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Liver function tests – Mayo Clinic

Overview

Liver function tests are blood tests used to help diagnose and monitor liver disease or damage. The tests measure the levels of certain enzymes and proteins in your blood.

Some of these tests measure how well the liver is performing its normal functions of producing protein and clearing bilirubin, a blood waste product. Other liver function tests measure enzymes that liver cells release in response to damage or disease.

Abnormal liver function test results don’t always indicate liver disease. Your doctor will explain your results and what they mean.

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Why it’s done

Liver function tests can be used to:

  • Screen for liver infections, such as hepatitis
  • Monitor the progression of a disease, such as viral or alcoholic hepatitis, and determine how well a treatment is working
  • Measure the severity of a disease, particularly scarring of the liver (cirrhosis)
  • Monitor possible side effects of medications

Liver function tests check the levels of certain enzymes and proteins in your blood. Levels that are higher or lower than normal can indicate liver problems. Some common liver function tests include:

  • Alanine transaminase (ALT). ALT is an enzyme found in the liver that helps convert proteins into energy for the liver cells. When the liver is damaged, ALT is released into the bloodstream and levels increase.
  • Aspartate transaminase (AST). AST is an enzyme that helps metabolize amino acids. Like ALT, AST is normally present in blood at low levels. An increase in AST levels may indicate liver damage, disease or muscle damage.
  • Alkaline phosphatase (ALP). ALP is an enzyme found in the liver and bone and is important for breaking down proteins. Higher-than-normal levels of ALP may indicate liver damage or disease, such as a blocked bile duct, or certain bone diseases.
  • Albumin and total protein. Albumin is one of several proteins made in the liver. Your body needs these proteins to fight infections and to perform other functions. Lower-than-normal levels of albumin and total protein may indicate liver damage or disease.
  • Bilirubin. Bilirubin is a substance produced during the normal breakdown of red blood cells. Bilirubin passes through the liver and is excreted in stool. Elevated levels of bilirubin (jaundice) might indicate liver damage or disease or certain types of anemia.
  • Gamma-glutamyltransferase (GGT). GGT is an enzyme in the blood. Higher-than-normal levels may indicate liver or bile duct damage.
  • L-lactate dehydrogenase (LD). LD is an enzyme found in the liver. Elevated levels may indicate liver damage but can be elevated in many other disorders.
  • Prothrombin time (PT). PT is the time it takes your blood to clot. Increased PT may indicate liver damage but can also be elevated if you’re taking certain blood-thinning drugs, such as warfarin.

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Risks

The blood sample for liver function tests is usually taken from a vein in your arm. The main risk associated with blood tests is soreness or bruising at the site of the blood draw. Most people don’t have serious reactions to having blood drawn.

How you prepare

Certain foods and medications can affect the results of your liver function tests. Your doctor will probably ask you to avoid eating food and taking some medications before your blood is drawn.

What you can expect

During the test

The blood sample for liver function tests is usually drawn through a small needle inserted into a vein in the bend of your arm. The needle is attached to a small tube, to collect your blood. You may feel a quick pain as the needle is inserted into your arm and experience some short-term discomfort at the site after the needle is removed.

After the test

Your blood will be sent to a laboratory for analysis. If the lab analysis is done on-site, you could have your test results within hours. If your doctor sends your blood to an off-site laboratory, you may receive the results within several days.

Results

Normal blood test results for typical liver function tests include:

  • ALT. 7 to 55 units per liter (U/L)
  • AST. 8 to 48 U/L
  • ALP. 40 to 129 U/L
  • Albumin. 3.5 to 5.0 grams per deciliter (g/dL)
  • Total protein. 6.3 to 7.9 g/dL
  • Bilirubin. 0.1 to 1.2 milligrams per deciliter (mg/dL)
  • GGT. 8 to 61 U/L
  • LD. 122 to 222 U/L
  • PT. 9.4 to 12.5 seconds

These results are typical for adult men. Normal results vary from laboratory to laboratory and might be slightly different for women and children.

Your doctor will use these results to help diagnose your condition or determine treatment you might need. If you already have liver disease, liver function tests can help determine how your disease is progressing and if you’re responding to treatment.

Alanine Aminotransferase (ALT) | Lab Tests Online

Sources Used in Current Review

2019 Review completed by H.L.Chong, MD, FRSPH, IPFPH, Clinical Scholar, Faculty of Public Health of the Royal Society of Physicians of United Kingdom.

ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. The American Journal of Gastroenterology. Volume 112. January 2017.

(Updated June 13, 2019) Sood, G MD. Acute Liver Failure Workup. Medscape Reference. Available online at https://emedicine.medscape.com/article/177354-workup#c2. Accessed August 2019.

McPherson RA, Matthew R, Pincus MR. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. Philadelphia: Elsevier Saunders; 2011.

Sources Used in Previous Reviews

Pagana K, Pagana T. Mosby’s Manual of Diagnostic and Laboratory Tests. St. Louis: Mosby; 1998.

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER and Bruns DE, eds. 4th ed. St. Louis, Missouri: Elsevier Saunders; 2006, Pp 604-606.

Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL eds, (2005) Harrison’s Principles of Internal Medicine, 16th Edition, McGraw Hill, Pp 1811-1815.

Pagana K, Pagana T. Mosby’s Manual of Diagnostic and Laboratory Tests. 3rd Edition, St. Louis: Mosby Elsevier; 2006, Pp 40-42.

Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry, AACC Press, Washington, DC, Pp 270-271.

Carey, W (January 1, 2009) Approach to the Patient with Liver Disease: A Guide to Commonly Used Liver Tests, Cleveland Clinic. Available online at http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/guide-to-common-liver-tests/. Accessed February 2010.

Henry’s Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson RA and Pincus MR, eds. Philadelphia: 2007, Pp 268-269.

(2000) Dufour, DR et al. National Academy of Clinical Biochemistry Standards of Laboratory Practice: Laboratory Guidelines for Screening, Diagnosis and Monitoring of Hepatic Injury http://www.aacc.org/SiteCollectionDocuments/NACB/LMPG/hepatic/hepatic_combined.pdf#page=3. Accessed February 2010.

(March 15, 2005) Giboney, P. Mildly Elevated Liver Transaminases in the Asymptomatic Patient. Am Fam Physician 2005; 71:1105–10. Available online at http://www.aafp.org/afp/2005/0315/p1105.html. Accessed February 2010.

(Feb 22, 2009) MedlinePlus Medical Encyclopedia: ALT. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003473.htm. Accessed February 2010.

Alanine Aminotransferase (ALT) (GPT), Serum. Mayo Clinic. Available online at http://www.mayomedicallaboratories.com/test-info/hematology/catalog/Overview/8362. Accessed September 2013.

Orlewicz, M. S. (Update April 20, 2012.) Alanine Aminotransferase. Medscape. Available online at http://emedicine.medscape.com/article/2087247. Accessed September 2013.

Nyblom, H. et. al. (July 2004.) High AST/ALT Ratio May Indicated Advanced Alcoholic Liver Disease Rather Than Heavy Drinking. National Center for Biotechnology Information PubMed. Available online at http://www.ncbi.nlm.nih.gov/pubmed/15208167. Accessed September 2013.

2016 review performed by Alan F. Weir, PhD, DABCC, Instructor, Fox Valley Technical College.

(September 9, 2014) Thompson, E. Gregory, MD. Alanine Aminotransferase (ALT). WebMD. Available online at http://www.webmd.com/digestive-disorders/alanine-aminotransferase-alt. Accessed on 4/05/16.

(September 5, 2014) Orlewicz, Marc S, MD. Alanine Aminotransferase. Medscape. Available online at http://emedicine.medscape.com/article/2087247-overview. Accessed on 4/05/16.

(June 2014) Durani, Yamini, MD. Blood Test: Alanine Aminotransferase (ALT, or SGPT). KidsHealth from Nemours. Available online at http://kidshealth.org/en/parents/test-alt.html. Accessed on 4/05/16.

(April 30, 2015) Davis, Charles Patrick, MD, PhD. Liver Blood Tests. MedicineNet. Available online at http://www.medicinenet.com/liver_blood_tests/page4.htm. Accessed on 4/05/16.

(December 30, 2014) Ratini, Melinda, DO, MS. Liver Function Tests. WebMD. Available online at http://www.webmd.com/a-to-z-guides/liver-function-test-lft. Accessed on 4/07/16.

Alanine aminotransferase. Nursing Central, Davis’s Lab and Diagnostic Tests. Available online at http://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425050/all/Alanine_Aminotransferase. Accessed on 4/05/16.

Alanine Aminotransferase. MedFriendly. Available online at http://www.medfriendly.com/alanine-aminotransferase.html. Accessed on 4/05/16.

Giboney, Paul T., MD. Mildly Elevated Liver Transaminase Levels in the Asymptomatic Patient. Am Fam Physician. 2005 Mar 15;71(6):1105-1110. Available online at http://www.aafp.org/afp/2005/0315/p1105.html. Accessed on 4/05/16.

(December 21, 2015) Blocka, Carla. ALT (Alanine Aminotransferase) Test. Healthline. Available online at http://www.healthline.com/health/alt. Accessed on 4/05/16.

Test ID: ALT Alanine Aminotransferase (ALT) (GPT), Serum. Mayo Clinic, Mayo Medical Laboratories. Available online at http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8362. Accessed on 4/05/16.

(February 8, 2015) Martin, Laura J., MD, MPH. Alanine transaminase (ALT) Blood test. US National Library of Medicine, MedlinePlus. Available online at https://www.nlm.nih.gov/medlineplus/ency/article/003473.htm. Accessed on 4/05/16.

McPherson, Richard A., MD. & Pincus, Matthew R., MD, PhD. (© 2007). Henry’s Clinical Diagnosis and Management by Laboratory Methods 21st Edition: Saunders, Philadelphia, PA. Pp. 22, 263, 268-269.

Burtis, Carl A., Ashwood, Edward R., & Bruns, David E. (© 2007). Tietz Fundamentals of Clinical Chemistry 6th Edition: Saunders, Philadelphia, PA. Pp 318-319, 322-324, 686-688.

Fischbach, Francis. (© 2000). A Manual of Laboratory and Diagnostic Tests 6th Edition: Lippincott, Philadelphia, PA. Pp 428-430.

LeFever, Joyce. (© 1999). Kee Laboratory and Diagnostic Tests with Nursing Implications 5th Edition: Appleton and Lange, Stanford, CT. Pp 15-17.

Reference Range, Interpretations, Collection and Panels

Description

ALT is an enzyme found primarily in the liver and kidney. It was originally referred to as serum glutamic pyruvic transaminase (SGPT). Normally, a low level of ALT is found in the serum. ALT is increased with liver damage and is used to screen for and/or monitor liver disease.

Alanine aminotransferase (ALT) is usually measured concurrently with AST as part of a liver function panel to determine the source of organ damage. ALT is more specific for liver damage since it is found primarily in the liver and has a longer half-life, whereas AST is found in many other organs. Liver diseases in which AST is higher than ALT include alcohol-induced liver damage, cirrhosis, and liver tumors. ALT catalyzes the transfer of an amino group from alanine to a-ketoglutarate, the products of this reversible transamination reaction being pyruvate and glutamate, as seen in the formula below:

  • glutamate + pyruvate ⇌ α-ketoglutarate + alanine

Of note, synthesis of ALT is dependent on vitamin B6 (pyridoxal phosphate) and will be decreased in the setting of low vitamin B6 and cirrhosis.

Indications/Applications

When liver disease is suspected (ie, jaundice, fatigue, nausea, vomiting, dark urine, pale colored stools, itching, ascites, mental changes, history of alcohol abuse, suspected acetaminophen overdose, family history of liver disease, exposure to hepatitis viruses)

To monitor liver function (ie, use of potentially hepatotoxic drugs, treatment of or status of chronic liver disease, hepatitis, alcohol-induced liver disease, cirrhosis, fatty liver disease, hepatic failure, Wilson’s disease, hemochromatosis)

Considerations

The AST:ALT ratio (De Ritis ratio) can be used to determine alcohol-induced liver disease, with AST:ALT ratio greater than 2.

Elevated AST and normal ALT can indicate a normal liver but damage to other organs and/or hemolysis.

Both AST and ALT are dependent on vitamin B6 (pyridoxal phosphate). Assays for AST and ALT assume adequate levels of vitamin B6 to accurately measure AST and ALT levels. Vitamin B6 depletion can result in artificially low AST and ALT levels.

Hemolyzed specimens should not be used.

ALT should be run the day of collection since activity is lost at room temperature, 4 º C, and -25 º C.

What Should I Do With This Abnormal ALT?

For more coverage on the clinical headlines and insights surrounding liver disease and more, visit our hepatitis C page.

You see a 48-year-old white man for his annual examination. He is in good health with no major medical problems and an unremarkable medical history. He states he regularly drinks one or two beers a day on the weekend but not usually on weekdays. He denies blood transfusions, tattoos or intravenous drugs. His father had diabetes. The patient is overweight with a body mass index (BMI) of 32. A screening chemistry panel is normal except for an aspartate aminotransferase (AST, formerly SGOT) level of 85 U/L (normal 15-50 U/L) and an alanine aminotransferase (ALT, formerly SGPT) level of 98 U/L (normal 5-50 U/L). He says you are the first doctor he has seen in more than 10 years and does not recall the last time he had a blood test.

What is your differential diagnosis, and what laboratory tests would you order?

Mild abnormal elevation of the aminotransferases is common in everyday practice. Most of the patients are asymptomatic and the liver test abnormalities are discovered incidentally during a routine check up or, sometimes when applying for a life insurance policy. It is important to see if these abnormalities are chronic or just of short duration and self limited. Liver test abnormalities of short duration and self limited are usually caused by medications, supplements or another underlying disease. The differential diagnosis in this patient includes nonalcoholic fatty liver disease (NAFLD)) since this is, by far, the most common cause of abnormal liver tests in the United States. Other possibilities include viral hepatitis (HBV, HCV and HEV), autoimmune hepatitis, iron storage disease, Wilson disease, alpha 1 antitrypsin deficiency and celiac sprue. Alcohol abuse is a consideration however, less likely because of the AST/ALT ratio. In alcoholic liver disease the AST is higher than the ALT.

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The laboratory tests for the evaluation of this patient include: HBsAg, HB core Ab, HCV Ab, ANA, SMA, ferritin, transferring saturation, ceruloplasmin, alpha 1 antitrypsin phenotype and tissue transglutaminase.

Hepatitis serologies are negative. Results of antinuclear and smooth muscle antibody testing are negative. The serum iron value is 100 ïÂ

Alanine Aminotransferase (ALT)


Alanine Aminotransferase (ALT)

Collection Medium:


Plasma Separator Tube 4.5 mL

Alternate
Collection Media:

Call laboratory for additional acceptable specimen collection containers.

Minimum:

3 mL; light green top or 1 Microtainer®

Testing
Schedule:

24 hrs/day, 7 days a week, including holidays.

Turn Around
Time:

1 hour (upon receipt in laboratory)

Reference Range:

Males 0-41 U/L; Females 0-33 U/L

Pediatric Normal Ranges:
Age              Male U/L    Female U/L
1-30 days          1-25        2-25
31-365 days        4-35        3-30
1-3 years          5-30        5-30
4-6 years          5-20        5-25
7-9 years          5-25        5-25
10-18 years        5-30        5-20

Comments:

Adult reference ranges changed 11/26/2013. The upper limit of normal
for alanine aminotransferase (ALT) reference ranges for adults is
controversial with some authorities recommending limits as low as 30
U/L for males and 19 U/L for females. There is increased incidence of
subclinical liver disease (e.g., early steatohepatitis) in patients
with ALT values in the range of 31-41 U/L for males and 20-33 U/L for
females. ALT values should always interpreted in conjunction with
clinical history, physical examination findings, and, if applicable,
data from other diagnostic tests.

References:

Schwimmer JB et al,. SAFETY Study: alanine aminotransferase cutoff
values are set too high for reliable detection of pediatric chronic
liver disease. Gastroenterology 2010; 138(4): 1357-1364.

Test
Limitations:

Criterion: Recovery within plus or minus 10% of initial value.

Icterus: No significant interference up to an I index of 60 for 
conjugated and unconjugated bilirubin (approximate conjugated and 
unconjugated bilirubin concentration: 60 mg/dL).

Hemolysis: No significant interference up to an H index of 200.  RBC 
contamination may elevate results.

Lipemia (Intralipid): No significant interference up to an L index of 
250 (approximate triglycerides concentration: 500 mg/dL). There is 
poor correlation between turbidity and triglycerides concentration. 
Lipemia may cause absorbance flagging as a result of an absorbance 
increase.

Sample
Processing:

Centrifuge at a speed and time necessary to get barrier separation of plasma/serum and cells within 1 hour of collection. Send specimen in original tube. Do Not transfer to another tube.
Each sample must be labeled with at least TWO full patient identifiers (First/Last Name & DOB are sufficient for non-UIHC affiliated clients) to avoid sample rejection/delays.

Sample
Storage:

Refrigerate.
All sample storage requirements are intended for delivery to UIHC within 24 hours of collection for testing. If samples won’t arrive in this time period, please call the UIHC Core Lab for alternative storage/shipping instructions (319-356-3527).

Transport
Instructions:

Place labeled specimen into zip-lock type biohazard bag; seal bag.
Place completed requisition into outside pocket of bag.
Transport in cooler with refrigerated coolant packs.

ALT blood test: what is it and how to interpret the results

The alanine aminotransferase test, also known as ALT or GPT blood test, is a type of exam that helps to identify damage and diseases of the liver, due to the elevated presence of the enzyme alanine aminotransferase in the blood, which is normally found between 7 and 56 U/L of blood.

This enzyme is present inside the liver cells and, so, when there is damage to this organ because of a virus or toxic substances, for example, it is common for the enzyme to be released into the bloodstream, leading to an increase in your blood test levels. This can mean:

Very high levels of ALT

  • 10 times higher than normal: this is usually a change caused by acute hepatitis due to viruses or the use of some drugs.
  • 100 times higher than normal: this is very common in people who use drugs, alcohol or other substances that cause severe liver damage.

High levels of ALT

  •  4 times higher than normal: can be a sign of chronic hepatitis and, so, it can indicate liver disease such as cirrhosis or cancer.

Despite being a very specific marker for liver damage, this enzyme can also be found in the muscles and the heart in a lesser amount, and, therefore, an increase in the concentration of this enzyme in the blood can be seen after intense physical exercises. To assess liver function and identify any damage, the doctor may also request another blood test to checkother enzymes, such as lactate dehydrogenase (LDH) and AST (or GOT). 

What to do in case of high ALT

In cases where the ALT blood test has a high value, it is recommended to seek a hepatologist to assess the clinical history and identify what may be the cause of the change to the liver. This doctor may also request other more specific tests such as hepatitis tests or a liver biopsy, to confirm the diagnostic hypothesis.

Furthermore, in cases of high ALT, it is also recommeded to follow an adequate diet for the liver, which should be low in fats and giving preference to boiled foods. 

When to do the ALT test

The ALT blood test is used to detect liver damage and, so, it can be recommended for people who have:

  • Liver fat or are overweight;
  • Excessive tiredness;
  • Loss of appetite; 
  • Nausea;
  • Vomiting;
  • Swelling of the belly;
  • Dark urine;
  • Yellow skin and eyes.

However, ALT levels may already be high even when the patient doesn’t have any symptoms, so it’s a great tool to diagnose liver problems early on. In this way, the ALT test can also be done when there is a history of exposure to the hepatitis virus, excessive use of alcoholic beverages or the presence of diabetes.

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ALT Blood Test (SGPT) for Liver

What Is ALT?

ALT is an enzyme found in many parts of the body, but the liver contains the highest concentration. This enzyme, formerly known by the name serum glutamic-pyruvic transaminase, or SGPT, is used by the body to break down food into energy. ALT levels normally remain fairly low, but rise when your liver is damaged. Because of this, a high ALT level are usually a straightforward indication that there is something wrong with your liver.


How Does an ALT Test Work?

Alanine transaminase, also known as ALT or SGPT, is an enzyme made by the liver to metabolize proteins. ALT is released into the bloodstream when liver cells are damaged. An ALT test measures the amount of ALT in the blood to assess if the liver is damaged. The most common reason to take an ALT test is to detect liver injury and to screen for/or help diagnose liver disease, as it is considered to be one of the best methods to identify liver issues.


Why take an ALT Test?

ALT blood tests are often part of liver function testing. The main reason to take an ALT test is if you or your doctor identify signs of liver damage or failure. It can also be taken to monitor the progression of liver diseases or to evaluate the effectiveness of treatment.


Signs of Liver Damage or Failure

Onset symptoms of liver failure include:

  • Nausea
  • Loss of appetite
  • Fatigue
  • Diarrhea

As you can see, the initial symptoms of liver failure are so broad that it can be difficult, if not impossible, to diagnose without testing.

The following are symptoms of liver failure that indicate the disease has progressed to the point of requiring immediate treatment or hospitalization:

  • Jaundice (yellow skin)
  • Bleeding easily
  • Swollen abdomen
  • Hepatic encephalopathy (mental disorientation/confusion)
  • Sleepiness
  • Coma

What can cause ALT levels to rise?

There are many things may increase the ALT levels in the blood. Some of these include:

  • Alcohol abuse
  • Hepatitis – an inflammatory condition of the liver
  • Cirrhosis – severe scarring and poor overall performance of the liver caused by high exposure to toxins like alcohol or viral infection
  • Death of liver tissue
  • A tumor in the liver
  • Poor blood flow to the liver
  • Hemochromatosis – a disorder that causes iron build up
  • Mononucleosis – an infection usually caused by the Epstein-Barr virus
  • Pancreatitis – pancreas inflammation
  • Diabetes

Things to Know Beforehand

You should tell your doctor about any drugs you are taking, as some prescription and over-the-counter medications can affect ALT levels. Acetaminophen (Tylenol) is a notable example. Your doctor may tell you to avoid taking some medications for a period of time prior to taking the test. Otherwise, there are not any precautions necessary to taking the test.


How Is the Test Taken?

Testing with Healthlabs.com is simple, quick, and easy. After you have purchased an ALT test and traveled to the lab you selected using our lab finder, a lab technician will perform a simple blood test. The technician inspects your arm for vein visibility first, chooses a spot to draw the blood, cleans the area with antiseptic, and wraps an elastic band around your upper arm in preparation for collection. The lab technician then carefully injects a sterile needle into the vein and draws blood. The entire process, depending on how busy the lab is, should take about 5-10 minutes.


What your ALT Test Results mean

The normal value of an ALT test depends on gender:

~29 to 33 U/L (units per liter) for men and ~19 to 25 U/L for women.

ALT levels typically fall somewhere within the 7 to 55 U/L range. Certain factors like age and gender can affect this range, but doctors should be able to recognize abnormal values regardless.

Both excessively high and low ALT levels are considered to be unhealthy, but higher-than-normal levels are the most likely to indicate liver damage.

90,000 What do the results of the analysis for the ALAT level mean?

AsAt is a cellular enzyme, the ratio of the content of which to the AlAt concentration makes it possible to reveal the presence of serious diseases of the heart, liver and muscles.

Where to take the analysis?

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Learn more …

Blood test is the first diagnostic procedure that is prescribed to a patient in order to identify the cause of ailment.In addition to the general biochemical analysis, there are dozens of more narrowly focused types of laboratory diagnostics, and one of them is the ALAT test, which is carried out to detect liver diseases.

Why donate blood for AlAt analysis?

AlAt (or ALT) is the abbreviated name for the enzyme alanine aminotransferase. It is found primarily in liver and kidney cells. It is found in small amounts in the heart and muscles. When liver cells are damaged, even at the earliest stages of the disease, AlAt enters the bloodstream.An increase in the level of ALT allows you to determine that not everything is in order with the liver, long before the manifestation of other symptoms of the disease – for example, hepatitis. That is why the activity of alanine aminotransferase can give very accurate information about the state of the liver and make a diagnosis in time.

Most often, the AlAt analysis is prescribed to check the condition of the liver with hepatitis, as well as when taking medications that can have a negative effect on this organ. This analysis can clarify the clinical picture in other toxic and infectious liver diseases.It should be noted that sometimes the activity of alanine aminotransferase increases in diseases of other organs.

AlAt analysis is often prescribed for symptoms characteristic of liver damage: chronic fatigue and loss of strength, loss of appetite, systematic nausea and vomiting, abdominal pain, jaundice, itching.

Sometimes this study is prescribed for people who do not have obvious signs of liver disease, but their health and lifestyle increase the risk of developing liver pathologies.The risk group includes people who have previously had hepatitis or have recently been in contact with other patients, suffering from obesity or diabetes, drinkers, people taking a large amount of drugs, and those who have a genetic predisposition to liver disease. The test is also performed regularly during the course of treatment for liver disease to check the effectiveness of therapy.

Often, an analysis for ALT is prescribed together with an analysis for the content of another enzyme – aspartate aminotransferase (AsAt). The ratio of AlAt and AsAt can tell a lot about the severity and nature of liver damage.

Usually, a referral for this type of research is given by a therapist, gastroenterologist, infectious disease specialist, hematologist, endocrinologist or surgeon.

How to prepare for the procedure?

Several factors affect the accuracy of the test results – changes in the level of alanine aminotransferase can cause some foods, stress, some drugs, exercise. In order for the data to be as accurate as possible, simple rules should be followed before taking analyzes.Blood is taken on an empty stomach, at least 12 hours after the last meal. Immediately before the analysis, you should spend 30-40 minutes in complete rest, excluding physical and emotional stress. Finally, smoking is not recommended on the day of analysis.

Important!
Not only medications can damage the liver, but also harmless – as many believe – dietary supplements. Some of them cause an increase in the level of AlAt. That is why it is necessary to tell your doctor not only about all medications taken, but about dietary supplements and vitamin complexes.

Interpretation of the results of the analysis for AlAt

Norm

In healthy people, the activity of AlAt in the blood is very low. Normally, the level of AlAt in the blood in children under six months is less than 60 U / L, under one year old – less than 54 U / L, under six years old – less than 30 U / L, up to 12 years old – less than 38 U / L. In healthy boys under 18 years old, this indicator does not exceed 27 U / l, in girls under 18 years old – 24 U / l. For adult men, the normal ALT value in the blood is less than 41 U / L, for adult women – less than 31 U / L.

By the way
Despite the fact that the norm of the AlAt content in the blood in women is 31 U / L, in the first trimester of pregnancy, a slight increase in the level of this enzyme is possible. As a rule, this is not considered a deviation and does not indicate the development of pathology.

Reasons for increased ALT activity

Elevated ALT may indicate the presence of serious liver diseases: viral hepatitis, toxic liver damage, cirrhosis, primary or metastatic liver cancer.It is also characteristic of fatty hepatosis and pancreatitis. The increase in the content of AlAt in the blood test is directly proportional to the severity of the disease. In some cases, this figure may exceed the norm by 50, or even 100 times. In acute viral infections, the level of this enzyme is very high, while in chronic hepatitis it can exceed the norm by only 4 times. An increase in the content of alanine aminotransferase by 5-10 times is very typical for carcinoma, and in cirrhosis of the liver, the level of ALT is about 5 times higher than the normal value.

Sometimes high ALT may not be directly related to liver disease. An increase in indicators is observed with hypoxia and shock, myocarditis, extensive myocardial infarction, myodystrophy, myositis, heart failure. In addition, a high level of ALT is typical for people who have received severe burns, for chronic alcoholics, people taking hepatotoxic drugs (these include immunosuppressants, antibiotics, anabolic steroids, some psychotropic drugs, antineoplastic drugs, oral contraceptives, sulfa drugs and salicylates).

In some cases, an increase in the level of AlAt is not associated with pathologies at all. In people who are intensively involved in sports or hard physical labor, as well as among fans of fast food (and any fatty food), the level of alanine aminotransferase often exceeds normal – however, not much.

Reasons for a decrease in the concentration of the enzyme in the blood

A low level of AlAt is also an alarming symptom. A decrease in the content of this enzyme in the blood is often a sign of severe liver damage, accompanied by a decrease in the number of cells that produce alanine aminotransferase. Such diseases include necrosis and cirrhosis of the liver. But everything is not so scary – sometimes the level of ALT decreases due to a lack of vitamin B6 in the body.

Indicator “AlAt” in the blood test: norm and deviations

The quantitative content of AlAt in the blood is an important indicator of many diseases of the liver – the largest gland in the human body. It can also inform about diseases of other internal organs. What blood test results indicate an increased or decreased ALT content, and what about normal? What can the deviation from the norm of the content of ALT lead to? We find out in this article.

AlAt in the blood and its role in metabolic mechanisms

AlAt, or alanine aminotransferase, is an enzyme that is produced in the greatest amount in the liver and in a lesser amount – in the kidneys, pancreas, myocardium and skeletal muscles. In case of damage to the listed organs in the blood, an increase in the level of ALT is observed. In a healthy body, the enzyme is contained in plasma in an insignificant amount.

Analysis for the content of ALT (ALT, GPT) helps in the diagnosis of diseases of the liver, pancreas and bile ducts, diseases of the heart muscle and skeletal muscles.Also, the doctor can give a referral to donate blood for an ALAT test if he wants to find out the degree of liver damage in hepatitis, the effect of drugs or other toxic substances on the condition of this gland. This test is mandatory for blood donors.

Often, together with the analysis for ALT, a study for AST (aspartate aminotransferase) is prescribed. Both of these enzymes help in the diagnosis of liver and heart diseases, but their number relative to each other is of particular importance.This ratio is called the de Ritis ratio. Its value is normally 0.91-1.75. The calculation of the coefficient is advisable only when AlAt and / or AsAt go beyond the reference values. A coefficient below 1 indicates damage to liver cells (hepatocytes), and above 2 indicates cardiovascular disease, possibly myocardial infarction. The procedures for donating blood for ALAT and ASAT are the same.

In order to get a reliable result of the analysis, you need to properly prepare for its implementation.Blood is taken in the morning, on an empty stomach. After the last meal, at least eight hours should pass. Heavy physical exertion should be avoided the day before. Eliminate alcohol five days before analysis. The biomaterial is taken from the vein. Vacutainer tubes (vacuum blood collection systems) are used, usually with a gel phase (preservative) without an anticoagulant. The material for research is blood serum. The Commission on Enzymes of the International Biochemical Union proposed to use “U / L” to designate the unit of measurement of indicators.

Norma AlAt

The level of alanine aminotransferase in a healthy body is quite low. Throughout life, the rate of enzyme production changes. So, in newborns, an overestimated indicator is considered normal, which is explained by the presence of physiological postpartum jaundice. It occurs due to the fact that during childbirth, a large amount of hemoglobin is “thrown” into the baby’s bloodstream. Within three to four weeks, hemoglobin in the baby’s body is actively decomposed, as a result of which bilirubin is formed.And it is its high concentration that causes the icteric manifestations.

In the first five days of a child’s life, it reaches 49 U / l, from five days to six months – up to 56 U / l. Further, the level of the indicator decreases: from six to 12 months – to 54 U / l, from one to three years – to 33 U / l. From three to six years, an amount of up to 29 U / l is considered the norm. From six to 12 years, the indicator will rise again – to 38–39 U / L, and from 12 to 17 years old depends on the gender of the child (for girls – up to 24 U / L, for boys – up to 27 U / L). The rate of the indicator in an adult man is up to 41 U / l. The norm for women is up to 31 U / l. Note that in women in the first trimester of pregnancy, a slight increase in ALT is possible, which is the norm. However, in late pregnancy, an increase in the enzyme content may indicate gestosis (a complication expressed in a feeling of weakness and increased blood pressure). The greater the deviation of AlAt from the norm, the more severe the symptoms of preeclampsia.

Deviations from normal values ​​indicate an inflammatory process in the body.

Reasons for AlAt increase

It is believed that the AlAt level in the blood serum is increased if it exceeds the norm by tens or even hundreds of times. Thus, the indicator increases more than 20 times with the development of acute forms of hepatitis A, B and C. Approximately six times the concentration of ALT increases in alcoholic hepatitis. If a disease such as fatty degeneration of the liver occurs, then the level of ALT can exceed the norm by two to three times. But with tumor lesions of the liver, the jump in the enzyme may be quite insignificant, but even a specialist should pay close attention to it.

Pay attention!

AlAt indicators can be affected by the intake of choleretics, steroids, oral contraceptives, psychotropic drugs, immunosuppressants, antineoplastic agents and others. If you are taking any of these drugs, you should consult your doctor before getting tested.

How to reduce the concentration of the enzyme?

The surest way to lower the level of AlAt in the blood is to diagnose and cure the pathology that caused the changes.In the treatment of liver diseases, which most often cause an increase in ALT, medications are taken that improve digestion, hepatoprotectors and choleretic agents. All of them have a number of contraindications, so they should be taken only as directed by a doctor.

If an increase in the amount of AlAt is caused by taking any medications, then it is worth stopping their use if possible. Let’s admit the selection of alternative therapy. In addition, in order to reduce the concentration of the enzyme, it is recommended to diversify your diet with foods containing vitamin D (these are fish, green vegetables, soy milk, dairy products and eggs).Carrots, squash, nuts, whole grains, and lean meats are also beneficial. Do not overuse fatty and salty foods. It is, of course, important to follow a healthy lifestyle.

During the course of treatment, the biochemical composition of the blood is periodically examined to find out how effective the prescribed therapy is.

Why ALT can be downgraded?

A decrease in the concentration of AlAt in the blood indicates a possible rupture of the liver, the occurrence of such serious diseases as cirrhosis and necrosis.Another likely reason for the decline lies in the lack of vitamin B6 in the body and in the intake of certain drugs containing aspirin, interferon, phenothiazine.

Alanine aminotransferase is present in almost all cells of the human body, but in different proportions. And when its content in the bloodstream changes, it affects the state of many systems. In order to avoid the serious consequences of possible diseases, one should not neglect diagnostic procedures, in particular, donating blood.

All information related to health and medicine is presented for informational purposes only and is not a reason for self-diagnosis or self-medication.

No. AN8ALT, ALT (alanine aminotransferase in the blood): indicators, norm

Alanine aminotransferase (ALT) is an enzyme belonging to the group of transaminases. ALT is localized mainly in the cytosol of cells and catalyzes a reversible transamination reaction, that is, the transfer of an amino group from alanine to α-ketoglutaric acid with the formation of pyruvate and glutamic acid.

The reaction takes place in the presence of a coenzyme, a vitamin B6 derivative. Excess or deficiency of vitamin B6 proportionally affects the activity of transaminases. In dogs and cats, the highest ALT concentrations are found in hepatocytes (especially near the portal area), therefore the determination of ALT in serum is usually included in the biochemical profiles for these animals. This enzyme is also present, but in lower concentrations, in the kidneys, pancreas, intestines, skeletal and cardiac muscle tissues and erythrocytes.In some mammals (for example, in rabbits), the ALT content in the liver and heart muscle is almost the same. Since ALT is predominant in the liver tissue in dogs and cats, serum activity is a more specific indicator of liver damage than AST. The level of serum ALT activity is proportional to the number of damaged cells, but not always associated with the severity of tissue damage. The serum ALT activity may be higher after sublethal damage to a large number of hepatocytes than after necrosis of several hepatic cells.Cholestasis and biliary obstruction can increase serum ALT activity due to toxic effects of bile salts on hepatocytes. Simultaneous study of the level of alkaline phosphatase and GGT in serum will reveal a possible cholestatic component in hepatic pathology. With an increase in ALT activity, a study of bile acids or the level of ammonia in the blood plasma will allow the assessment of liver function. An increase in ALT activity is also observed in severe muscle damage (especially in dogs).

Despite the fact that the activity of ALT in skeletal and cardiac muscles is significantly lower than the activity of this enzyme in the liver and amounts to 5 and 25%, respectively, damage to these muscles can cause a significant increase in ALT levels due to the greater mass of muscle tissue. In severe muscle injuries, the levels of AST and CPK also increase, but the increase in ALT is less pronounced than the increase in AST. Examining the activity of a more specific enzyme found in muscle, such as CPK, can help determine if muscle tissue is the source of the ALT leak. An increase in ALT activity is also noted due to acute intestinal enteropathies, intravascular hemolysis (especially in cats), during hypoxia, as a result of toxic effects on hepatocytes, and in a number of other cases.

Serum ALT levels are usually not considered significant unless they are 2–3 times the upper limit of normal. The serum half-life of ALT is 17 to 60 hours in dogs and 3.5 hours in cats. After severe acute hepatocellular liver damage (for example, exposure to toxic substances), the level of the enzyme increases significantly after 12 hours and reaches a peak within 1–2 days.

With the cessation of exposure to damaging factors, the rate of normalization of serum ALT activity does not always correspond to the expected one, taking into account the half-life of the enzyme in the blood serum, and is 1–3 weeks. This slow decrease can be explained by an increase in ALT activity during the reparative regeneration of the liver tissue.

PREANALYTICS

To obtain more accurate results, animals should be on a starvation diet for at least 12 hours before testing.The sample is stable for 1 week at a storage temperature of + 2 ° C … + 8 ° C; keeps stability for more than 1 week when freezing -17C … -23C. Severe hemolysis and lipemia can cause a moderate increase in the ALT value in the test sample.

INTERPRETATION

The results of the study contain information exclusively for doctors. The diagnosis is made on the basis of a comprehensive assessment of various indicators and additional information.

VET UNION laboratory measurement units : Unit / l.

Reference values:

Dogs: 0 – 6 months – 10–32 U / l; 6-12 months – 10–45 U / l; over one year old – 10–65 U / l.
Cats: 0-6 months – 10-50 U / l; 6-12 months – 10–75 U / l; over one year old – 10–85 U / l.
Ferrets: 78–149 U / L – albinos; 82–289 U / L – dark.
Horses: 4–20 U / l.
Leopard: 10-146 U / l.
Tiger: 21-109 U / l.
Chinchilla: 10–35 U / l.
Hamster: 22–128 U / l.
MRS: 60–84 U / l.
Cattle: 17–37 U / l.
Rabbit: 14–80 U / l.
Rat: 20–92 U / l.
Guinea pig: 10-25 U / l.
Mouse – 26 -77 U / l.

In neonatals, when fed with colostrum, the ALT level in the first three days of life can reach 337 U / L. The test result is influenced by substances that change the concentration of phosphopyridoxal (vitamin B6). Due to the lack of vitamin B6, the level of ALT activity remains at a low level even in cases of hepatocellular lesions.With the appointment of acetaminophen (paracetamol), an increase in the activity of serum ALT is sometimes noted as a result of the action of the formed reactive hepatotoxic metabolites. An increase in serum ALT activity may be observed in dogs with hyperadrenocorticism or with the administration of corticosteroid hormone medications (for steroidal hepatopathy). The increase in ALT levels is usually insignificant (2-5 times) and is detected a few days after the start of therapy. After discontinuation of therapy, the activity of serum ALT decreases slowly.Such changes are individual and depend on the dose and duration of treatment. Some drugs are hepatotoxic and therefore increase serum ALT levels (eg, sulfonamides, sodium thiacetarsamide, erythromycin, rifampicin). Anticonvulsants (eg, phenobarbital, primidone, phenytoin) also cause mild increases in serum ALT in dogs.

Level Up:

Hepatitis.
Hypoxia (anemia, cardiovascular disease).
Neoplasia of the hepatobiliary system.
Steroidal hepatopathy.
The action of hepatotoxic drugs or toxins.
Liver lipidosis.
Pancreatitis
Traumatic lesions of the liver tissue.
Parasitizing the hepatic fluke.
Copper storage disease.
Damage or extensive necrosis of muscle tissue, myositis.
Muscle fatigue.

Downgrade:

Liver atrophy (congenital portosystemic shunts).
Decreased vitamin B6 levels.

ALT and AST are increased in the child

Hello dear doctor! A child, a boy of 9 years old, is often ill. Two years ago, in March 2014, I had severe scarlet fever, dehydration, and was treated with penicillin antibiotics. Two months earlier, we had had bronchitis, which was treated with an antibiotic, and then otitis media, and we were injected with ceftriaxone.Two months after scarlet fever, we again had bronchitis and we also treated it with an antibiotic. In total, it turned out that within five and a half months the child received 5 antibiotics in pills and injections, and all only as prescribed by a doctor! Then there were no antibiotics for a whole year, but still the child was sick every month and received antiviral and antipyretic drugs. In June 2015, we passed the analysis for biochemistry and received the following results:

ALT -197 U / l (norm up to 39),
AST – 168 U / l (norm up to 47),
Gamma-GT – 80 U / l (norm up to 17),
Alkaline phosphatase – 468 U / l (norm up to 500),
LDH – 215 U / l (norm up to 332),
Total protein – 73 g / l (norm 60-80),
Total bilirubin – 7.3 μmol / l (norm 3.4 – 20.5),
TSH – 3.18 mU / l (norm 0.4-5.0).

Analyzes for hepatitis A, B, C – negative, CMV, toxoplasmosis, giardiasis, mononucleosis – not detected. Abdominal ultrasound – everything is normal. The doctor prescribed Karsil for 1t.x 2p. / Day for 1 month, then Hofitol, Hofitol could not drink (diarrhea).

On January 14, 2016, we repeated the tests for biochemistry and these are the results:
ALT – 120 U / L (norm up to 39),
AST -58 U / L (norm up to 47),
Gamma-HT – 64 U / l (norm up to 17),
Alkaline phosphatase – 442 U / l (norm 156-369) (the laboratory said that their markers have changed since our last analysis),
LDH – 214 U / l (norm up to 332) ,
Total protein – 76 g / L (norm 60-80),
C-reactive protein – 0. 2 mg / L (norm 0.0-5.0),
Total bilirubin – 9.2 μmol / L ( norm 3.4-20.5),
Creatinine – 67 μmol / L (norm 46-63),
Albumin -50 g / L (norm 38-54),
Pancreatic amylase -27 U / L (norm up to 50 ),
Lipase – 15 U / L (norm 8-78),
Urea – 6.5 mmol / L (norm 1.8-6.4)
Triglycerides – 1.08 mmol / L (norm 0.34-1 , 13)
Cholesterol – 5.02 mmol / L (norm 3.13-5.25)
Cholesterol-HDL – 1.63 mmol / L (norm 0.98-1.94)
Cholesterol_LDL (according to Friedwald) – 2.90 mmol / L (norm 1.63-3.34)
Cholinesterase – 11 001 U / L (norm 5800-14600)
Coefficient of atherogenicity – 2.1 (norm 2.0-3.0)

The child all this time feels good, mobile, active, outwardly there are no manifestations, eats and sleeps like always, during these six months he has grown by 3-4 cm, although he has not recovered, weight 25-26 kgThe doctor suggests drinking Ursofalk 1 capsule a day to restore the liver. I read that Ursofalk increases transaminases and I don’t know what to do. What is your advice in this situation?

What analyzes can tell about heart.

What are analyzes? Analyzes are confirmation or exclusion of a disease, which was an opinion after a clinical examination of a patient. With their help, the doctor will find out what exactly prevents your body from living and working normally, what is the state of its individual organs and systems.

So, what do these analyzes say if there are pains in the region of the heart? Determination of enzymes contained within cells is of great importance in the diagnosis of diseases associated with myocardial damage. And depending on which and how many cells die, their values ​​will also change.

Indicators of biochemical blood test:

ALT (alanine aminotransferase): to 68E / L, when assessing the level of this enzyme, it should be borne in mind that it is contained not only in the myocardium, but to a greater extent in the liver, therefore AST and ALT are always determined together, which helps in differentiating damage to the heart and liver. The timing of the increase in ALT is similar to that of AST.

AST (aspartate aminotransferase) : up to 45U / L, this enzyme is found in large quantities in the myocardium, and its increase, in most cases, indicates damage to cardiomyocytes – muscle cells of the heart; an increase in AST in the blood serum is observed in myocardial infarction (95-98%) cases within 6-12 hours from the onset of the disease. The maximum increase is noted on days 2-4, and on days 5-7, the enzyme level returns to normal.There is a clear relationship between the AST numbers and the size of the heart muscle necrosis focus. Therefore, if the amount of necrosis is less than 5 mm in diameter, it is possible to maintain the level of this enzyme within the normal range, which must also be taken into account.

LDH (lactate dehydrogenase) and the fractions that make up this indicator: up to 250 U / L, is considered a specific marker in AMI, an increase in the activity of the isoenzyme LDH1 and LDH2, even with normal indicators of total LDH activity, indicates the presence of small necrosis in the heart muscle.With AMI, its level rises rapidly by 2-4 days, and normalizes only at 2-3 weeks. The LDH level provides valuable information about MI throughout the course of the disease. Other fractions LDH3 and LDH4 are enzymes of the lung tissue, LDH5 – liver.

CPK (creatine phosphokinase) and the fractions that make up this enzyme: up to 190 U / L, creatine phosphokinase – is considered a specific marker (especially an increase of more than 10 times) in acute myocardial infarction. It increases in the acute period (in the first 4-8 hours from the onset of the disease), much ahead of the activity of the above enzymes and is a marker of early diagnosis of AMI, especially the CPK-MB isoenzyme.After 8-14 hours, the CPK value can reach its maximum value, and normalization can occur in 3-4 days. Also, the value of CPK can increase with myocarditis;

troponin test: to 0. 4 μg / L. Troponin is a specific contractile protein that is part of the structure of the heart muscle and skeletal muscles. This test is a diagnostic marker for suspected acute myocardial cell damage, is one of the key results in the diagnosis of acute myocardial infarction;

myoglobin: 12-92 μg / l.A muscle tissue protein that is involved in cell respiration. If it appears in the blood, it is regarded as a decay product of the muscle tissue of the heart or skeleton, with the appropriate clinic, it may indicate necrosis (necrosis) of the focus of the muscle tissue of the heart, therefore it is also considered a specific marker of this pathology.

Indicators of ALT, AST, CPK, CPK-MB, LDH, myoglobin and troponin test closely correlate with the size of the necrosis focus in the heart muscle, and therefore have not only diagnostic, but also prognostic value.

Acid phosphatase: 67-167 nmol / (s · L), increases in activity in patients with severe, complicated MI, mainly transmural;

C-reactive protein (CRP): up to 0.5 mg / l, its detection indicates the presence of a pathological process in the body, in particular inflammatory or necrotic. It belongs to the proteins of the so-called “acute phase”. A strongly positive reaction to CRP indicates the severity of the inflammatory process.

sialic acids: 2.0-2.36 mmol / l, the content of sialic acids may increase with endocarditis, MI;

electrolytes, mainly represented by ions K + (norm 3.6 – 5.2 mmol / l), Na + (norm 135 – 145 mmol / l), Cl- (norm 100 – 106 mmol / l), Ca2 + ( norm 2.15-2.5 mmol / l). An increased amount of potassium in the serum may be accompanied by a clinically disturbed heart rhythm, which is confirmed by an ECG. Atrioventricular blockade of the cardiac conduction system may develop, a syndrome of premature excitation of the ventricles, ventricular fibrillation, and such a formidable violation as cardiac arrest may develop. Therefore, patients with cardiac arrhythmias need to control the content of K + ions in the body. On the other hand, a decrease in potassium in the blood can also lead to adverse consequences in these patients – myocardial hyporeflexion. A decrease in the level of sodium ions can be accompanied by the development of insufficiency of the cardiovascular system, since the ratio of K + and Na + ions, as regulators of processes in the cell, is in constant interaction and a decrease in one leads to an increase in the other ion.Hyperchloremia occurs in patients with kidney disease and can also lead to the development of cardiovascular failure;

lipid spectrum, is associated in a common person with the word “cholesterol”. In this case, substances (lipoproteins of various densities, triglycerides) are determined that are involved in the exchange of cholesterol (CS) (the norm in the blood is 3.1 – 5.2 mmol / l). In addition to the value of total cholesterol, an important indicator is the coefficient of atherogenicity (the norm is up to 4), which shows the ratio of “good” and bad “lipids involved in the metabolism of fats and cholesterol, and the threat of the development or progression of atherosclerosis and all the ensuing consequences.An increase in lipoprotein and triglyceride fractions can be both a physiological state (alimentary in nature) and a pathological state. An increase in lipids is characteristic of widespread atherosclerosis, obesity accompanying and causing arterial hypertension. Or it would be more accurate to say that this is a disruption in the work of internal organs and intermediate links of lipid and triglyceride metabolism, expressed in an increase in atherogenicity, causes the deposition of cholesterol in vessels of various diameters, the deposition of “reserve fat”, which leads to the above diseases.Therefore, with widespread atherosclerosis, in this blood test, you can see increased values ​​of ß-lipoproteins and total cholesterol. However, a decrease in the concentration of phospholipids can be seen. But at the same time, it is necessary to take into account the fact that there are age-related fluctuations in blood fats.

coagulogram – an analysis by which you can see the “viscosity” of the blood, or in other words, whether there is a threat of blood clots, which can lead to the formation of blood clots with different localization, which in turn can be complicated by pulmonary embolism, in which there is instantaneous death.Or, on the contrary, to see how high the likelihood of bleeding is and whether it will be able to stop on its own, after an operation, for example, to replace a heart valve.

Any analysis or research gives the doctor additional information that helps to more accurately diagnose, determine the stage of the disease, and prescribe treatment. Analyzes also help to control the course of the disease, the effectiveness of the prescribed treatment, as well as to ensure the safety of therapy. But sometimes more research is required to confirm or supplement the results of past analyzes.

Fedorova Lyubov Alekseevna – doctor of the first category, therapist, cardiologist of the Tet-a-Tet Medical Center.

Images to HTML – Learning Web Development

In the beginning, the Web was just text, which was pretty boring. Fortunately, this did not last long – until it became possible to insert images (and other more interesting types of content) into web pages. There are other types of media, but it makes sense to start with the humble element used to insert a simple image into a web page.In this article, we’ll walk through how to use an element, starting with the basics, annotating using

, and how it relates to CSS background images.

To place the image on the page, you need to use the tag . This is an empty element (meaning that it does not contain text and an end tag), which requires at least one attribute to use – src (pronounced es-ar-si , sometimes its full name is said, source ). The src attribute contains the path to the image you want to embed in the page, and can be a relative or absolute URL, just like the values ​​for the href attribute for the element.

Note : Before proceeding, you should remember the URL types to update the relative and absolute addresses in memory.

For example, if your image is named dinosaur.jpg , and it is in the same directory as your HTML page, you can embed this image as:

    

If the image was in the images subdirectory , inside the same directory as the HTML page (which Google recommends for indexing and SEO purposes), then you can embed it like this:

    

And so on.

Note : Search engines also read image names and count them to optimize the search query. Therefore, give your images meaningful names: dinosaur.jpg is better than img835.png .

You can embed an image using an absolute URL, for example:

    

But this is pointless, as it just forces the browser to do more work by requesting an IP address from the DNS server every time. You will almost always keep your site images on the same server as your HTML.

Warning: Most images are protected.Do not display images on your site yet:

  • you will not own the image
  • you will not have written permission from the owner of the image, or
  • until you have sufficient proof that the image is in the public domain.

Copyright infringement is illegal. Also, never include a link to an image hosted on someone else’s site in your src attribute. This is called hotlinking.’hotlinking’). Remember, stealing the bandwidth of someone else’s site is illegal. It also slows down your page and gives you no control over whether the image is removed or replaced with something nasty.

Our code above will give us the following output:

Note : Elements such as and are sometimes referred to as overridden elements. This is because the content of an element and its size determines the external resource (like an image or video file), not the content of the element itself.You can read more about them in Replaced Elements.

Alternative text

The next attribute we’ll look at is alt . Its value should be a textual description of the image for use in situations where the image cannot be viewed / displayed or rendering takes a long time due to a slow internet connection. To demonstrate the use of attribute alt in practice, let’s modify the code from the previous example:

 Head and torso of a dinosaur skeleton;
he has a large head with long, sharp teeth  

The easiest way to see the alt attribute in action is to make a deliberate mistake in the filename. For example, if we wrote the name of the image as dinosooooor.jpg , the browser would not be able to display it and the text from the alt attribute :

would appear on the screen

So, in what cases can the text from attribute alt be useful to us? Here are some examples:

  • A visually impaired user uses a screen reader that can read aloud descriptions of elements on a web page.In fact, having text in the alt attribute to describe the image can be helpful for most users.
  • In case there was an error in the file name or path to it (as described above).
  • The browser does not support this image format. Some people still use text browsers like Lynx, which display text from alt attribute instead of images.
  • If you want to add the ability to find your image using search engines.For example, search engines can search for matches of search queries with the text attribute alt .
  • If users have disabled the display of images on the page to reduce the amount of data transferred and to hide distracting elements. This is a common practice for mobile phone users, as well as in countries with low bandwidth and high Internet traffic costs.

What exactly should you write in attribute alt ? First and foremost, it depends on why why images are on the page at all.In other words, what will you lose if your image doesn’t show up:

Basically, the main idea here is to provide something useful when the images are not visible. This ensures that all users don’t miss out on anything on the page. Try disabling images in your browser and see how it looks. You will soon find out how useful alt text is when the images are not visible.

Width and Height

You can use the width and height attributes to specify the width and height of your image.You can find the width and height of your image in a variety of ways. For example, on a Mac, you can use Cmd + I to get image information. To repeat our example, we can do this:

  The head and torso of a dinosaur skeleton;
          it has a large head with long sharp teeth   

This does not result in much difference in display under normal circumstances.But if the image will not be shown, for example, when the user has just navigated to the page, and it has not yet loaded, you tell the browser to leave space for rendering the image:

This is good practice and will result in the page loading faster and smoother.

However, you must not resize your images using HTML attributes. If you set the image size too large, you will end up with images that look grainy, blurry, or too small, and waste bandwidth to download an image that doesn’t fit the user’s needs.The final image may also look distorted if you do not maintain the correct aspect ratio. It is recommended that you use a graphics editor to resize the image to the desired size before inserting it into your web page.

Note : If you really need to resize the image, you should use CSS instead.

Image title

As with links, you can also add title attribute to images to provide additional information if needed.In our example, we could do it like this:

  The head and torso of a dinosaur skeleton;
          it has a large head with long sharp teeth   

This gives us a tooltip on hover, just like in links:

However, this is not recommended – title has a number of accessibility issues, mainly due to the fact that screen reader support is very unpredictable and most browsers will not display it unless you hover your mouse over (e.g. no access for keyboard users).It is often better to include this kind of supporting information in the main body of an article than to attach it to an image. However, it is useful in some circumstances; for example, in image galleries when you don’t have room for their titles.

Active Learning: Image Embedding

Now it’s our turn to play a little! This Active Learning section will guide you through a simple embedding exercise. You will be provided with a simple tag; we would like you to embed the image located at the following link:

https: // raw.githubusercontent.com/mdn/learning-area/master/html/multimedia-and-embedding/images-in-html/dinosaur_small.jpg

Earlier we said never use hotlinks to images from other servers, this case is for educational purposes only, so we will let you neglect that one time.

We would also like you to:

  • Added any alternative text, and tested how it works by adding an error to the image link.
  • Set the correct values ​​ width and height (hint: it’s 200px wide and 171px high), then experiment with other values ​​to see what the effect will be.
  • Set title to for the image.

If you make a mistake, you can always clear the code using the Reset button. If you really don’t understand how to do it, click the Show solution button to see the answer:

Starting the conversation about titles, there are many ways you can add a title to your image. For example, there is nothing that can stop you from doing it this way:

  
The head and torso of a dinosaur skeleton;
            it has a large head with long sharp teeth

A T-Rex on display in the Manchester University Museum.

This is normal. It contains everything you need and is nicely styled with CSS. But, there is a problem: there is nothing here that semantically links the image to its title, and this can be difficult for readers. For example, when you have 50 images and titles, which title goes with which image?

The best solution would be to use HTML5 elements

and
.They were created solely for this purpose: to provide a semantic container for pictures and to clearly link the picture to the title. Our example above could be rewritten like this:

 
The head and torso of a dinosaur skeleton;
            it has a large head with long sharp teeth
A T-Rex on display in the Manchester University Museum.

Element

tells browsers and assistive technology that the title describes the content of the

element.

Note : From an accessibility point of view, headers and alt have different meanings. Headers help even those who have the ability to view the image, while alt provides a replacement for the missing image functionality. Thus, headers and alt do not mean the same thing, because both are used by the browser in the absence of an image. Try disabling images in your browser to see what it looks like.

The

tag is not an image. It is an independent structural element that:

  • Conveys meaning in a compact, intuitive way.
  • Can be used in various places on the page.
  • Provides valuable information to support the body text.

The

tag can be multiple images, a piece of code, audio, video, an equation, a table, or something else.

Active Learning: Creating a

In this Active Learning section, we would like you to take the text from the previous Active Learning section and convert it to

:

  • Wrap it in the
    element.
  • Copy the text from the title attribute , remove the title attribute , and type the text into the
    element .

In case of an error, you can always dial the code again by pressing the Reset button. If you get stuck, click the Show solution button to see the answer:

You can use CSS to embed images in web pages (or JavaScript, but that’s another story entirely). The CSS options background-image and other background- * are used to control the placement of the background image.For example, to fill the background of each paragraph on a page, do the following:

  p {
  background-image: url ("images / dinosaur.jpg");
}  

The resulting image can be easily positioned and controlled, unlike its HTML counterpart. So why bother with HTML images? As stated above, CSS background images are for decoration only. If you just want to add something pretty to your page to improve visuals, that’s fine.However, these kinds of images have no semantic meaning at all. They cannot have any textual equivalents visible to the visitor, they are invisible to screen readers. This is where HTML images shine!

Bottom Line: If the image is important in the context of your page content, you should use HTML images. If the picture is a trivial decoration, use CSS background images.

You have reached the end of this article, but can you recall the most important information? You can look for additional tests to make sure you have internalized this information before moving on.See Check your knowledge of images in HTML.

That’s all for now. We’ve looked at images and their titles in detail. In the next article, we’ll look at how to use HTML to embed video and audio into web pages.

90,000 AST and ALT in cats

AST (aspartate aminotransferase) and ALT (alanine aminotransferase) are enzymes from the group of transferases used in the diagnosis of myocardial and liver diseases.

AST and ALT are synthesized intracellularly and, during normal functioning of the body, only small amounts enter the bloodstream.

Normal serum AST values ​​in dogs range from 11-42 units / l, in cats – 9-39 units / l. The ALT level in dogs is 9-52 units / l, in cats – 19-79 units / l.

An increase in the level of aminotransferases in the blood serum occurs as a result of cytolysis (destruction of cells) and is observed in a number of diseases, especially with damage to tissues rich in these enzymes – the liver and myocardium.

AST. An increase in the level of AST in the blood serum is observed with necrosis (death) of liver cells, which happens in many severe liver diseases, for example, with cirrhosis, lipidosis; with hepatitis, damage to brain tissue, kidney, skeletal muscle necrosis, myocardial infarction (in animals, this pathology is rare). Also, an increase in indicators in laboratory analysis causes the use of anticoagulants (anticoagulants), vitamin C and some anticonvulsants (anticonvulsants) – in this case, we are not talking about a pathological process if the increase is moderate.