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.

Cholecystitis

Cholecystitis refers to severe abdominal pain associated with gallbladder inflammation or gallstones. Acute Cholecystitis can manifest as sharp cramping pain in the right upper quadrant of the abdomen. This pain can spread to the back or below the right shoulder blade. It usually appears after a fatty meal. Cholecystitis might also lead to nausea and vomiting and often jaundice. The person suffering Cholecystitis might notice clay colored stools and fever. Diagnostic tests that are prescribed to detect this condition are Liver function test, abdominal ultrasound and Endoscopy.

In many cases, Cholecystitis can clear on its own, with the right low fat diet and antibiotics. But in other cases, Cholecystectomy may be done to remove the gallbladder. Acute Cholecystitis needs to be treated urgently lest it lead to complications such as a perforated gallbladder or gangrenous Cholecystitis where the gallbladder tissue dies. On the other hand, cholangitis involves infection of the bile ducts either due to biliary obstruction or bacterial infection.

High Triglyceride

Triglycerides are vital to various cells functions and determine the amount of reserve energy that our body can offer. Triglycerides come from food and are also produced by the body. High blood triglyceride or hypertriglyceridemia is a lipid disorder. High Triglyceride levels are usually accompanied by high total blood cholesterol levels. Blood Triglyceride levels are indicative of a person's susceptibility to various diseases such as hypertension, heart attack, cardiovascular disease and atherosclerosis. High levels of Triglycerides increase the risk of diabetes and pancreatitis. Blood triglyceride levels of around 150 to 170 mg/dL are considered normal. While high Triglyceride levels are those above 200 mg/dL, those having triglyceride levels greater than 499 mg/dL are at high risk. (see below the table) High Triglyceride levels also put a person at increased risk of thrombosis.

To evaluate the risk factors associated with elevated levels of cholesterol, levels of Triglyceride must also be factored in as cholesterol and Triglyceride levels can vary independently.

Reference Range of Triglyceride:

• Normal: Less than 150 mg/dL
  
• Borderline High: 150 - 199 mg/dL
  
• High : 200 - 499 mg/dL
  
• Very High : Greater than or equal to 500 mg/dL
  

Clinical Information on Triglyceride: Triglycerides are esters of the trihydric alcohol glycerol with three long chain fatty acids. They are partly synthesized in the liver and some of it come from the diet. Enhanced plasma levels of Triglycerides reflect metabolic abnormality. High level of Triglycerides by itself, is not nearly as harmful as LDL cholesterol. Together with high cholesterol level, it constitutes a high risk factor for any of the following diseases:

• biliary obstruction
  
• diabetes mellitus
  
• nephrotic syndrome
  
• Renal Failure
  

Or metabolic disorders related to endocrinopathies. Another cause of high levels of Triglycerides can be drug induced - e.g.;prednisone, isotretinoin.

High levels of Triglycerides beyond 1000 mg/dL can be fatal because of chylomicron induced pancreatitis which may show only abdominal pain as a symptom.

Blood Triglyceride levels are measured with a blood test after abstaining from food for 12 hours and alcohol for 72 hours before testing. Drugs such as fibrates are often prescribed to reduce elevated levels of triglycerides and cholesterol. Tips to lower triglyceride:

• Losing excess weight
  
• Regular exercise regimen
  
• Reducing caloric intake especially fatty foods
  
• Restricting alcohol intake