. It may indicate drug-related hepatitis, hypoxemia of the liver ("passive congestion" where blood flow is restricted, starving other parts of the liver of needed oxygen), recovering hepatitis, milder degrees of alcohol or possibly cocaine use or an iron-overload condition known as hemochromatosis.

The focus is not on longstanding disease, but on cellular damage to the liver, for example, from hepatitis or acute gall bladder inflammation.  However, normal levels may be misleading. Diseases that might exist despite normal liver enzyme levels include metastatic liver disease (cancer) or cirrhosis without any current cell necrosis (a type of cell death). This can be either because the stressor (usually alcohol) is no longer being used or because the liver is so damaged, there aren't that many cells left to damage and cause increases in enzyme levels.

GGTP

Optimal Range: 20-30 U/L

Causes of Increased

Hepatic inflammation

  • Viral Hepatitis (HAV, HBV, HCV, etc.)
  • Alcohol abuse
  • Mononucleosis, CMV
  • Myocardial infarction
  • Diabetes mellitus
  • Neurologic disease
  • Trauma
  • Sepsis

Obstruction of bile ducts

  • Pancreatic disease
  • Drugs (phenobarbital, anti-convulsants, phenytoin, etc.)
  • Gallstones or a tumor in the bile duct

Causes of Decreased

  • Hypothyroid
  • Low magnesium
  • Hypothalamic malfunction

Discussion:  Since the only known source of GGTP is the liver, it is an excellent and specific indicator of liver damage or problems with the drainage of bile in the liver (biliary obstruction).  It will be one of the first to elevate. This, along with SGOT and SGPT, is an excellent way to determine liver and biliary dysfunction.  Alternatively, if the alkaline phosphatase increases without an increase in GGT, this suggests that there is a disorder outside the liver, such as bone, placenta or intestine.

Albumin

 

Albumin is one of the two major types of protein in the blood and promotes the transfer of nutrients and wastes to and from the blood and cells. Manufactured in the liver, serum levels of albumin decrease during chronic liver disease. Albumin is also a marker of wasting, which sometimes may begin even before there is any weight loss.  It also reflects your general nutritional status. Urine tests may show an increase of protein in the urine, which may indicate kidney damage.   See the my web page on proteins.

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