The Liver (3)

When do we receive abnormal values of the following lab tests? Gamma-glutamyl transferase (GGT) Gamma-GT GGT levels are elevated in liver diseases, liver metastasis and in biliary obstruction . When testing for alcohol abuse , the enzyme test of choice is the GGT, because it increases immediately if the liver is damaged due to alcohol abuse. Monitoring the course of hepatitis, GGT can also be used. Patients get an excellent prognosis if the GGT is normal. Other reasons for GGT activity change are in the case of a heart attack, or when a patient suffers from a stroke or diabetes mellitus Type 2.

Alanine aminotransferase (ALT) or Serum Glutamic-Pyruvic Transaminase (SGPT) ALT, ALAT bzw. GPT Liver cirrhosis, chronic hepatitis, metastatic carcinoma, acute hepatitis and non-malignant hepatic obstruction are all diseases that elevate the ALT. Further, infectious mononucleosis, which often involves the liver, also elevates ALT. In general, whenever the ALT is elevated, the liver tissue is damaged.

Aspartate Transaminase (AST) respectively, Serum Glutamic-Oxaloacetic Transaminase (SGOT) GOT In hepatitis, the AST level is elevated even before jaundice appears and it takes weeks until it returns to normal. Also a liver shock, a trauma or liver cirrhoses can cause an elevation of the AST. Soon after a myocardial infarction, the AST is elevated; this is the reason why we call AST a “cardiac enzyme”. Also a nephropathy or a skeletal muscle damage will elevate the blood AST levels.

Cholinesterase Cholinesterase decreases after extensive exposure of pesticides or after an intoxication within a few minutes or hours after the exposure. It can remain decreased for as long as one to three months. Reduced cholinesterase levels can also be caused by chronic liver disease and malnutrition . Rarely, patients show an inherited decrease of cholinesterase values.

Prothrombin Time (PT) Prothrombin time (syn: Quick’s value) is a very sensitive test to determining the amount of prothrombin present in blood plasma and for determination of prothrombin clotting time. It indicates the liver synthesis rates during acute parenchymal liver diseases. The PT is especially abnormal in liver diseases.

Bilirubin Indirect (unconjugated) bilirubin level is increased in the case of liver cirrhosis, transfusion reactions, and hemolytic or pernicious anemia. Direct (conjugated) bilirubin is elevated during a viral hepatitis infection, drug reactions and alcoholic liver diseases. If there is a blockage of the bile ducts (e.g. by gallstones, tumors, or scarring of the bile ducts it is also elevated. Low bilirubin levels are generally not too worrying, and are not monitored.

Alpha-Fetoprotein (AFP) Formed in the yolk sac and the liver of the fetus, this globulin usually disappears from the bloodstream after birth, except for trace amounts . In pregnant women the alpha-fetoprotein examination is performed on amniotic fluid to detect specific congenital defects. In non-pregnant patients, AFP determination is the first choice for use as a tumormarker. If alpha-fetoprotein is markedly increased, it is a sign for a primary hepatocellular carcinoma (hepatoma) of the liver, liver cirrhosis and some types of testicular cancer or ovarian cancer. Small amounts of AFP are present in some non-malignant liver diseases in adult patients and children. Patients with cirrhosis and those who are carriers of hepatitis B or C are at greater risk of liver cancer. For these patients it may prudent to advise periodic screenings with AFP and ultrasound to detect tumors that may still be treatable.

When is a Radiological Diagnosis Advised? Various liver diseases require different diagnostic radiology techniques. Standard examinations include ultrasound, x-ray, CT, MRT, radionuclide imaging (using technetium sulfur colloid or technetium phytate), and, as an invasive method, angiography. ERCP can be used to detect (and treat) gallstones and to diagnose diseases of the liver, the bile ducts and the pancreas.

What about Histology? Different pathology techniques are used in the case of non-alcoholic fatty liver disease, liver cirrhosis, chronic viral hepatitis C, drug-induced liver injury, Wilson’s disease and other uncommon inherited metabolic diseases.

BIBLIOGRAPHY 1. Bartolozzi C, Lencioni R (eds.): Liver Malignancies. Berlin Heidelberg: Springer 1999. 2. http://dict.leo.org. 3. www.dict.cc. 4. www.webster-dictionary.org.

EXERCISE: 1. In a non-pregnant patient, what might the elevated value of AFP in the serum indicate? a. Congenital enzyme defect b. Infertility c. Malignant tumor of the liver

2. Which of the following terms is a synonym for indirect bilirubin? a. Water-soluble bilirubin b. Free bilirubin c. Conjugated bilirubin

3. If a patient has an increased ALT and AST, a priority diagnosis is a. Impaired gas exchange b. Fluid volume deficit c. Activity intolerance

You’ll find the answers on: http://tinyurl.com/weiterbildung-englisch

Die Autorin: Carmen Lobitz mail@lobitz-seminare.de www.lobitz-seminare.de

Carmen Lobitz ist freie Trainerin, Lehrerin und MTA. Sie gründete 1998 in Berlin lobitz seminare, die u.a. Englischseminare für Health Professionals anbieten.

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Lösung für Exercise:

Answer: 1. c Answer: 2. c Answer: 3. c

The Liver (3)

When do we receive abnormal values of the following lab tests?

Gamma-glutamyl transferase (GGT)Gamma-GT

Alanine aminotransferase (ALT) or Serum Glutamic-Pyruvic Transaminase (SGPT)ALT, ALAT bzw. GPT

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The Liver (3)

When do we receive abnormal values of the following lab tests?

Gamma-glutamyl transferase (GGT)Gamma-GT

Alanine aminotransferase (ALT) or Serum Glutamic-Pyruvic Transaminase (SGPT)ALT, ALAT bzw. GPT

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