Abnormal liver enzyme

Abnormal liver enzyme detection and estimation provides a comprehensive foundation for the identification of inflammatory diseases associated with the liver. These values are raised when liver cells are damaged. Routine liver function test helps in the estimation and detection of abnormal liver enzymes.

In many cases liver enzyme abnormalities are caused because of hepatocellular injury. This condition results when the liver cells are damaged producing leaky membranes. The intracellular enzymes enter the blood stream as a result of these leaky membranes. The predominant intracellular liver enzymes which are analyzed indicating the hepatocellular damage are aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Hepatitis is one of major causes for the hepatocellular damage.

Cholestasis is another condition, resulting in the production of abnormal liver enzymes. It is caused because of biliary obstruction or hepatic infiltration. The resulting enzymes produced because of these conditions include alkaline phosphatase (ALT) and gamma glutamyl transpeptidase (GGT).

Risk factors due to abnormal liver enzymes

The risk factors pertaining to the onset of liver disease are based upon factors such as behavior, medications and systemic illness. The patients categorized based on the behavior include IV drug users, history of multiple sex partners, alcohol abuse and tattoos. The patients categorized based on the medication include acetaminophen and anticonvulsant drug users. Systemic conditions such as diabetes, auto immune diseases, obesity and metastatic cancers are major risk factor indicatives of hepatocellular damage which elevate the abnormal liver enzyme values.

Liver function test

Alanine aminotransferase (ALT): It is also known as serum glutamic pyruvic transaminase (SGPT) analysis. It helps in the detection of hepatocellular damage due underlying conditions such as hepatitis. The reference range for the ALT test is 9 -72 u/l.

Alkaline phosphatase (ALP): This test used in the detection of biliary obstruction in liver and also bone disorders. The results are correlated with other liver function tests to diagnose liver cell damage. The reference range is 38-126 u/l

Aspartate aminotransferase (AST): AST is also used in the detection of liver cell damage and membrane leakage of the liver cells. The reference range is 8- 50 u/l.

Bilirubin: Bilirubin diagnostic test is administered to detect conditions such as cirrhosis, hepatitis and presence of gall stones. It is predominantly ordered in the case of newborns to detect the incidence of jaundice. The reference range for total bilirubin is 0.2-1.3 mg/dl.

Albumin: Albumin test signifies the presence of liver disorder or nephrotic syndrome. Low albumin levels indicate the presence of liver damage. The reference range is 3.9- 5.0 g/dl.

Lactate dehydrogenase (LDH): LDH values indicate the presence of tissue damage. It is used to detect tissue damage associated liver, kidney and cardiac origins. The reference range for LDH is 313-618 u/l.

Comprehensive metabolic panel (CMP): Comprehensive metabolic panel pertaining to liver disease is very significant in the detection of underlying liver disorders such as hepatitis especially in newborns. It also helps in the identification of liver damage caused because of alcohol consumption.

Gamma glutamyl transferase (GGT): This test acts as a precursor for the estimation of alkaline phosphatase values pertaining to hepatocellular damage and biliary obstruction. GGT and ALP tests are interrelated in case of hepatic and bone disorders.

Total protein: Total protein levels are measured by evaluating the albumin and globulin ratios. The reference range for total protein is 6.3- 8.2 g/dl. The decrease in total protein value indicates the onset of liver or kidney disease.

Paraesthesias

Paraesthesias, also spelled paresthesias, is a medical term that refers to abnormal sensations in the body, typically involving a feeling of tingling, pricking, numbness, or "pins and needles." These sensations are often described as uncomfortable or abnormal and may be experienced in various parts of the body, such as the hands, feet, arms, legs, or other areas.

Paraesthesias can be caused by a variety of underlying medical conditions or factors, including:

• Nerve Compression or Irritation: Pressure on or damage to nerves, such as in conditions like carpal tunnel syndrome or sciatica, can lead to paraesthesias.
  
• Nerve Disorders: Diseases that affect the nervous system, like peripheral neuropathy, multiple sclerosis, or diabetic neuropathy, can result in abnormal sensations.
  
• Poor Circulation: Reduced blood flow to specific body parts can lead to paraesthesias, as tissues may not receive sufficient oxygen and nutrients.
  
• Vitamin Deficiencies: Deficiencies in certain vitamins, particularly B vitamins like B12 and folate, can contribute to nerve-related symptoms, including paraesthesias.
  
• Infections and Inflammatory Conditions: Conditions like shingles, Lyme disease, or autoimmune diseases can cause nerve inflammation and lead to abnormal sensations.
  
• Medications and Toxins: Some medications or exposure to toxins can induce paraesthesias as a side effect.
  
• Trauma or Injury: Physical injury or trauma to nerves or tissues can result in temporary or chronic paraesthesias.
  
• Psychological Factors: In some cases, paraesthesias may be related to psychological stress or anxiety.
  

Some medications have the potential to affect the nervous system and cause these symptoms. It's important to note that individual responses to medications can vary, and not everyone will experience paraesthesias as a side effect. Here are some categories of medications and specific drugs that are known to be associated with paraesthesias:

• Chemotherapy Drugs: Several chemotherapy agents, such as paclitaxel, vincristine, and cisplatin, can cause peripheral neuropathy, leading to paraesthesias in the hands and feet.
  
• Anticonvulsant Medications: Some anticonvulsants, including phenytoin and carbamazepine, may cause paraesthesias as a side effect.
  
• Antidepressant Medications: Tricyclic antidepressants like amitriptyline and selective serotonin reuptake inhibitors (SSRIs) like fluoxetine have been associated with paraesthesias in some individuals.
  
• Antiretroviral Drugs: Certain medications used to treat HIV, such as zidovudine and didanosine, may lead to peripheral neuropathy and paraesthesias.
  
• Antibiotics: Some antibiotics, particularly fluoroquinolones (e.g., ciprofloxacin), have been linked to peripheral neuropathy and paraesthesias.
  
• Antifungal Medications: Antifungal agents, such as fluconazole, can occasionally cause peripheral neuropathy and associated symptoms.
  
• Antihypertensive Medications: Diuretics and calcium channel blockers are classes of drugs that may rarely induce paraesthesias.
  
• Statins: Statin medications used to lower cholesterol levels, like atorvastatin and simvastatin, have been reported to cause muscle-related paraesthesias in a minority of users.
  
• Immunomodulatory Drugs: Medications used for autoimmune diseases, like interferons and monoclonal antibodies, can result in paraesthesias.
  
• Local Anesthetics: Certain local anesthetics used in medical or dental procedures may lead to temporary paraesthesias.
  

Vitamin B3, also known as Niacin, is an essential nutrient that plays a crucial role in various bodily functions, including energy metabolism and maintaining the health of the nervous system. While niacin deficiency can lead to neurological symptoms, including paraesthesias (abnormal sensations like tingling or numbness), it is rare in well-nourished individuals.

However, high doses of niacin, often used in the treatment of certain medical conditions like high cholesterol, can indeed cause paraesthesias as a side effect. This is a well-known side effect of niacin therapy and is commonly referred to as the "niacin flush." The niacin flush involves a warm, tingling sensation, often accompanied by redness and flushing of the skin, particularly on the face and upper body. Some people may describe it as a temporary, uncomfortable form of paraesthesias.

The niacin flush is usually harmless and transient, lasting for about 15-30 minutes after taking a high-dose niacin supplement. Over time, the body may develop some tolerance to this side effect. Nevertheless, individuals who experience severe or persistent paraesthesias or other adverse effects from niacin should consult their healthcare provider. It's important to take niacin supplements as directed by a healthcare professional, as high doses can have potential side effects, including liver toxicity, gastrointestinal disturbances, and other adverse reactions.

Diagnosis and management of paraesthesias typically involve a thorough medical history, physical examination, and, if necessary, further diagnostic tests such as nerve conduction studies, electromyography, blood tests, or imaging studies. The underlying cause of paraesthesias must be identified and treated accordingly. Management may involve addressing the primary medical condition, physical therapy, medication, or lifestyle changes to alleviate the abnormal sensations and improve the patient's overall well-being.

Colposcopy

Colposcopy is a diagnostic tool that is often followed after an abnormal Pap smear test. A Colposcope is much like a large electric microscope that allows the physician to visualize the cervix, vaginal and genital area.

Basically a Colposcope is a complex optical instrument using light and magnification to distinguish dysplasia and cervical cancer from benign cervical findings. The word Colposcope is derived from 'colpo' indicating a vagina and 'scope' which refers to 'look'.

The physician applies vinegar solution to look for Leukoplakia and abnormal vessels. Colposcopy aids in viewing the cervix for any abnormal vascular changes. A colposcopy is suggested when there is any abnormality observed in the cervix or there is evidence of HPV. With a camera attached, images can be saved for records. During this procedure, any tissue sample or cervical biopsy can be taken for further investigation. This may cause slight discomfort and cramping. This diagnostic tool can be helpful in detecting any inflammation, cancerous growth or infection.

Preparation before colposcopy: Some conditions may require some medications before a session of colposcopy. Atrophic vaginal or cervical epithelium can be treated with intravaginal estrogen for 2-4 weeks before colposcopy in order to 'normalize' the epithelium.

Primary indications for colposcopy include abnormal Pap results or an abnormal appearing cervix. Early detection of cervical cancer is possible with colposcopy. Colposcopy is done in cases where a woman has unexplained bleeding during intercourse or there is any abnormal tissue on the cervix, vagina or vulva.

The Papanicolaou smear (Pap smear or Pap test) is a common test for dysplasia and cancer of the uterine cervix. In the US alone more than 50 million Pap Smear tests are taken every year. The Pap test is a cytologic examination of cells from the cervical transformation zone. A Pap test is often used to differentiate malignant cysts from common and mostly benign cysts. For example, Nabothian cysts are common and considered as a normal feature of the adult cervix.

A pelvic examination can sometimes help detect cysts and polyps. Endocervical polyps are the most common benign neoplasms of the uterine cervix. They are usually asymptomatic (but sometimes may cause vaginal discharge or post coital spotting) and occur in the 40 - 60 years. Most polyps are benign and the incidence of malignancy is approximately 1 in 1000.