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Script Gillian: ALT, AST Sam: ALP, gamma GT Christine: Albumin, PT, INR Jen: Bilirubin and types

of jaundice ALT Alanine transaminase is an enzyme that catalyses the alanine cycle Alanine and lactate are produced when muscles undergo anaerobic respiration, and both are transformed into glucose by the liver Large levels of alanine transaminase are present in the liver, so when hepatocytes are injured or inflamed, the blood concentration of ALT rises Clinically negligible quantities of ALT are found elsewhere in the body, unlike AST, so it serves as a more specific indicator of liver damage Normal levels: female <34, male <45 This indicates inflammation and injury to hepatocytes AST Aspartate transaminase is an important enzyme in amino acid metabolism Found in liver, heart, muscle, brain, kidney and red blood cells AST is elevated when any of these organs are damaged, e.g. it will rise after a myocardial infarction, acute renal disease and trauma Normal levels: female 6 34, male 8 40 This indicates inflammation and injury to hepatocytes

ALP Alkaline phosphatase is an enzyme responsible for removing the phosphate group from various molecules and is more effective in an alkaline environment Mainly occurs next to the bile ducts in the liver, and in bone It is elevated in biliary obstruction e.g. gallstones, primary biliary cirrhosis, primary sclerosing cholangitis and cholecystisis Normal range: 20 140 This indicates disease in the biliary tract Gamma GT Gamma-glutamyl transpeptidase is an enzyme that transfers gammaglutamyl groups, and is mainly found in the liver It is similar to ALP in detecting disease of the biliary tract, but for this ALP is the preferred test It is elevated by large quantities of alcohol ingestion, and may indicate alcohol abuse in alcoholic liver disease Also increased in obese patients Normal range: female 5 55, male 15 85

Albumin Albumin is the main protein of serum blood plasma, and its primary function is to regulate the colloid oncotic pressure of blood It is synthesised by the liver ONLY The ability of the liver to make albumin is affected in liver failure, cirrhosis and viral hepatitis Below 3.5 grams per decilitre is considered low May be reduced by diarrhoea, infection, poor diet and iron deficiency PT and INR Prothrombin time measures how long it takes for the blood to clot and can be tested by various methods The internalised normalised ratio is a way of standardising the prothrombin time, so that the different values produced by the testing method does not confuse doctors as to what the PT result means for the patient Normal PT: 11 - 13.5 seconds; normal INR: 0.8 1.1 The liver makes proteins essential for blood clotting, so a high PT and INR can indicate liver disease These results can also be affected by medication (e.g. warfarin and antibiotics), vitamins, and some foods Bilirubin Bilirubin is a breakdown product of haemoglobin, and if it is present in levels greater than 35 micromoles/litre, jaundice results Before bilirubin reaches the liver, it is unconjugated, and so high levels of unconjugated bilirubin suggest haemolytic anaemia The liver conjugates bilirubin, and a raised conjugated level is seen in liver disease and bile duct conditions. It is particularly high in bile duct conditions Normal range: 3 20 micromoles/litre ALP raised, ALT slightly raised think of a problem in the bile duct ALT raised, ALP slightly raised think of a problem in the liver Very high ALT, slightly raised AST think of viral/drug induced/severe necrosis of liver Very high AST, slightly raised ALT think alcoholic or drug induced liver disease Jaundice Pre-hepatic (unconjugated hyperbilirubinaemia) o Raised unconjugated bilirubin o The LFTs should be normal Intrahepatic (acute liver inflammation) o Very high ALT o Bilirubin levels increase with increased damage to the liver i.e. a very damaged liver will give very high levels of bilirubin o ALP should only be slightly raised o Increased prothrombin time ( may exceed 25 seconds in severe liver failure) Post-hepatic (obstructive) o High bilirubin o High ALP o Normal ALT

Bilirubin can single out pre-hepatic (high unconjugated levels) High ALP with an ALT less than 2x normal patient should reduce alcohol intake and lose weight High ALP with an ALT more than 2x normal test for liver disease (viral hepatitis, hemochromatosis, autoimmune disease) and ultrasound the liver

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