DOCSLIB.ORG

Elevated Liver Function Tests in Type 2 Diabetes

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Elevated Liver Function Tests in Type 2 Diabetes FEATURE ARTICLE Elevated Liver Function Tests in Type 2 Diabetes Elizabeth H. Harris, MD iver function tests (LFTs) are postprandial states. Loss of insulin effect up-regulation of SREBP-1c and subse- commonly used in clinical prac- on the liver leads to glycogenolysis and quent simulation of de novo lipogenesis Ltice to screen for liver disease, an increase in hepatic glucose produc- in the liver leads to increased intracellu- monitor the progression of known dis- tion. Abnormalities of triglyceride stor- lar availability of triglycerides, promot- ease, and monitor the effects of poten- age and lipolysis in insulin-sensitive tis- ing fatty liver. This also increases VLDL tially hepatotoxic drugs. sues such as the liver are an early mani- assembly and secretion.1 Thus, hyperin- The most common LFTs include festation of conditions characterized by sulinemia might directly lead to hepatic the serum aminotransferases, alkaline insulin resistance and are detectable ear- insulin resistance with associated fatty phosphatase, bilirubin, albumin, and lier than fasting hyperglycemia. The pre- changes. prothrombin time. Aminotransferases, cise genetic, environmental, and meta- The excess in free fatty acids found such as alanine aminotransferase (ALT) bolic factors and sequence of events that in the insulin-resistant state is known and aspartate aminotransferase (AST), lead to the underlying insulin resistance, to be directly toxic to hepatocytes. measure the concentration of intracellu- however, is not fully understood.1 Putative mechanisms include cell lar hepatic enzymes that have leaked In animal models, chronic hyperin- membrane disruption at high concen- into the circulation and serve as a sulinemia is found to predispose the liver tration, mitochondrial dysfunction, tox- marker of hepatocyte injury. Alkaline to relative resistance to insulin. This is in formation, and activation and inhibi- phosphatase (AP), ␥-glutamyl transpep- characterized by a failure of insulin to tion of key steps in the regulation of tidase (GGT), and bilirubin act as signal an increase in insulin receptor metabolism.3 Other potential explana- markers of biliary function and substrate-2. Upregulation of sterol regu- tions for elevated transaminases in cholestasis. Albumin and prothrombin latory element-binding protein 1c insulin-resistant states include oxidant reflect liver synthetic function. (SREBP-1c) also occurs, leading to stress from reactive lipid peroxidation, The aminotransferases AST and ALT increased lipogenesis.2 Despite down- peroxisomal beta-oxidation, and are normally < 30–40 units/l. Elevations regulation of the insulin receptor sub- recruited inflammatory cells. The of aminotransferases greater than eight strate-2–mediated insulin signaling path- insulin-resistant state is also character- times the upper limit of normal reflect way in insulin-resistant states, the ized by an increase in proinflammatory either acute viral hepatitis, ischemic hep- cytokines such as tumor necrosis fac- atitis, or drug- or toxin-induced liver IN BRIEF tor-␣ (TNF-␣), which may also con- tribute to hepatocellular injury. In pre- injury. Much more common than Individuals with type 2 diabetes have liminary studies, an increased patients with acute hepatitis, however, a higher incidence of liver function frequency of specific TNF-␣–promoter are patients with chronic mild elevation test abnormalities than individuals polymorphism was found in nonalco- of aminotransferases, or AST and ALT who do not have diabetes. Mild holic steatohepatitis (NASH) patients, < 250 units/l for > 6 months. chronic elevations of transaminases suggesting a possible genetic link or Chronic mild elevation of transami- often reflect underlying insulin resist- predisposition to fatty liver found in nases are frequently found in type 2 dia- ance. Elevation of transaminases insulin-resistant states.4 betic patients. This article will provide a within three times the upper limits of The above theories all attribute ele- review of the pathology, incidence, caus- normal is not a contraindication for vated transaminitis to direct hepatocyte es, and drug therapy related to type 2 starting oral antidiabetic or lipid- injury. It is also hypothesized that eleva- diabetic patients with elevated LFTs. modifying therapy. In contrast, antidi- tion in ALT, a gluconeogenic enzyme abetic agents have generally been whose gene transcription is suppressed Theories Behind LFT Elevation shown to decrease alanine amino- by insulin, could indicate an impairment in Diabetes transferase levels as tighter blood glu- in insulin signaling rather than purely The liver helps maintain normal blood cose levels are achieved. glucose concentration in the fasting and hepatocyte injury.5 CLINICAL DIABETES • Volume 23, Number 3, 2005 115 FEATURE ARTICLE Can Elevated LFTs Predict the betes. The authors concluded that higher abnormal LFTs who were awaiting liver Development of Diabetes? ALT is a risk factor for type 2 diabetes biopsy. Sixty-eight of the patients had GGT is a nonspecific marker that is and indicates a potential role of type 2 diabetes; four had type 1 diabetes. known to rise in patients with type 2 increased hepatic gluconeogenesis All of the patients had hepatomegaly or diabetes. In epidemiological studies, it and/or inflammation in the pathogenesis abnormal LFTs. They had normal blood has a positive association with alcohol of type 2 diabetes. counts, serum electrolytes, and renal intake, cigarette smoking, coronary heart function. None had decompensated heart disease, BMI, systolic blood pressure, Incidence of Elevated LFTs in failure. Only 5 gave a history of social serum triglyceride, heart rate, uric acid, Diabetes drinking; the other 67 patients were clas- and hematocrit. It has an inverse associ- Salmela et al.10 studied the prevalence of sified as abstainers. ation with physical activity level.6 abnormal LFTs and their relationship to Of the 72 patients who underwent Because GGT increases in diabetes, and clinical findings in 175 unselected dia- liver biopsy, all 4 with type 1 diabetes increases as BMI increases, it has been betic outpatients in Finland. One hun- had normal liver histology, but only 5 of proposed as another marker of insulin dred and eighteen patients were classi- the 68 with type 2 diabetes had normal resistance. fied as having type 2 diabetes and 57 as liver histology. The most commonly ele- To determine whether elevated GGT having type 1 diabetes. Of those with vated LFT in the nine patients with nor- could predict the development of type 2 type 2 diabetes, 33 patients used insulin mal histology included bilirubin and AP. diabetes, a prospective cohort study of in addition to diet and oral hypo- ALT was less frequently elevated, and 7,458 nondiabetic men aged 40–59 years glycemic drugs including sulfonylurea GGT was not elevated at all. was conducted for 12 years.7 Mean and metformin. None of the patients had Of the 63 patients with abnormal liv- serum GGT at the start of the study was known chronic liver disease, and none er histology, 48 had fatty liver or steato- significantly higher in the 194 men who had clinically significant diabetic sis with nonspecific inflammatory developed type 2 diabetes than in the rest nephropathy. Hemoglobin A1c (A1C) changes, whereas 14 had evidence of of the cohort who did not develop dia- averaged 11.2 ± 2.4%. fibrosis. GGT and ALT were most com- betes (20.9 vs. 15.3 units/l, P < 0.0001). LFTs measured included albumin, monly elevated. As histology worsened The association was independent of total bilirubin, AST, ALT, AP, GGT, and (steatosis to inflammation to fibrosis), serum glucose and BMI. However, when serum concentrations of cholic acid and there was no significant difference in GGT was added to a model for predict- chenodeoxycholic acid. Fifty-seven per- mean values of ALT and GGT. There- ing the development of type 2 diabetes, it cent of the 175 diabetic outpatients (100 fore, although abnormal LFT results are did not improve the power of BMI and subjects) had at least one abnormal LFT; common in diabetes, especially in over- glucose for predicting the development 27% (48 subjects) had at least two abnor- weight type 2 diabetic patients, they are of type 2 diabetes. mal tests. The type 2 diabetic patients not reliable in predicting histological Ohlson et al.8 found elevated ALT in more frequently had elevated ALT (22.9 changes in the liver. nondiabetic Swedish men to be a risk vs. 5.3%) and GGT (23.7 vs. 10.5%) lev- In a larger study, Erbey et al.11 ana- factor for type 2 diabetes, independent of els than those with type 1 diabetes. On lyzed 18,825 noninstitutionalized obesity, body fat distribution, plasma the other hand, patients with type 1 dia- patients within the United States with an glucose, lipid, AST, bilirubin concentra- betes more frequently had elevated oversampling of African Americans and tions, and family history of diabetes. bilirubin levels (21.1 vs. 10.2%). Howev- Mexican Americans. Of the total sample, With similar results, Vozaroza et al.9 fol- er, increases in LFTs were rarely more 4.1% had elevated ALT, and 6.7% had lowed 451 nondiabetic Pima Indians for than twice the upper limit of normal. type 2 diabetes. Of those with type 2 dia- an average of 6.9 years to determine Multivariate analysis showed BMI betes, the prevalence of elevated ALT whether hepatic enzyme elevations could > 25 kg/m2 and poor diabetic control was 7.8%, compared to a 3.8% preva- be linked to the development of type 2 (fasting blood glucose > 216 mg/dl) lence in those without diabetes. The diabetes. At baseline, ALT, AST, and were the most significant clinical vari- prevalence of ALT elevation greater than GGT were related to percent body fat. ables associated with elevated ALT and three times normal was not significantly After adjustment for age, sex, body fat, GGT. Elevated ALT was also associated different between the nondiabetic and whole body insulin sensitivity, and acute with onset of diabetes within the past 4 diabetic patients (0.4 vs.
Load more

Recommended publications
  • Evaluation of Abnormal Liver Chemistries
    ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries Paul Y. Kwo, MD, FACG, FAASLD1, Stanley M. Cohen, MD, FACG, FAASLD2, and Joseph K. Lim, MD, FACG, FAASLD3 1Division of Gastroenterology/Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA; 2Digestive Health Institute, University Hospitals Cleveland Medical Center and Division of Gastroenterology and Liver Disease, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; 3Yale Viral Hepatitis Program, Yale University School of Medicine, New Haven, Connecticut, USA. Am J Gastroenterol 2017; 112:18–35; doi:10.1038/ajg.2016.517; published online 20 December 2016 Abstract Clinicians are required to assess abnormal liver chemistries on a daily basis. The most common liver chemistries ordered are serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase and bilirubin. These tests should be termed liver chemistries or liver tests. Hepatocellular injury is defined as disproportionate elevation of AST and ALT levels compared with alkaline phosphatase levels. Cholestatic injury is defined as disproportionate elevation of alkaline phosphatase level as compared with AST and ALT levels. The majority of bilirubin circulates as unconjugated bilirubin and an elevated conjugated bilirubin implies hepatocellular disease or cholestasis. Multiple studies have demonstrated that the presence of an elevated ALT has been associated with increased liver-related mortality. A true healthy normal ALT level ranges from 29 to 33 IU/l for males, 19 to 25 IU/l for females and levels above this should be assessed. The degree of elevation of ALT and or AST in the clinical setting helps guide the evaluation.
    [Show full text]
  • Metabolic Regulation of Heme Catabolism and Bilirubin Production
    Metabolic Regulation of Heme Catabolism and Bilirubin Production. I. HORMONAL CONTROL OF HEPATIC HEME OXYGENASE ACTIVITY Arne F. Bakken, … , M. Michael Thaler, Rudi Schmid J Clin Invest. 1972;51(3):530-536. https://doi.org/10.1172/JCI106841. Research Article Heme oxygenase (HO), the enzyme system catalyzing the conversion of heme to bilirubin, was studied in the liver and spleen of fed, fasted, and refed rats. Fasting up to 72 hr resulted in a threefold increase in hepatic HO activity, while starvation beyond this period led to a gradual decline in enzyme activity. Refeeding of rats fasted for 48 hr depressed hepatic HO activity to basal values within 24 hr. Splenic HO was unaffected by fasting and refeeding. Hypoglycemia induced by injections of insulin or mannose was a powerful stimulator of hepatic HO. Glucose given together with the insulin abolished the stimulatory effect of the latter. Parenteral treatment with glucagon led to a twofold, and with epinephrine to a fivefold, increase of hepatic HO activity; arginine, which releases endogenous glucagon, stimulated the enzyme fivefold. These stimulatory effects of glucagon and epinephrine could be duplicated by administration of cyclic adenosine monophosphate (AMP), while thyroxine and hydroxortisone were ineffective. Nicotinic acid, which inhibits lipolysis, failed to modify the stimulatory effect of epinephrine. None of these hormones altered HO activity in the spleen. These findings demonstrate that the enzymatic mechanism involved in the formation of bilirubin from heme in the liver is stimulated by fasting, hypoglycemia, epinephrine, glucagon, and cyclic AMP. They further suggest that the enzyme stimulation produced by fasting may be […] Find the latest version: https://jci.me/106841/pdf Metabolic Regulation of Heme Catabolism and Bilirubin Production I.
    [Show full text]
  • Jaundice Protocol
    fighting childhood liver disease Jaundice Protocol Early identification and referral of liver disease in infants fighting childhood liver disease 36 Great Charles Street Birmingham B3 3JY Telephone: 0121 212 3839 yellowalert.org childliverdisease.org [email protected] Registered charity number 1067331 (England & Wales); SC044387 (Scotland) The following organisations endorse the Yellow Alert Campaign and are listed in alphabetical order. 23957 CLDF Jaundice Protocol.indd 1 03/08/2015 18:25:24 23957 3 August 2015 6:25 PM Proof 1 1 INTRODUCTION This protocol forms part of Children’s Liver Disease Foundation’s (CLDF) Yellow Alert Campaign and is written to provide general guidelines on the early identification of liver disease in infants and their referral, where appropriate. Materials available in CLDF’s Yellow Alert Campaign CLDF provides the following materials as part of this campaign: • Yellow Alert Jaundice Protocol for community healthcare professionals • Yellow Alert stool colour book mark for quick and easy reference • Parents’ leaflet entitled “Jaundice in the new born baby”. CLDF can provide multiple copies to accompany an antenatal programme or for display in clinics • Yellow Alert poster highlighting the Yellow Alert message and also showing the stool chart 2 GENERAL AWARENESS AND TRAINING The National Institute of Health and Clinical Excellence (NICE) has published a clinical guideline on neonatal jaundice which provides guidance on the recognition, assessment and treatment of neonatal jaundice in babies from birth to 28 days. Neonatal Jaundice Clinical Guideline guidance.nice.org.uk cg98 For more information go to nice.org.uk/cg98 • Jaundice Community healthcare professionals should be aware that there are many causes for jaundice in infants and know how to tell them apart: • Physiological jaundice • Breast milk jaundice • Jaundice caused by liver disease • Jaundice from other causes, e.g.
    [Show full text]
  • Serum Levels of True Insulin, C-Peptide and Proinsulin in Peripheral Blood of Patients with Cirrhosis
    Diabetologia (1983) 25: 506-509 Diabetologia Springer-Verlag 1983 Serum Levels of True Insulin, C-Peptide and Proinsulin in Peripheral Blood of Patients with Cirrhosis T. Kasperska-Czy~ykowa 1, L. G. Heding 2 and A. Czy2yk 1 1Department of Gastroenterology and Metabolic Diseases, Medical Academy of Warsaw, Poland, and 2Novo Research Institute, Bagsvaerd, Denmark Summary. The levels of proinsulin, immunoreactive insulin, but the difference was less pronounced and only significant at true insulin (calculated from the difference, namely immuno- a few of the time points. The serum level of C-peptide was reactive insulin-proinsulin) and C-peptide were determined in very similar in both groups. These results emphasize that cir- the fasting state and during a 3-h oral glucose tolerance test af- rhosis is a condition in which the serum proinsulin level is ter administration of 100 g of glucose in 12 patients with cir- raised and that this hyperproinsulinaemia contributes greatly rhosis with normal oral glucose tolerance test (50 g) and in to the increased immunoreactive insulin levels observed in 12 healthy subjects serving as controls. In the patients with cir- patients with this disease. rhosis the serum levels of proinsulin and immunoreactive in- sulin were significantly higher in the fasting state and after Key words: Insulin, cirrhosis, C-peptide, proinsulin, oral glu- glucose loading than in the healthy subjects. The serum level cose tolerance test. of true insulin was also higher in the patients with cirrhosis, After the introduction of a radioimmunoassay for se- Patients and Methods rum (plasma) insulin determination (IRI) many authors reported raised levels of this hormone in the peripheral blood of patients with cirrhosis [1, 5-7, 9, 16-19].
    [Show full text]
  • A Novel Perspective on the Biology of Bilirubin in Health and Disease
    Opinion A Novel Perspective on the Biology of Bilirubin in Health and Disease 1,z 2,z, 3 Silvia Gazzin, Libor Vitek, * Jon Watchko, 4,5,6,7 1,8, Steven M. Shapiro, and Claudio Tiribelli * Unconjugated bilirubin (UCB) is known to be one of the most potent endogenous Trends antioxidant substances. While hyperbilirubinemia has long been recognized as Historically known for its toxicity but an ominous sign of liver dysfunction, recent data strongly indicate that mildly recently recognized as a powerful pro- tective molecule, BLB is gaining more elevated bilirubin (BLB) levels can be protective against an array of diseases attention due to its pleiotropic biomo- associated with increased oxidative stress. These clinical observations are lecular effects and those of the supported by new discoveries relating to the role of BLB in immunosuppression enzymes involved in BLB metabolism (the ‘Yellow Players’). and inhibition of protein phosphorylation, resulting in the modulation of intra- cellular signaling pathways in vascular biology and cancer, among others. Both heme oxygenase (HMOX) and bili- Collectively, the evidence suggests that targeting BLB metabolism could be verdin reductase (BLVR) (the main enzymes in BLB metabolism) act on considered a potential therapeutic approach to ameliorate a variety of numerous signaling pathways, with conditions. unsuspected biological consequences. The interconnections of such pathways highlight an incredibly complex biomo- From a Biological Waste Product to a Potent Biological Compound lecular network. Yellow player mole- UCB (see Glossary), the end product of the heme catabolic pathway, has long been recognized cules can have important physiological as a sign of liver dysfunction or a potential toxic factor causing severe brain damage in newborns.
    [Show full text]
  • Liver Function Tests in Type 2 Sudanese Diabetic Patients
    International Journal of Nutrition and Metabolism Vol. 3(2) pp. 17-21, February 2011 Available online http://www.academicjournals.org/ijnam ISSN 2141-2340 ©2011 Academic Journals. Full Length Research Paper Liver function tests in type 2 Sudanese diabetic patients Ayman S. Idris 1*, Koua Faisal Hammad Mekky 1, Badr Eldin Elsonni Abdalla 2 and Khalid Altom Ali 3 1Department of Biochemistry, Faculty of Science and Technology, Al-Neelain University, P. O. Box 12702, Al Baladya St. Khartoum, Sudan. 2Department of Biochemistry, Faculty of Medicine, University of Gezira, Sudan. 3Department of Biochemistry, Faculty of Medicine, International University of Africa, Sudan. Accepted 21 January, 2011 This study was planned to evaluate the liver function in patients with type 2 diabetes mellitus by measuring aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transpeptidase (GGT), total protein and albumin. The study was carried out in Wad Medani, Abo Agla Diabetes Centre. 50 patients with type 2 diabetes mellitus (23 male and 27 female) were included in the study. Their ages ranged between 43 and 79 years. Thirty matched normal individuals were taken as control group. In the present study, mean values of ALT, AST and GGT were significantly higher in patients than in the control (P<0.001). Total protein and albumin concentrations in patients were lower compared to control group (P<0.01). The mean of serum glucose in patients revealed significant difference (P<0.000) in comparison to the control group. Although the differences were statistically significant, the means of ALT, AST, GGT, total protein and albumin were falling within the normal range.
    [Show full text]
  • Understanding Your Liver Function Results
    www.healthinfo.org.nz Understanding your liver function results Your liver is a very important organ that has many jobs. Some of its jobs are to make proteins, make bile to help you digest fats, store energy, and break down some toxins and medicines. Liver function tests are done if you have symptoms of a liver condition or risk factors for liver disease such as fatty liver, viral hepatitis or high alcohol use. They are also checked if you are taking medicines that can affect how your liver works. Terms used Protein: this is the total of all the different types of protein in your blood. Albumin: this is the main protein your liver makes. It goes into your blood and helps to carry many things around your body. Bilirubin: this is something your body makes when it breaks down old red blood cells and replaces them with new ones. Bilirubin gives bile its yellow colour. Alkaline phosphatase (ALP): this is an enzyme in your liver and bones. (An enzyme is a chemical that helps to speed up other chemical processes.) GGT: this stands for gamma glutamyltransferase, which is an enzyme in your liver. ALT: this stands for alanine aminotransferase, which is another enzyme in your liver. AST: this stands for aspartate aminotransferase, which is also an enzyme in your liver. Normal result If you have a copy of your test results, it will show your results and a normal range for each test. The normal ranges may vary depending on your gender and age group and whether you're pregnant or have any underlying health conditions.
    [Show full text]
  • Association Between Serum Bilirubin and Albuminuria in Type 2 Diabetes Mellitus and Diabetic Nephropathy
    Original Research Article DOI: 10.18231/2394-6377.2018.0048 Association between serum bilirubin and albuminuria in type 2 diabetes mellitus and diabetic nephropathy Suryapriya Rajendran1, Manju M.2,*, Sasmita Mishra3, Rakesh Kumar4 1,4Assistant Professor, 2Associate Professor, 3Professor and HOD, Dept. of Biochemistry, 4Dept. of General Medicine, Aarupadai Veedu Medical College and Hospital, Puducherry, India. *Corresponding Author: Email: [email protected] Received: 16th February, 2018 Accepted: 20th March, 2018 Abstract Introduction: Diabetic nephropathy develops due to oxidative stress and inflammation resulting from chronic hyperglycemia. Bilirubin, a product of heme catabolism is found to have antioxidant and anti-inflammatory properties. Though previous studies have examined the relationship between total bilirubin and diabetic nephropathy, very few studies have focused on indirect and direct bilirubin levels. Hence, the present study aimed to compare serum bilirubin (total, indirect and direct) levels between non- diabetics, type 2 diabetics and diabetic nephropathy subjects and also to correlate albuminuria with serum bilirubin in type 2 diabetics and diabetic nephropathy subjects. Materials and Methods: 50 non-diabetics, 50 type 2 diabetics and 50 diabetic nephropathy subjects were included in the study. Fasting blood glucose, HbA1C, serum bilirubin (total, indirect and direct), serum creatinine, urine microalbumin and urine creatinine were measured. Estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (ACR) was calculated. Results: Total bilirubin, direct and indirect bilirubin were significantly decreased in type 2 diabetics and diabetic nephropathy subjects compared to non-diabetics. Total bilirubin and indirect bilirubin were also significantly decreased in diabetic nephropathy subjects compared to type 2 diabetics. Total bilirubin, direct and indirect bilirubin showed significant negative correlation with albuminuria (Urine ACR) in type 2 diabetics and diabetic nephropathy subjects.
    [Show full text]
  • Cholestasis and Neonatal Hypoglycaemia
    MOJ Clinical & Medical Case Reports Case Report Open Access Cholestasis and neonatal hypoglycaemia Abstract Volume 10 Issue 4 - 2020 Glucose is essential as the main brain energy source, hypoglycemia is dangerous and may Nahla Kamel Gaballa,1 Hossam Bassiouny,2 cause neuronal damage as well as siezers and acidosis. The undetectable hypoglycemia has Tahany Abdel hameed,2 Mahmoud EL serious effects if passed unnoticed specially in infants who cannot explain their sensation 3 4 1 and complain , any abnormal clinical or laboratory response should be addressed as a Moniar, Hazem Zakaria, Eman Awad, Heba 5 special entity and dealing with as if a complain that must be investigated. Abd Alla 1Lecturer of Anesthesia and intensive care department, national liver institute, Menoufia University, Egypt 2Lecturer of pediatric hepatology department, Menoufia University, Egypt 3Assistant Lecturer of Anesthesia and intensive care department, Menoufia University, Egypt 4Associate professor of hepatopancreatobiliary, surgical department national liver institute, Menoufia University, Egypt 5Lecturer of clinical pathology and hematology, clinical pathology department, Menoufia University, Egypt Correspondence: Nahla Kamel Gaballa, Lecturer of Anesthesia and intensive care department, national liver institute, Menoufia University, Egypt, Email Received: June 23, 2020 | Published: July 14, 2020 Case report -2.5ml/kg was given(short term hypoglycemia treatment) ,starting the operation and he was diagnosed as type 2 obstruction, the next hourly An infant 83 days old for Kassi operation, 4.5kg, normal growing reading of RBS was 77mg/dl and again second bolus of Glucose parameters and reactive, without mother complain regarding feeding 10% was given, then starting Glucose 10% infusion 5mg/kg/min, or suckling, normal birth history, progressive jaundice after birth and the operation lasted for 4hours including hernial repair and caudal history of blood transfusion after Hb drop in rural pediatric department.
    [Show full text]
  • The Asymptomatic Outpatient with Abnormal Liver Function Tests 169 Leading to Shortage of Pyridoxal 50-Phosphate, Which Is a Cofactor for Both AST and ALT
    The Asymptomatic Outpatient with Abnormal Liver FunctionTests Michael Krier, MD, Aijaz Ahmed, MD* KEYWORDS Aminotransferases (ALT and AST) LFT Alkaline phosphatase Albumin Prothrombin time Traditionally, the constellation of biochemistry tests including liver enzymes, total bili- rubin, and hepatic synthetic measures (prothrombin time (PT) and serum albumin level) are referred to as liver function tests (LFTs). Abnormal LFTs can be encountered during primary health care visits, routine blood donation, and insurance screening. A reported 1% to 4% of asymptomatic patients exhibit abnormal LFTs, leading to a size- able number of annual consultations to a gastroenterology and/or hepatology prac- tice.1 A cost-effective and systematic approach is essential to the interpretation of abnormal LFTs.2–7 A review of pattern of abnormal LFTs, detailed medical history, and a comprehensive physical examination help establish a foundation for further indi- vidualized testing. Further investigation often involves biochemical testing for disease- specific markers, radiographic imaging, and even consideration of a liver biopsy. In the following account, markers of hepatic injury are reviewed followed by a discussion on an approach to various patterns of abnormal LFTs in an asymptomatic patient. ABNORMAL LFTS: MARKERS OF HEPATIC INJURY Abnormal LFTs can be found in 2 main predominant patterns of hepatic injury, hepa- tocellular necrosis or cholestasis. Differentiation between these 2 main patterns of hepatic injury provides clues for further testing. However, in practice, patients present with a mixed pattern of hepatic injury. Markers of Hepatocellular Injury Aminotransferases Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are normally intracellular enzymes with mitochondrial and cytoplasmic forms.8 Their names reflect Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite # 210, Stanford, CA 94304, USA * Corresponding author.
    [Show full text]
  • Laboratory Tests Haematology
    LABORATORY TESTS HAEMATOLOGY TEST FUNCTION UNITS INCREASED DECREASED Hb Oxygen carrying component of blood g/dL Dehydration Blood loss Haemoglobin Chronic obstructive lung disease After anticancer drugs eg chemotherapy & Smoking PARP inhibitors, due to bone marrow Heart failure depression Renal cancer Iron, folate and vitamin B12 deficiency Haematological malignancy Chronic illness Haemolysis Chronic kidney disease Haematological malignancy Platelets (Thrombocytes) Vital for blood coagulation. 109/L Thrombocythaemia Thrombocytopenia Acute blood loss Infections Chronic illness Drugs – e.g. cytostatics Certain forms of anaemia Radiotherapy (rare) Infection Immunologic disorders Poor spleen function Haematological malignancy Cancer infiltrating bone marrow 9 WBC Protect the body against invading micro- 10 /L Infections Drug – e.g. cytostatics White Blood Cells / Leukocytes organisms. Haematological malignancies Radiotherapy (rare) Other cancers Haematological malignancy Differential: Basophils The relative percentage of the various Therapy with corticosteroids Cancer infiltrating bone marrow Eosinophils cells found in the blood is known as the Metabolic illnesses Immune disorders Neutrophils (white cell) differential count. Recovering bone marrow Severe infections Lymphocytes Monocytes ESR Non-specific indication of inflammation mm/H Focus or cause of inflammation Immune disorders Erythrocyte Sedimentation Infection Congestive heart failure Rate Connective tissue disorder Rheumatoid arthritis
    [Show full text]
  • Liver Function Testing
    Liver function testing What are liver function tests? Role of the liver A liver function test (LFT) is a blood test that gives an What are liver function tests? indication of whether the liver is functioning properly. The test is also very useful to see if there is active What are the substances damage in the liver (hepatitis) or sluggish bile flow (cholestasis). measured in an LFT blood test and what’s so important about Liver function tests measure the amount of particular them? chemicals in the blood. This gives a gauge of possible damage to liver cells - damage that can be caused by Total protein many things including HCV. So a more correct term for Albumin a liver test would actually be a liver dysfunction test. Globulin It’s important to remember that diagnosis of liver Bilirubin disease depends on a combination of patient history, physical examination, laboratory testing, biopsy and GGT sometimes imaging studies such as ultrasound scans. ALK Phos Diagnosis of hepatitis C usually also involves antibody tests (see Edition 19) or PCR tests (see Edition 20). ALT AST People reading this page should keep in mind that abnormalities within liver tests don’t necessarily point Platelet count to specific diseases. Only a physician who knows all Adult range / normal range the aspects of a specific case can reliably make a diagnosis. What are the substances measured in an LFT blood test and what’s so important about them? Role of the liver Total protein The role of the liver is to keep the body’s complex internal chemistry in balance.
    [Show full text]