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
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.
