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.
The liver is responsible for neutralizing the blood of toxins, germs and bacteria as well as producing immune agent to control infections. Bile, critical to the absorption of fats and fat-soluble vitamins is made by the liver. Cirrhosis is a condition where the liver is affected by irreversible scar tissue leading to its damage and consequent failure. Blood flow to the liver is then affected. Symptoms of cirrhosis range from exhaustion and fatigue to weight loss and abdominal pain. A person suffering from liver cirrhosis may experience abdominal pain and loss of appetite. There are noticeable red spider veins under the skin and the skin and eyes may turn yellow. There is decreased interest in sex and edema (swelling on hands and legs) might be noticed. A person suffering from cirrhosis and damaged liver may notice an increased tendency to bruise and bleed easily. Intense itching is felt on account of the bile products being deposited in the skin. Gallstones may develop as a result of inadequate bile reaching the gallbladder. There might be a buildup of toxins in the brain bringing about bouts of unresponsiveness and forgetfulness. Cirrhosis can bring on Portal hypertension - a condition where there is reduced flow of blood to the portal vein and increased pressure within it. Cirrhosis can eventually lead to liver cancer caused by carcinoma. Impotence, kidney dysfunction and osteoporosis are other likely complications of liver disease.
Cirrhosis of the liver is usually caused by chronic alcoholism or hepatitis C. Other possible factors leading to cirrhosis are problems in the immune system and damaged bile ducts.
Chronic Alcoholism - One of the common causes for cirrhosis is alcoholism. But this condition occurs only after at least 10 years or more of heavy drinking. Alcohol affects the liver's ability to metabolize proteins, fats and carbohydrates.
Chronic hepatitis - Hepatitis C virus can lead to severe inflammation and damage of the liver, thereby causing cirrhosis. Hepatitis B is one of the most common causes of liver inflammation in many of the developing nations.
Blocked bile ducts - In such a condition, the bile is unable to travel out of the liver and instead ends up damaging liver tissue. This can be a congenital defect in some infants.
Cirrhosis of the liver can cause many other abnormalities. It can leads to elevated levels of triglycerides, cholesterol and sugar. Diabetes mellitus is a common fallout. There might be a fall in platelet count and GI bleeding. In severe cases of cirrhosis, there can be an immune system dysfunction or even brain swelling and later coma. The liver of an affected person will feel be larger and harder to touch. A liver scan or ultrasound can help detection of cirrhosis. A liver biopsy is sometimes resorted to. Damage to the liver due to cirrhosis cannot be reversed but further complications can be reduced with the right treatment. Cirrhosis caused by excess alcohol consumption needs lifestyle changes such as avoiding alcohol and following a nutritious diet. Low-sodium diet can help drain excess fluid-buildup within the body. Chronic viral hepatitis B and C are treated with prednisone and azathioprine. Any bacterial infection is treated with appropriate antibiotics. Liver transplantation surgery is done on cases where the liver is not capable of functioning. With the help of modern drugs such as cyclosporine and tacrolimus, the success of liver transplantation surgery has risen manyfold.
Hepatoma is primary liver cancer which occurs in the liver itself and did not spread from another area of the body to the liver. Often associated with cirrhosis of liver and hepatitis B infections, malignant hepatoma is common among alcoholics. It is found in people above 40 years of age and more noticed among men than women.
While the exact cause of malignant hepatoma is not known, there are several risk factors that contributes to the cause of hepatoma. These include being above 40 years of age, male sex, history of cirrhosis and exposure to hepatitis viruses B, C, D and G. Symptoms of malignant hepatoma may be the same as other liver diseases, including pain and swelling in the abdominal area, loss of weight, appetite, jaundice, fatigue and fever. Crucial pain extending to the back and shoulder is another symptom, when the cancer progresses. A collection of fluid known as ascites in the abdomen occurs in some patients, while some show signs of bleeding in the digestive tract.
The procedure for diagnosis is for the medical practitioner to go through the medical history of the patient first and physically examine the patient's abdomen for lumps if any. The liver could be swollen, hard and sore. Certain diagnostic parameters inclusive of blood tests are conducted to determine and evaluate the liver condition and function. An ultrasound and CT scan are undertaken to detect possible tumors in the liver. If necessary, a sample of liver tissue is sent for a biopsy to confirm if the hepatoma is malignant. Sometimes, a doctor looks for chest x-ray to understand if the liver tumor is primary or has spread to the lungs as well.
Hepatomas are neither contagious nor hereditary. They could be cured, if detected in the early stages. But unfortunately, most hepatomas are detected late making the rate of survival very low. In most advanced stages, malignant hepatoma cannot be cured although treated to relieve pain. Surgery is recommended if cancer is contained in one lobe of the liver and the patient is healthy enough without afflictions of cirrhosis, jaundice or ascited. Sometimes, chemotherapy or radiation therapy is undertaken to destroy the cancer cells in order to slow the disease spread. Although chemotherapy is not very successful but is tried in patients whose tumor is too large or advanced to be surgically resected. Liver transplant is adopted in patients who suffer acute liver damage with too large a portion of the tumor in the liver.
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Bibliography / Reference
Collection of Pages - Last revised Date: December 13, 2019