#aminotransferases

[jcmicr]

Role of Alpha Fetoprotein in hepatocellular carcinoma by MuhammadWaqar Mazhar in Journal of Clinical and Medical Images, Case Reports 

Abstract

Hepatocellular carcinoma prevelance rate is higher in Pakistan due to HCV mortality rate, consumption of Alchol, and regular smoking, higher level of AFP progression normal liver cells into fatty liver cells, after inflammation it convert into HCC.In this study, we find the correlation between AFP and hepatocellular carcinoma. AFP involve in development of liver cancer, LFT’s test elevation and HCV also cause of cancer.

Keywords: Hepatocellular Carcinoma; Alpha Fetoprotein; alanine amino transferases; aspartate aminotransferases.

Introduction

Hepatocellular carcinoma is the 4th most common malignancy in worldwide and it is leading cause of cancer like disease in liver, and it exceed more than 1 million deaths per year by 2030 [1]. Acute hepatitis and acute liver failure are the most serious medical condition that require early diagnosis by release of IL-6, TNF-α and elevated alanine amino transferases, aspartate aminotransferases, alkaline phosphatase and α -Fetoprotein that progress healthy liver in to fatty liver known as steatosis and then inflammation occur in this and leads to hepatocellular carcinoma [2]. Most cases of HCC due to the virus like HCV and HBV, Diabetic and obesity, alcohol related diseases, non- alcohol related diseases, carcinogens like aflatoxins compounds [3]. HCC is the most common cancer that have high mortality rate in cancers due to mortality of HCV and NLFD. In Pakistan HCC ratio high due to prevalence and mortality rate of HCV [4]. The major treatment of HCC are chemotherapy, radiotherapy, transplantation and surgery. Because the most cases diagnose at the late stage, surgery cannot be performed and drugs are the only treatment of HCC [5]. Most patients in HCC become more drug resistance drug resistance. Drug treatment is the best choice of patients who are not edible for surgery. HCC is usually resistance to chemotherapeutic drugs. Because it hinders liver cancer treatment. In recent years targeted drugs use as medication and immune checkpoint inhibitors are introduce for treatment [6].

In the previous research evidence indicates that alpha-fetoprotein has high false-positive rate in diagnosis of early stage of HCC. The EASL clinic practices shows that AFP as a biomarker for liver transplantation and drug indicator [7]. The AFP level increased in many patients’ ad its risk for progression of HCC. AFP, currently the only biomarker available for HCC drug treatment, function as immune suppressor and promote malignancy transformation in HCC [8]. HCC is resistant to traditional chemotherapeutic agents such as doxorubicin, tetrahydrofolate, oxaliplatin, cisplatin, and gemcitabine. currently the recommended drugs include such as targeted therapeutics and immune checkpoint inhibitors [9].

AFP is a glycoprotein that secreted by endoderm embryonic tissue. The lower level of AFP in blood due to AFP is decrease in mature hepatocytes and that AFP gene expression is blocked. It is possible that AFP involved in HCC development and progression become an important factor affecting HCC diagnosis and treatment. AFP plays an important role in promoting cancer cell proliferation and, inhibition cancer cell apoptosis.

LFT’s test performed for liver injury, alanine aminotransferases, aspartate aminotransferases and alkaline phosphatase. These enzymes are commonly elevated in liver disease patients. Alkaline phosphatase and AFP play important role in the diagnosis of cancer.

Case Study

The patient name was sikandar, age 56 patient feel pain in their abdomen and sudden loss of weight. The patient has already hepatitis C infection and their PCR results were positive with high viral load. Due to serious illness it admitted in emergency ward 12, Nishter Hospital Multan. The doctors panel referred some test and kept in observations for better health condition.

The total bilirubin level was 2.05mg/dl in their blood and their normal values 0.6 - 1.2. The serum glutamate-pyruvate transaminase level is 43U/L and normal values up to 40. Aspartate amino transferases and alkaline phosphatase level were high in blood respectively 151 U/L and 493 U/l show in (Figure 1). Its indicate liver injury and cirrhosis. The AFP test indicates correlation with Hepatocellular carcinoma. The AFP level in patient was 6101ng/ml and normal values were 0.1 – 10. Higher level of AFP indicates that HCC have positive relation with AFP to proliferate cancer. The test formed by fully automated state of the Art analyzer Beckman Coulter 700 AIJ.

https://jcmimagescasereports.org/wp-content/uploads/2022/10/fig-1-10.jpg

Figure 1: Liver function and Alpha Feto Protein test in patient.

After blood reports, doctor suggest ultarosund Computrised Tomography whole abdominal view. In view, spleen size becomes enlarged 6cm, calculi in gall bladder, heterogeneous patchy atrial enhancement of right lobe, and some nodules seen in both lobes of liver. The doctor findings the AFP correlation with HCC, splenomegaly, ascites, cholelithiasis and protosystematic collaterals.

https://jcmimagescasereports.org/wp-content/uploads/2022/10/fig-2-10.jpg

Figure 2: Ultrasound Computrised Tomography whole abdomen.

The patient diagnosed with hepatocellular carcinoma at last stage, and doctor reffered to liver transplantation in india. But after 4 weeks he cannot survive.

Conclusion

Hepatitis C was the major risk of hepatocellular carcinoma in Pakistan. Smoking and alcohol have big problem to influence HCC in humans. The case study show that alpha fetoprotein has correlation with HCC. Higher Alkaline phosphatase and serum Bilirubin level enhance the liver carcinoma. AFP play role in cell proliferation, cancer cell differentiation and cell cycle arrest.

For more details : https://jcmimagescasereports.org/author-guidelines/ 

[orangemocharaktajino]

he ain't wrong

[girlyblunts]

My doctor thinks that I have gastroparesis, and I’m waiting for so many blood work results but my A1C levels are pre-diabetic :-)

[healixhospitals24]

Learn to interpret your liver function test results with our comprehensive guide. Understand commonly used liver tests and their implications for your health.

Do Visit: https://www.healixhospitals.com/blogs/reading-and-interpreting-your-liver-function-test-a-guide-to-commonly-used-liver-tests

[harmeet-saggi]

Understanding Liver Function Test

What is a liver function test?

A liver function test is a blood test that measures the levels of various enzymes and proteins in your blood. These substances are produced by the liver, and they can be a sign of liver damage or disease.

[jcrmhscasereports]

Case of Necrotizing Pancreatitis following COVID-19 Infection by Faezeh Sehatpour in Journal of Clinical Case Reports Medical Images and Health Sciences  

ABSTRACT

New aspects of COVID-19 are increasingly being recognized. Although the virus is mainly known to affect the lungs, involvement of other organs including the heart, liver, gastrointestinal, renal and pancreas is also detected. Acute pancreatitis is detected as one of both the early and late presentations of COVID -19. Cytokine storm or the presence of angiotensin-converting enzyme 2 (ACE2) receptor in pancreatic cells, are both two causes of pancreatic injury in COVID-19 infection. In this study, we reported a 25-year-old man admitted to our department with the impression of necrotizing pancreatitis concomitant with COVID-19 infection. Patient's lab data, imaging and outcomes were documented in full detail.

Abbreviations:

WBC, white blood cell;HB, hemoglobin; MCV, mean corpuscular volume; PLT, platelet; BUN, blood urea nitrogen; Na, sodium; K, potassium; ; AST, aspartate aminotransferase; ALT, alanine aminotransferase; ALK.P, alkaline phosphatase; ALB, albumin; LDH, Lactate dehydrogenase ; CPK, creatine phosphokinase; CRP,c-reactive protein; AFP,alpha-fetoprotein; CEA,carcinoembryonic antigen; CA19-9,cancer antigen 19-9; Immunoglobulin G4.

INTRODUCTION

The Covid-19 pandemic is an ongoing pandemic that started in December 2019 and spread rapidly around the word. COVID-19 was caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), first identified in Wuhan, China. So far, more than 200 countries have been affected by the pandemic. (1)

New aspects of COVID-19 are increasingly being recognized. Although the virus is mainly known to affect the lungs, involvement of other organs including the heart, liver, gastrointestinal, renal and pancreas is increasingly being reported. (2)

The involvement of the gastrointestinal system is maybe due to the expression of the angiotensin-converting enzyme2 (ACE2) on the hepatocyte, cholangiocyte and  other parts of the GI tract. (3) In a recent survey, acute pancreatitis was detected as one of both early and late presentations of COVID -19. (4-6) However, it is still unclear whether SARS-COV-2 directly affects pancreatic cells because of ACE2, if it is a cytokine storm which causes pancreatic injury. (7)

We reported a case of COVID-19 with subsequent acute necrotizing pancreatitis.

CASE REPORT

A 25-year-old man without any known medical disease presented to our emergency department with progressive epigastric pain, nausea and vomiting and anorexia one week prior to admission. He has no history of alcohol consumption. He also had a history of admission to another hospital about two weeks ago with a diagnosis of COVID-19 pneumonia. On admission, he has a blood pressure of 115/75 mm HG, a heart rate of 100 beats per minute, a temperature of 37.1 ⁰C and oxygen saturation of 95% while the patient is breathing in the room air. Primary investigations summarized in Table-1. Amylase and lipase were 146 IU/L and 82 IU/L respectively. Nasal swab test for COVID-19 (RT-PCR for SARS-CoV-2) was positive. Abdominal sonography showed markedly prominent pancreas with in homogeneous parenchymal echogenicity and large cystic lesion arising from the pancreas, in favor of acute complicated pancreatitis with pseudo cyst. The gall bladder has a normal size and wall thickness without any gall stones. The pancreatic duct was not dilated.  Due to the finding of abdominal ultra sound, CT scan of abdomen was done on him which revealed an enlarged pancreas with necrosis of the main portion of pancreatic parenchyma. Large cystic lesion measuring 15×7×11 cm in size arising from the pancreatic neck with extension to the right and left side of the abdomen suggestive of large pancreatic pseudo cyst (figure1).  Lung HRCT (low dose) also showed bilateral peripheral ground glass opacities in favor of COVID-19 pneumonia (figure2). According to the findings of a physical exam, laboratory data and clues in imaging immediate management of acute necrotizing pancreatitis (invasive intravenous hydration and pain control) was started for him. He was finally discharged from the hospital with a full recovery.

Table 1: laboratory data

Figure 1: Abdominal CT scan:  large loculated pseudo cystic structure measuring about 158mm*100mm in lesser sac due to post pancreatitis pseudo cyst formation.

Figure 2: lung HRCT: multiple ground glass and bilateral pleural effusion

DISCUSSION

Acute pancreatitis is an acute inflammation of the pancreas characterized by abdominal pain, nausea, vomiting and elevated exocrine pancreatic enzymes; amylase and lipase. Gallstones and chronic alcohol abuse are the most common causes of acute pancreatitis. Viruses are uncommon causes of acute pancreatitis. Pancreatitis has been reported with several viruses, including mumps, coxsackievirus, hepatitis A and B virus, cytomegalovirus, varicella-zoster, herpes simplex and human immunodeficiency virus. (8)

Although we have not conclusively proven the presence of the virus in the pancreas, the causes of COVID-19 and acute pancreatitis and the lack of other clear causes for pancreatitis strengthen the relationship between the two diseases.  In this study, the patient presented with necrotizing COVID-19in 19 in the early post period of COVID-19 infection.

In Fan Wang and colleagues' survey, 52 COVID-19 cases followed and showed that 17% of COVID-19 patients developed pancreatic injury and presented with mild elevated pancreatic enzymes; serum amylase and lipase without clinically severe pancreatitis. The possibility of drug induced acute pancreatitis in patients who have received medication due to COVID-19 is also expressed as one of the reasons for acute pancreatitis in COVID-for19 infection. (9) Saffa Saeed Al Mazrouei and his teammates reported a 24-year-old patient with acute non-necrotizing pancreatitis with concurrent COVID-19. No evidence of pseudo cyst or abscess was detected in his imaging. (10)

Pancreatic damage can be due to the direct effect of the virus on pancreatic cells or indirectly secondary to the immune system. In another study in Wuhan, it showed that ACE2 was expressed in the pancreas higher than the lung in the normal population, indicating that SARS-CoV-2 can bind to ACE2 in the pancreas and cause pancreatic cell damage. (7, 11)

Acute pancreatitis is one of the presentations or complications of COVID-19 infection. Further investigation with samples is needed to reveal the pathophysiology, presentation, treatment and prognosis of acute pancreatitis in COVID-19 infection.

For more information: https://jmedcasereportsimages.org/about-us/

For more submission : https://jmedcasereportsimages.org/

[tenth-sentence]

The aminotransferases in chloroplasts may have a significant role in amino acid biosynthesis, because plant leaves or isolated chloroplasts exposed to radioactively labeled carbon dioxide rapidly incorporate the label into glutamate, aspartate, alanine, serine, and glycine.

"Plant Physiology and Development" int'l 6e - Taiz, L., Zeiger, E., Møller, I.M., Murphy, A.

[cncpathlabs]

The aspartate aminotransferase test (AST) is a liver function test. Your liver is responsible for making a fluid called bile, which helps in the digestion of food. It also eliminates waste products and other toxins from your blood.

[primamedikatama]

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[jcmicr]

Role of Alpha Fetoprotein in hepatocellular carcinoma by MuhammadWaqar Mazhar in Journal of Clinical and Medical Images, Case Reports  

Abstract

Hepatocellular carcinoma prevelance rate is higher in Pakistan due to HCV mortality rate, consumption of Alchol, and regular smoking, higher level of AFP progression normal liver cells into fatty liver cells, after inflammation it convert into HCC.In this study, we find the correlation between AFP and hepatocellular carcinoma. AFP involve in development of liver cancer, LFT’s test elevation and HCV also cause of cancer.

Keywords: Hepatocellular Carcinoma; Alpha Fetoprotein; alanine amino transferases; aspartate aminotransferases.

Introduction

Hepatocellular carcinoma is the 4th most common malignancy in worldwide and it is leading cause of cancer like disease in liver, and it exceed more than 1 million deaths per year by 2030 [1]. Acute hepatitis and acute liver failure are the most serious medical condition that require early diagnosis by release of IL-6, TNF-α and elevated alanine amino transferases, aspartate aminotransferases, alkaline phosphatase and α -Fetoprotein that progress healthy liver in to fatty liver known as steatosis and then inflammation occur in this and leads to hepatocellular carcinoma [2]. Most cases of HCC due to the virus like HCV and HBV, Diabetic and obesity, alcohol related diseases, non- alcohol related diseases, carcinogens like aflatoxins compounds [3]. HCC is the most common cancer that have high mortality rate in cancers due to mortality of HCV and NLFD. In Pakistan HCC ratio high due to prevalence and mortality rate of HCV [4]. The major treatment of HCC are chemotherapy, radiotherapy, transplantation and surgery. Because the most cases diagnose at the late stage, surgery cannot be performed and drugs are the only treatment of HCC [5]. Most patients in HCC become more drug resistance drug resistance. Drug treatment is the best choice of patients who are not edible for surgery. HCC is usually resistance to chemotherapeutic drugs. Because it hinders liver cancer treatment. In recent years targeted drugs use as medication and immune checkpoint inhibitors are introduce for treatment [6].

In the previous research evidence indicates that alpha-fetoprotein has high false-positive rate in diagnosis of early stage of HCC. The EASL clinic practices shows that AFP as a biomarker for liver transplantation and drug indicator [7]. The AFP level increased in many patients’ ad its risk for progression of HCC. AFP, currently the only biomarker available for HCC drug treatment, function as immune suppressor and promote malignancy transformation in HCC [8]. HCC is resistant to traditional chemotherapeutic agents such as doxorubicin, tetrahydrofolate, oxaliplatin, cisplatin, and gemcitabine. currently the recommended drugs include such as targeted therapeutics and immune checkpoint inhibitors [9].

AFP is a glycoprotein that secreted by endoderm embryonic tissue. The lower level of AFP in blood due to AFP is decrease in mature hepatocytes and that AFP gene expression is blocked. It is possible that AFP involved in HCC development and progression become an important factor affecting HCC diagnosis and treatment. AFP plays an important role in promoting cancer cell proliferation and, inhibition cancer cell apoptosis.

LFT’s test performed for liver injury, alanine aminotransferases, aspartate aminotransferases and alkaline phosphatase. These enzymes are commonly elevated in liver disease patients. Alkaline phosphatase and AFP play important role in the diagnosis of cancer.

Case Study

The patient name was sikandar, age 56 patient feel pain in their abdomen and sudden loss of weight. The patient has already hepatitis C infection and their PCR results were positive with high viral load. Due to serious illness it admitted in emergency ward 12, Nishter Hospital Multan. The doctors panel referred some test and kept in observations for better health condition.

The total bilirubin level was 2.05mg/dl in their blood and their normal values 0.6 - 1.2. The serum glutamate-pyruvate transaminase level is 43U/L and normal values up to 40. Aspartate amino transferases and alkaline phosphatase level were high in blood respectively 151 U/L and 493 U/l show in (Figure 1). Its indicate liver injury and cirrhosis. The AFP test indicates correlation with Hepatocellular carcinoma. The AFP level in patient was 6101ng/ml and normal values were 0.1 – 10. Higher level of AFP indicates that HCC have positive relation with AFP to proliferate cancer. The test formed by fully automated state of the Art analyzer Beckman Coulter 700 AIJ.

Figure 1: Liver function and Alpha Feto Protein test in patient.

After blood reports, doctor suggest ultarosund Computrised Tomography whole abdominal view. In view, spleen size becomes enlarged 6cm, calculi in gall bladder, heterogeneous patchy atrial enhancement of right lobe, and some nodules seen in both lobes of liver. The doctor findings the AFP correlation with HCC, splenomegaly, ascites, cholelithiasis and protosystematic collaterals.

Figure 2: Ultrasound Computrised Tomography whole abdomen.

The patient diagnosed with hepatocellular carcinoma at last stage, and doctor reffered to liver transplantation in india. But after 4 weeks he cannot survive.

Conclusion

Hepatitis C was the major risk of hepatocellular carcinoma in Pakistan. Smoking and alcohol have big problem to influence HCC in humans. The case study show that alpha fetoprotein has correlation with HCC. Higher Alkaline phosphatase and serum Bilirubin level enhance the liver carcinoma. AFP play role in cell proliferation, cancer cell differentiation and cell cycle arrest.

For more details : https://jcmimagescasereports.org/author-guidelines/ 

[mcatmemoranda]

Rheumatoid Arthritis:

Refer to rheumatologist.

●Nonpharmacologic measures – Nonpharmacologic measures, such as patient education, psychosocial interventions, and physical and occupational therapy, should be used in addition to drug therapy. Other medical interventions that are important in the comprehensive management of RA in all stages of disease include cardiovascular risk reduction and immunizations to decrease the risk of complications of drug therapies.

●Initiation of DMARD therapy soon after RA diagnosis – We suggest that all patients diagnosed with RA be started on disease-modifying antirheumatic drug (DMARD) therapy as soon as possible following diagnosis, rather than using antiinflammatory drugs alone, such as nonsteroidal antiinflammatory drugs (NSAIDs) and glucocorticoids (Grade 2C). Better outcomes are achieved by early compared with delayed intervention with DMARDs.

●Tight control of disease activity – Tight control treatment strategies to "treat to target" are associated with improved radiographic and functional outcomes compared with less aggressive approaches. Such strategies involve reassessment of disease activity on a regularly planned basis with the use of quantitative composite measures and adjustment of treatment regimens to quickly achieve and maintain control of disease activity if targeted treatment goals (remission or low disease activity) have not been achieved. (

●Pretreatment evaluation – Laboratory testing prior to therapy should include a complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), aminotransferases, blood urea nitrogen, and creatinine. Patients receiving hydroxychloroquine (HCQ) should have a baseline ophthalmologic examination, and most patients who will receive a biologic agent or Janus kinase (JAK) inhibitor should be tested for latent tuberculosis (TB) infection. Screening for hepatitis B and C should be performed in all patients. Some patients may require antiviral treatment prior to initiating DMARD or immunosuppressive therapy, depending upon their level of risk for hepatitis B virus (HBV) reactivation.

●Adjunctive use of antiinflammatory agents – We use antiinflammatory drugs, including NSAIDs and glucocorticoids, as bridging therapies to rapidly achieve control of inflammation until DMARDs are sufficiently effective. Some patients may benefit from longer-term therapy with low doses of glucocorticoids.

●Drug therapy for flares – RA has natural exacerbations (also known as flares) and reductions of continuing disease activity. The severity of the flare and background drug therapy influence the choice of therapies. Patients who require multiple treatment courses with glucocorticoids for recurrent disease flares and whose medication doses have been increased to the maximally tolerated or acceptable level should be treated as patients with sustained disease activity. Such patients require modifications of their baseline drug therapies.

●Monitoring – The monitoring that we perform on a regular basis includes testing that is specific to evaluation of the safety of the drugs being; periodic assessments of disease activity with composite measures; monitoring for extraarticular manifestations of RA, other disease complications, and joint injury; and functional assessment.

●Other factors affecting target and choice of therapy – Other factors in RA management that may influence the target or choice of therapy include the disabilities or functional limitations important to a given patient, progressive joint injury, comorbidities, and the presence of adverse prognostic factors.

Osteoarthritis

General principles – General principles of osteoarthritis (OA) management include providing continuous care that is tailored to the patient according to individual needs, goals, and values and should be patient-centered. Treatment can be optimized by OA and self-management education, establishing treatment goals, and periodic monitoring.

●Monitoring and assessment – The management of OA should include a holistic assessment which considers the global needs of the patient. Patient preferences for certain types of therapies should also be assessed, as compliance and outcomes can be compromised if the care plan does not meet the patient's preferences and beliefs.

●Overview of management – The goals of OA management are to minimize pain, optimize function, and beneficially modify the process of joint damage. The primary aim of clinicians should include targeting modifiable risk factors. Due to the modest effects of the individual treatment options, a combination of therapeutic approaches is commonly used in practice and should prioritize therapies that are safer.

●Nonpharmacologic therapy – Nonpharmacologic interventions are the mainstay of OA management and should be tried first, followed by or in concert with medications to relieve pain when necessary. Nonpharmacologic therapies including weight management and exercises, braces and foot orthoses for patients suitable to these interventions, education, and use of assistive devices when required.

●Pharmacologic therapy – The main medications used in the pharmacologic management of OA include oral and topical nonsteroidal antiinflammatory drugs (NSAIDs). Other options include topical capsaicin, duloxetine, and intraarticular glucocorticoids. Our general approach to pharmacotherapy is described below.

•In patients with one or a few joints affected, especially knee and/or hand OA, we initiate pharmacotherapy with topical NSAIDs due to their similar efficacy compared with oral NSAIDs and their better safety profile.

•We use oral NSAIDs in patients with inadequate symptom relief with topical NSAIDs, patients with symptomatic OA in multiple joints, and/or patients with hip OA. We use the lowest dose required to control the patient's symptoms on an as-needed basis.

•We use duloxetine for patients with OA in multiple joints and concomitant comorbidities that may contraindicate oral NSAIDs and for patients with knee OA who have not responded satisfactorily to other interventions.

•Topical capsaicin is an option when one or a few joints are involved and other interventions are ineffective or contraindicated; however, its use may be limited by common local side effects.

•We do not routinely use intraarticular glucocorticoid injections due to the short duration of its effects (ie, approximately four weeks).

•We avoid prescribing opioids due to their overall small effects on pain over placebo and potential side effects (eg, nausea, dizziness, drowsiness), especially for long-term use and in the older adult population.

•We do not routinely recommend nutritional supplements such as glucosamine, chondroitin, vitamin D, diacerein, avocado soybean unsaponifiables (ASU), and fish oil due to a lack of clear evidence demonstrating a clinically important benefit from these supplements. Other nutritional supplements of interest that may have small effects on symptoms include curcumin (active ingredient of turmeric) and/or Boswellia serrata, but the data are limited.

●Role of surgery – Surgical treatment is dominated by total joint replacement, which is highly effective in patients with advanced knee and hip OA when conservative therapies have failed to provide adequate pain relief.

●Factors affecting response to therapy – The discordance of radiographic findings to pain supports the notion that the mechanisms of pain are complex and likely multifactorial. The placebo effect is also known to impact response to therapy.

●Prognosis – Although there is great variability among individuals and among different phenotypes of OA, courses of pain and physical functioning have been found to be predominantly stable, without substantial improvement or deterioration of symptoms over time.

[healixhospitals24]

Reading And Interpreting Your Liver Function Test - A Guide To Commonly Used Liver Tests

The liver is a vital organ responsible for numerous metabolic functions in the body, including detoxification, protein synthesis, and bile production. Monitoring liver health is crucial for early detection and management of liver diseases. One of the primary tools for assessing liver function is the Liver Function Test (LFT). In this guide, we will delve into the commonly used liver tests, how to interpret the results, and what they indicate about your liver health.

Understanding Liver Function Tests

Liver Function Tests (LFTs) are a group of blood tests that provide valuable insights into the health and function of the liver. These tests measure various enzymes, proteins, and substances in the blood that are indicative of liver health.

Key components of Liver Function Tests

Alanine Aminotransferase (ALT): Elevated levels suggest liver damage, commonly caused by conditions like hepatitis or fatty liver disease.

Aspartate Aminotransferase (AST): Similar to ALT, elevated AST levels indicate liver damage but may also be elevated in conditions affecting the heart or muscles.

Alkaline Phosphatase (ALP): Elevated ALP levels may suggest liver or bone disease.

Total Bilirubin: Increased levels may indicate liver dysfunction or obstruction of bile ducts.

Albumin and Total Protein: These are measures of liver synthetic function; decreased levels may suggest liver disease.

What are the causes of abnormal liver function test results?

Causes of abnormal liver function test results can vary and may indicate different underlying conditions. Some common causes include:

1. Build-up of Fat in the Liver:

* Non-alcoholic fatty liver disease (NAFLD) can lead to abnormal liver function tests, especially in overweight or obese individuals.

2. Liver Inflammation and Damage:

* Infections, toxic substances like alcohol or certain medications, and immune conditions can cause liver inflammation and subsequent abnormal test results.

3. Liver Overworking:

* When the liver is under stress from processing medicines or toxic substances like alcohol or paracetamol, it can result in abnormal liver function tests.

4. Bile Duct Blockage:

* Blockages in the bile ducts, such as by gallstones, can lead to abnormal liver function test results.

5. Liver Conditions and Diseases:

* Underlying conditions like Wilson's disease, haemochromatosis, or Gilbert's syndrome can affect liver function and result in abnormal test values.

6. Liver Injury:

* Physical injury to the liver, trauma, or presence of abscesses or tumors within the liver can cause abnormal liver function tests.

7. Medications and Supplements:

* Certain medications, over-the-counter drugs, herbal remedies, and traditional medicines can also impact liver function test results.

8. Other Factors:

* Factors like high alcohol intake, viral infections, autoimmune conditions, metabolic liver diseases, heart problems, and tumors in the liver can contribute to abnormal liver function tests.

Continue Reading: https://www.healixhospitals.com/blogs/reading-and-interpreting-your-liver-function-test-a-guide-to-commonly-used-liver-tests

[joellavine]

Cholestasis during pregnancy

Cholestasis is a condition that affects the liver, gallbladder, and bile ducts. It can occur in two ways. Extrahepatic cholestasis occurs outside the liver (also known as non-obstetric cholestasis). Intrahepatic cholestasis, also called obstetric cholestasis, happens inside the liver. In pregnant women, hormones change the way bile flows through the gallbladder and the bile ducts. This causes bile to build up in the liver and spill into the bloodstream.

Obstetric cholestasis is a pregnancy-related liver disorder that occurs in approximately 1 in 200 women during their third trimester. It is marked by itching, high levels of serum aminotransferases and bile acids, and signs and symptoms that go away on their own two to three weeks after birth.

In severe obstetric cholestasis, the condition can be very serious and lead to premature birth, fetal distress, and stillbirth. Surgical treatment is usually recommended to prevent these complications and lessen the risk for you and your baby.

Fortunately, there is an effective treatment for obstetric cholestasis called ursodeoxycholic acid. It protects interstitial Cajal-like cells in the gallbladder from undergoing apoptosis by inhibiting TNF-a expression, thus preventing oxidative stress and thrombotic complications.

Cholestasis of pregnancy (also called intrahepatic cholestasis) is a liver disorder that can develop during your pregnancy. Your doctor will diagnose it by doing a physical exam and a blood test that shows how well your liver is functioning.

The tests will also measure how much bile acid is in your bloodstream. The more bile acids you have, the more likely you are to have cholestasis during pregnancy.

Intrahepatic cholestasis of pregnancy is a rare, reversible disease that typically occurs in the second half of pregnancy. It causes severe pruritus and an elevation of total serum bile acids, which may lead to jaundice in 10% of patients.

A pregnant woman with obstetric cholestasis (also called intrahepatic cholestasis of pregnancy) may experience itching without a rash. It typically starts in the third trimester and goes away after delivery.

Cholestasis occurs when bile, the digestive fluid that helps break down fats, does not leave the liver for the small intestine. This causes bile acids to build up in the bloodstream and cause itching.

The bile acids can also cause problems with a pregnant woman’s ability to absorb fat, and this can affect her blood clotting. This can also affect her baby, increasing the risk of stillbirth and premature birth.

Cholestasis occurs because of an impairment in the normal flow of bile. This leads to the accumulation of bile acids, bilirubin, and cholesterol.

The main cause of cholestasis is obstruction of the bile flow in the hepatocytes or cholangiocytes. This can happen for a number of different reasons.

One of the most common causes is a blockage in your gallbladder (bile ducts). Another cause is an obstruction in the liver or the tubes that carry bile from your stomach to your intestine.

You may need to take medication to help your bile move through your body more easily. This can reduce your itching and help your bile levels return to normal.

Cholestasis is a condition in which the flow of bile from your liver to your small intestine slows down or stops. This can happen due to problems with your liver, bile duct, or pancreas.

If you have obstetric cholestasis, your doctor will check for other health issues to help determine the cause. You'll have a physical exam and get blood tests to measure the level of bile acid in your blood as well as your liver function.

In most cases, obstetric cholestasis resolves after you deliver your baby. But you'll need to keep up with monitoring for a while after you give birth. You may have ultrasounds and fetal heart monitors to make sure your baby is okay.

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It is important to capture wild animals with minimal stress to reduce morbidity and mortality. Oral premeditates have the potential to reduce stress during handling and ease the subsequent administration of anesthetic drugs.  This study was conducted to evaluate the hematological and serum biochemical changes associated with anesthesia in male Bonnet Macaques using haloperidol or chlordiazepoxide premedication.

Materials and methods: Twelve adult male Bonnet Macaques aged around 4 to 6 years were randomly allotted to two groups of six each. The duration of the study was five hours. Animals of Group I were administered chlordiazepoxide (10 mg/kg body weight) orally and animals of Group II were administered haloperidol (1 mg/kg body weight) orally four hours before anesthetizing with the intramuscular injection of midazolam (0.1 mg/kg) and ketamine (10 mg/kg). Hematological parameters such as hemoglobin concentration, erythrocyte, total leucocyte count, the volume of packed red cells, granulocyte, monocyte, and lymphocyte count were evaluated. Biochemical parameters such as creatine kinase, aspartate aminotransferase, alanine aminotransferase, cortisol, glucose, calcium, sodium, and potassium were evaluated from the venous blood sample collected at 0th minute and 30th minute after induction of anesthesia.

Results: The results of the current study indicate that in hematological parameters, the volume of packed cells was significantly different at 0th and 30th minute in both groups. The total leucocyte count was significantly different at 0th  and 30th minute in Group I and Group Ⅱ, and the monocyte count was significantly different at 0th and 30th minute in Group I. For biochemical parameters, a significant difference was observed in creatine kinase in group II at 0th and 30th minute and cortisol at time 0th between Group I and Group II.

Conclusion: These results highlight the impact of anesthesia protocols on stress responses in Bonnet Macaques. Haloperidol premedication was linked to a greater increase in cortisol and creatine kina

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SGOT and SGPT: Indicators of Liver Health

By: Mrs Mayuri Mathur

Liver function tests, such as SGOT (serum glutamic oxaloacetic transaminase) and SGPT (serum glutamic pyruvic transaminase), play a crucial role in assessing liver health. Elevated levels of SGOT and SGPT can indicate liver damage or disease, making it essential to understand these markers and their implications for overall health.

Introduction

Liver function tests are blood examinations used to identify the underlying cause of symptoms and monitor liver health or damage. They assess the levels of specific enzymes and proteins in the bloodstream.

Some tests evaluate the liver's ability to perform its normal functions, such as producing proteins and eliminating bilirubin, a waste product found in blood. Other tests measure enzymes released by liver cells in response to injury or illness.

Liver function tests include:

Alanine transaminase (ALT) and aspartate transaminase (AST) are enzymes found in the liver that indicate liver cell damage when elevated. 

Alkaline phosphatase (ALP) levels may rise due to liver damage or bone disease. 

Albumin and total protein levels assess liver protein synthesis; low levels indicate liver disease or other conditions. 

Bilirubin levels indicate liver function and may rise due to liver disease or bile duct blockage. 

Gamma-glutamyltransferase (GGT) levels indicate liver or bile duct damage, while L-lactate dehydrogenase (LD) levels rise with liver damage. 

Prothrombin time (PT) assesses blood clotting ability, often prolonged in liver disease or due to certain medications.

What are SGOT and SGPT?

SGOT (AST - Aspartate Aminotransferase) and SGPT (ALT - Alanine Aminotransferase)are important indicators of liver function. These enzymes are found in various tissues throughout the body, with the highest concentrations in the liver. When liver cells are damaged or destroyed, these enzymes are released into the bloodstream, causing their levels to rise in blood tests. The elevated levels of these enzymes may be indicative of:

Liver Diseases: Conditions like hepatitis (viral or alcoholic), cirrhosis, fatty liver disease, and liver cancer can cause elevated SGOT and SGPT levels.

Alcohol Consumption: Excessive alcohol intake can lead to liver inflammation and damage, increasing SGOT and SGPT levels.

Medications: Some medications, such as certain antibiotics, cholesterol-lowering drugs, and pain relievers, can elevate liver enzymes.

Obesity and Metabolic Syndrome: Conditions associated with insulin resistance, like obesity and metabolic syndrome, can lead to non-alcoholic fatty liver disease (NAFLD), elevating liver enzymes.

Liver Damage Progression: Persistently elevated SGOT and SGPT levels may indicate ongoing liver damage, potentially progressing to more severe conditions like cirrhosis or liver failure.

Cardiovascular Risk: Elevated SGOT levels have been linked to an increased risk of cardiovascular events, indicating broader health implications beyond liver health.

Dangerous Levels of SGOT and SGPT

An SGOT to SGPT ratio exceeding 2 strongly suggests the presence of alcoholic hepatitis and cirrhosis. The ratio of SGOT to SGPT shows a significant increase in patients diagnosed with alcoholic hepatitis and cirrhosis (2.85 +/- 0.2) compared to those with postnecrotic cirrhosis (1.74 +/- 0.2), chronic hepatitis (1.3 +/- 0.17), obstructive jaundice (0.81 +/- 0.06), and viral hepatitis (0.74 +/- 0.07).

Regular monitoring of SGOT and SGPT levels is crucial for early detection and management of liver diseases. Elevated levels can indicate ongoing liver damage, prompting further investigation and treatment to prevent complications.

Educational and Healthcare Interventions: 

Educational and healthcare interventions for managing SGOT (AST) and SGPT (ALT) levels focus on promoting liver health through education, lifestyle changes, and medical management. Here's a comprehensive approach:

Education on Liver Function: It is crucial to understand the roles of SGOT and SGPT in liver function. Educate patients on how these enzymes reflect liver health and why monitoring their levels is essential.

Healthy Lifestyle Guidance: Provide dietary recommendations emphasizing a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Limit saturated fats, sugars, and processed foods. Encourage portion control and regular meal times.

Medication Review: Review medications and supplements to identify any that may affect liver function. Adjust or monitor dosages as necessary under medical supervision.

Screening and Monitoring: Establish protocols for regular liver function tests to monitor SGOT and SGPT levels. This allows early detection of liver abnormalities and timely intervention.

Treatment of Underlying Conditions: Address underlying conditions such as viral hepatitis, fatty liver disease, or autoimmune disorders promptly. Tailor treatment plans to manage these conditions effectively.

Health Promotion: Promote overall health and well-being through stress management techniques, adequate hydration, and regular physical activity. These practices support liver function and overall health.

Patient Empowerment: Empower patients with knowledge and resources to take an active role in managing their liver health. Provide educational materials, support groups, and access to healthcare professionals for ongoing guidance.

Collaborative Care Approach: Foster collaboration between healthcare providers, specialists, dietitians, and mental health professionals to offer comprehensive care. This approach ensures holistic management of SGOT and SGPT levels.

Lifestyle Tips for Managing SGOT and SGPT Levels:

Healthy Diet: Consume a balanced diet rich in fruits, vegetables, lean proteins, and whole grains. Limit saturated fats, sugars, and processed foods. Drink plenty of water to help flush toxins from your body and support overall liver function.

Limit Alcohol: Excessive alcohol consumption can elevate SGOT and SGPT levels. If you drink, do so in moderation or avoid alcohol altogether.

Weight Management: Maintain a healthy weight through regular exercise and a balanced diet. Obesity can contribute to fatty liver disease, leading to elevated liver enzymes.

Medication Management: Some medications can increase SGOT and SGPT levels. Always take medicines as prescribed and inform your healthcare provider of any ongoing supplements or over-the-counter drugs.

Avoid Toxins: Minimize exposure to environmental toxins and chemicals that can harm the liver. Use protective gear if working with chemicals.

Monitor health Regularly: Regular check-ups with your healthcare provider can help monitor liver function. Discuss any concerns about SGOT and SGPT levels and follow recommended screening guidelines.

Healthy Habits: Quit smoking if you smoke, as it can worsen liver health. Stress-reduction techniques like yoga or meditation can be incorporated to manage stress, which can impact liver function.

Follow Medical Advice: Follow your healthcare provider's recommendations for managing SGOT and SGPT levels, including any necessary medications, lifestyle changes, or dietary adjustments.

Conclusion

Understanding the significance of liver function tests encourages proactive healthcare behaviors. Medical and healthcare education and disease awareness empower individuals to make informed decisions about their health and promotes early detection of liver disorders, facilitates prompt intervention, and ultimately improves outcomes by preventing complications associated with liver disease.

Adopting proactive and preventive strategies can help manage and prevent elevated SGOT and SGPT levels, promoting better liver health and overall well-being. Always consult your healthcare provider for personalized advice based on your specific health needs.