Standard liver tests – PMC

Clin Liver Dis (Hoboken). 2016 Jul; 8(1): 13–18.

Published online 2016 Jul 26. doi: 10.1002/cld.562

, M.D.
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and , M.D.
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Abbreviations

AIH

autoimmune hepatitis

ALT

alanine aminotransferase

AMA

antimitochondrial antibodies

AP

alkaline phosphatase

AST

aspartate aminotransferase

DILI

drug‐induced liver injury

ERCP

endoscopic retrograde cholangiopancreatography

gGT

γ‐glutamyl transpeptidase; LIT, liver injury test

MELD

Model for End‐Stage Liver Disease

MRCP

magnetic resonance cholangiopancreatography

NASH

nonalcoholic steatohepatitis

PBC

primary biliary cholangitis

ULN

upper limit of normal

The liver is the largest organ in the body and arguably the most important organ for protein production and detoxification, both of which are facilitated by a myriad of enzymes. Both the detection of enzymes released from liver cells and proteins produced by the liver and released into the blood can be used to analyze liver health.

Standard liver tests (Tables and ) that assess injury to the liver include alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatases (APs). The excretory function of the liver can be estimated by bilirubin and the metabolic function of the liver by clotting tests and albumin.

Table 1

Standard Liver Tests, Their Sources of Origin, and Abnormalities

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Table 2

Elevation of Liver Chemistries With Liver Diseases

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Tests that describe injury of the liver such as aminotransferases and AP have historically been mislabeled liver injury tests (LIT). In contrast, standard tests such as albumin, bilirubin, and prothrombin time are useful in evaluating liver function.

The pattern of elevation of the different enzymes can be used to discriminate hepatocellular from cholestatic or mixed injury; AST and ALT are more elevated in patients with hepatocellular injury, whereas AP and γ‐glutamyl transpeptidase (gGT) are more elevated in cholestatic injury.

Normal values for laboratory results are defined as those found in 95% of a population. Thus, 2.5% of a population will be above and below the normal values, respectively. But being outside the normal does not immediately reflect illness; that is, a bilirubin level below normal has no clinical consequences. Contrarily, being within the normal value does not necessarily reflect a healthy state. In that regard it has been suggested to use an upper limit of 19 and 30 U/L for ALT for women and men, respectively,¹ to reflect healthy values. This also fits the observed increased mortality in individuals with ALT values that are normal but above the healthy range. ² Thus, liver transaminases likely will be described as healthy (≤19 U/L for women and ≤30 U/L for men) and normal values (i.e., <65 U/L). The normal values will depend on the specific laboratory population, thus limiting standardization.

For some assessments such as drug safety, the times upper limit of normal (ULN) is established to define safety margins. Substituting the healthy range values for normal range value will therefore need to be carefully addressed in the future.

Mild abnormalities in liver‐related tests may warrant repeat testing before a more extensive workup is initiated. Abnormal liver chemistries may occur in 1% to 4% of the asymptomatic population.³, ²¹

Transaminases are involved in transferring the amino groups of aspartate and alanine to ketoglutaric acid. Although ALT is more liver specific, elevated ALT levels are also reported in myopathies (Table ).⁴, ⁵

Table 3

Disease Association According to Aminotransferases Elevation Pattern

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Hepatocyte injury results in altered cell membrane permeability causing the excessive leakage of transaminases. Periportal hepatocytes (zone 1) have relatively more ALT, whereas the hepatocytes near the central vein (zone 3) have more AST (Fig. ). Thus, causes of hepatic inflammation that are predominantly involving zone 1 such as viral and autoimmune hepatitis result in predominantly ALT elevation. In contrast, ischemic or toxic insults are more likely to involve zone 3, causing a predominance of AST elevation. AST/ALT ratio, also known as De Ritis ratio, is useful in assessing various liver diseases.⁶ In alcoholic hepatitis, AST is usually higher than ALT, with the AST/ALT ratio reaching 2:1. In acute viral hepatitis, ALT levels are usually higher than AST. High AST/ALT ratio (>1.5) in acute viral hepatitis may be indicative of potential fulminant course.⁹ AST/ALT ratio greater than 1.0 in chronic liver diseases may be indicative of advanced fibrosis.⁸, ⁹ AST and ALT are also used together with platelets to assess the likelihood of advanced liver fibrosis and are part of the aspartate aminotransferase‐to‐platelet ratio index (APRI) and FIB‐4 score:

• APRI: AST level (/ULN) / platelet counts (10⁹/L) × 100

• FIB‐4 score: [age (years) × AST (U/L)]/{platelets (10⁹/L) × [ALT (U/L)]^1/2}.

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Zone 1 has more ALT than AST, and zone 3 has more AST than ALT. Autoimmune and viral hepatitis predominantly involve zone 1 (ALT > ALT). Ischemic and toxic events, heart failure, and Budd‐Chiari syndrome predominantly involve zone 3 (AST > ALT). AP is mostly present on basolateral membrane of hepatocytes lining the bile canaliculi. Reproduced from PLoS Biology. Copyright 2005, Frevert et al.

Aminotransferases are normal or only mildly elevated in obstructive jaundice except in acute phase of biliary obstruction caused by the passage of gallstone into the common bile duct.¹⁰ In this case, aminotransferases may reach values greater than 1000, decreasing quickly, with liver test rapidly evolving into those of typical cholestasis or normalizing completely.

Aminotransferases levels also vary with age, sex, race, and body mass index.¹¹ Levels are found to be higher in obese patients and lower in dialysis patients,¹² whereas ALT levels are noted to decline with weight loss. ¹³ AST levels are 15% higher in African American males as compared with Caucasians.¹¹ Some individuals may have asymptomatic AST elevation caused by a defect in clearance of the enzyme.¹⁴ Transaminases levels can be very high in patients with acute viral hepatitis, drug‐induced liver injury, hepatic ischemia, and Budd‐Chiari syndrome (Fig. ). In asymptomatic patients with no underlying disease, mild aminotransferase elevation for more than 6 months warrants further investigation.²²

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Typical AST elevation and De Ritis ratios for different kinds of liver diseases.

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Algorithms for evaluation of elevated aminotransferases (A), AP (B), and bilirubin (C), respectively. Abbreviations: AIH, autoimmune hepatitis; AMA, antimitochondrial antibodies; DILI, drug‐induced liver injury; ERCP, endoscopic retrograde cholangiopancreatography; MRCP, magnetic resonance cholangiopancreatography; NASH, nonalcoholic steatohepatitis; PBC, primary biliary cholangitis.

AP is the standard liver test reflecting cholestasis and can be complemented by gGT. gGT is part of a typical liver panel in some countries, whereas in the United States the standard liver test usually includes only AST, ALT, and AP. Because gGT is diffusely located in endoplasmic reticulum of bile ductal cells, its elevation is less specific for cholestasis but supports the suspicion that an elevated AP is liver derived as opposed to being of extrahepatic origin (Tables and ).¹⁵

Table 4

Elevated AP

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Elderly individuals older than 60 years, especially women, may have a mildly elevated AP. ¹⁶ Individuals with blood types O and B may have an elevation of the serum AP after eating a fatty meal because of the influx of intestinal AP into circulation.⁷ AP can also be nonpathologically elevated in children and adolescents undergoing rapid bone growth¹⁶ and in women late in normal pregnancies because of the influx of placental AP.¹⁷

Bilirubin, albumin, and prothrombin time are standard tests to evaluate the liver function.

Bilirubin is the result of enzymatic breakdown of heme. Bilirubin is conjugated in the liver, resulting in water solubility. The conjugated bilirubin is then secreted into the bile. In healthy individuals, conjugated bilirubin comprises a small proportion of total bilirubin.¹⁸

In adults, unconjugated bilirubin elevation is most often of extrahepatic origin, mainly caused by hemolysis. In the absence of hemolysis, isolated unconjugated hyperbilirubinemia in an otherwise healthy patient should raise the suspicion for Gilbert syndrome. Up to 5% of the population has Gilbert syndrome, which is due to partial defects in uridine 5′‐diphosphate‐glucuronosyltransferase, the enzyme that conjugates bilirubin.¹⁹ Crigler‐Najjar syndrome is a rare cause of unconjugated hyperbilirubinemia.

In adults, conjugated hyperbilirubinemia is almost always a sign of biliary obstruction or impaired hepatic function. Two rare hereditary conditions cause defects in the secretory mechanism, Dubin‐Johnson syndrome and Rotor syndrome, which result in elevated conjugated bilirubin.

Total serum bilirubin with increased prothrombin time correlates with poor outcomes in alcoholic hepatitis.¹⁸ Both are also critical components of Model for End‐Stage Liver Disease (MELD) score and Child‐Pugh score.

Serum albumin is exclusively synthesized by hepatocytes, but the long half‐life of albumin makes it difficult to interpret in the setting of acute liver injury. In chronic liver disease, albumin is the first of the three standard liver function tests to decline in advancing liver cirrhosis, before increase in bilirubin or prothrombin time. Albumin less than 35 g/dL should raise suspicion for cirrhosis. Differential diagnosis for hypoalbuminemia includes protein malnutrition of any cause, as well as protein‐losing enteropathies, nephrotic syndrome, and chronic infection.

With the exception of factor VIII, all coagulation factors are synthesized in the liver. Because of the short half‐lives of the coagulation factors, these are the best parameters to measure synthetic function of liver in acute conditions. This is most frequently done by prothrombin time determination. Because most clotting factors synthesized in the liver depend on vitamin K, prothrombin time is affected by vitamin K deficiency or use of vitamin K inhibitors. Vitamin K deficiency is seen in patients with chronic cholestasis or fat malabsorption from disease of the pancreas or small bowel. Prothrombin time is a better indicator of hepatic dysfunction than the international normalized ratio (INR),²⁰ despite INR having become a crucial part of the MELD score used for prioritizing liver allocations. In acute and chronic liver disease, prolonged prothrombin time (>5 seconds), which does not respond to parenteral vitamin K, is a poor prognostic sign.

Potential conflict of interest: Nothing to report.

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Liver Function Tests-Ranges-High & Low

Liver Function Tests (LFT)

Liver function tests (LFT) are blood tests, which are commonly performed to assess liver functions or liver injury. LFT is also known by other names such as, liver panel, liver function panel, liver profile hepatic function panel, LFT.

An initial step in detecting liver damage is a simple blood test to determine the level of certain liver enzymes (proteins) in the blood. Under normal circumstances, these enzymes mostly reside within the cells of the liver.

But when the liver is injured for any reason, these enzymes are spilled into the blood stream. Enzymes are proteins that are present throughout the body, each with a unique function.

Enzymes help to speed up (catalyze) routine and vital chemical reactions in the body.

Liver function tests (also known as a liver panel) are blood tests that measure different enzymes, proteins, and other substances made by the liver. These tests check the overall health of the liver.

Following are the different substances often tested at the same time on a single blood sample for LFT:

• Albumin a protein made in the liver
• Total protein.  This test measures the total amount of protein in the blood.
• ALP ALP(alkaline phosphatase), ALT (alanine transaminase), AST (aspartate aminotransferase), and gamma-glutamyl transferase (GGT). These are different enzymes made by the liver.
• Bilirubin, a waste product made by the liver.
• Lactate dehydrogenase (LD), an enzyme found in most of the body’s cells. LD is released into the blood when cells have been damaged by disease or injury.
• Prothrombin time (PT), a protein involved in blood clotting.

If levels of one or more of these substances are outside of the normal range, it may be a sign of liver disease.

Aminotransferase Enzymes (ALT, AST)

The aminotransferase enzymes catalyze chemical reactions in which an amino group from one amino acid (amino acids are building blocks of proteins) is transferred from a donor molecule to a recipient molecule, hence, the names “aminotransferases. ”

Medical terms can sometimes be confusing, as is the case with these enzymes because they have interchangeable names that commonly appear in both medical and non-medical articles. For example:

• Another name for aminotransferase is transaminase.
• The enzyme aspartate aminotransferase (AST) is also known as serum glutamic oxaloacetic transaminase (SGOT).
• Alanine aminotransferase (ALT) is also known as serum glutamic pyruvic transaminase (SGPT).

Briefly, AST = SGOT and ALT = SGPT; they are enzymes produced by the liver and other types of cells.

Alanine aminotransferase (ALT)

Alanine aminotransferase (ALT) is present primarily in liver cells. In viral hepatitis and other forms of liver disease associated with hepatic necrosis, serum ALT is elevated even before the clinical signs and symptoms of the disease appear.

Although serum levels of both aspartate aminotransferase (AST) and ALT become elevated whenever disease processes affect liver cell integrity, ALT is a more liver-specific enzyme.

Serum elevations of ALT are rarely observed in conditions other than parenchymal liver disease. Moreover, the elevation of ALT activity persists longer than does AST activity.

Aspartate Aminotransferase (AST)

Aspartate aminotransferase (AST) is a transaminase enzyme that catalyzes the conversion of aspartate and alpha-ketoglutarate to oxaloacetate and glutamate.

The AST enzyme was formerly known as serum glutamate oxalate transaminase (SGOT) and is present in all tissues except bone, with highest levels in liver and skeletal muscle. Concentration of AST is elevated after bruising, trauma, necrosis, infection, or neoplasia of liver or muscle.

The AST enzyme is found in cerebrospinal fluid, exudates, and transudates in proportion to the amount of cellular damage.

Where AST (aspartate aminotransferase) and ALT (aminotransferase enzymes) are Found

AST (SGOT) is normally found in a variety of tissues including the liver, heart, muscle, kidney, and brain. It is released into the serum when any one of these tissues is damaged.

For example, the AST level in serum is elevated in heart attacks or with a muscle injury. It is, therefore, not a highly specific indicator of liver injury as its elevation can occur as a result of other injured tissues.

ALT (SGPT) is, by contrast, normally found largely in the liver. This is not to say that it is exclusively located in the liver, but that is where it is most concentrated.

It is released into the bloodstream as the result of liver injury. Thus, it serves as a fairly specific indicator of liver status.

High (Elevated) Levels of AST and ALT

Following are the normal ranges of AST and ALT:

• The normal range of values for AST (SGOT) is about 5 to 40 units per liter of serum (the liquid part of the blood).
• The normal range of values for ALT (SGPT) is about 7 to 56 units per liter of serum.

The ranges of AST and ALT numbers may differ slightly depending on the technique and protocols used by different laboratories worldwide. However, normal reference ranges are routinely provided by each laboratory and printed with each patient’s individual report.

AST (SGOT) and ALT (SGPT) are reasonably sensitive indicators of liver damage or injury from different types of diseases or conditions, and collectively they are termed liver tests or liver blood tests.

However, it must be emphasized that higher-than-normal levels of these liver enzymes should not be automatically equated with liver disease. They may mean liver problems or they may not.

For example, elevations of these enzymes can occur with muscle damage. The interpretation of elevated AST and ALT results depends upon the entire clinical evaluation of an individual, and so it is best done by physicians experienced in evaluating liver disease and muscle disease.

Moreover, the precise levels of these liver enzyme tests do not correlate well with the extent of liver problems or the prognosis (outlook). Thus, the exact levels of AST (SGOT) and ALT (SGPT) cannot be used to determine the degree of liver disease or predict the future prognosis for liver function.

For example, patients with acute viral hepatitis-A may develop very high AST and ALT levels (sometimes in the thousands of units/liter range), but most patients with acute viral hepatitis-A recover fully without residual liver disease.

Again, patients with chronic hepatitis-C infection typically have only a little elevation in their AST and ALT levels while having substantial liver injury and even advanced scarring of the liver (cirrhosis) from ongoing minor inflammation of the liver.

Types of Liver Function Tests (LFT)

A liver function test is one of a group of tests that check levels of certain enzymes and other proteins in the blood. Some of the tests look for enzymes that are found in liver disease  and when the liver is damaged. Others check that the liver is working properly, the way it should.

Following are some of the blood tests reflect liver function:

• Coagulation panel (prothrombin time or PT, and international normalized ratio or INR): These tests measure blood’s ability for normal clotting and prevention of bleeding and bruising. This is the function of certain proteins called clotting factors that normally are produced in the liver. Normal values are about 9.5 to 13.8 seconds.
• Albumin level (hypoalbuminemia): Albumin is a very common protein found in the blood with a variety of functions. It also is produced only in the liver, and if its levels are lower than normal it can be suggestive of chronic liver disease or liver cirrhosis. Of note, many conditions other than liver disease also may cause low albumin levels. Normal values are about 3.5 to 5 g/dL.
• Bilirubin: This molecule is a byproduct of the routine destruction of red blood cells occurring in the liver. It is normally released as bile in the feces. Elevation of the bilirubin can suggest liver dysfunction. However, other conditions with increased destruction of red blood cells also can cause elevated bilirubin levels despite normal liver function. Normal values are about 0.1 to 1.0 mg/dL.
• Platelet count: Low platelet count (thrombocytopenia) has many causes, one of which can be advanced liver disease. Normal platelet counts are about 150,000 to 400,000 per (µL).
• Glucose: Glucose level is maintained in the body by a variety of mechanisms. The liver can release glucose in the blood for nourishment of other cells in case of starvation with insufficient oral intake of glucose. This process, called gluconeogenesis, is another major function of the liver. In advanced liver disease, this function of the liver can be compromised leading to unusually low glucose levels in the absence of adequate oral intake. Again, a large number of patients with liver cirrhosis become glucose intolerant and develop diabetes.
• GGT (Gamma-glutamyl transpeptidase): This enzyme is thought to indicate possible liver damage; the higher the abnormal level, the more likely there is liver damage. Normal levels of GGT are about 9 to 48 U/L.
• ALP (alkaline phosphatase): The liver synthesizes the highest amounts of this enzyme so high levels in the blood may suggest liver injury among other causes. Normal levels of ALP are about 45 to 115 U/L.
• LD or LDH (Lactate dehydrogenase): This enzyme may be elevated in many types of diseases, including liver disease. Normal levels are about 122 to 222U/L.

Reasons for Abnormal Liver Tests

Abnormal liver tests may be detected a variety of liver conditions in the blood. Some of those are the following:

• Mild to moderate elevations of the liver enzymes are common. They are often unexpectedly encountered on routine blood screening tests in otherwise healthy individuals. The AST and ALT readings in such cases are usually between twice the upper limits of normal and several hundred units/liter. One of the most common causes of mild to moderate elevations of these liver tests is a condition referred to as fatty liver disease (steatohepatitis or hepatic steatosis). In the United States, the most frequent cause of fatty liver disease is alcohol abuse. 

Alcoholic fatty liver disease only happens in people who are heavy drinkers, especially those who have been drinking for a long period of time.

The risk is higher for heavy drinkers who are women, have obesity, or have certain genetic mutations.

Other causes of fatty liver include diabetes mellitus, and obesity. Fatty liver disease tests are composed of several tests including blood tests, CT and/or MRI scan tests, and in some patients, a liver biopsy.

• Hepatitis-B and Hepatitis-C are other causes of chronic mild to moderate liver enzyme elevation. In these conditions, ALT and AST may be only slightly high and the degree of abnormality in liver function tests can indicate the degree of injury.
• Chronic and acute alcohol use also can commonly cause abnormal liver blood tests. In alcoholic hepatitis, the range of liver tests can vary greatly. In chronic alcohol liver disease or alcoholic cirrhosis, slight elevation of ALT and AST may be observed, whereas, in acute alcoholic hepatitis, high liver enzyme numbers are often seen.
  
• Some medications can be responsible for a mild to moderate increase in the liver enzyme tests.

Medications that can cause increased liver enzyme tests (AST and ALT) levels

Following are examples of some of the common medications with potential liver toxicity:

Pain Relief Medications

• Aspirin
• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin)
• Naproxen (Naprosyn, Naprelan, Anaprox, Aleve)
• Diclofenac (Voltaren, Cataflam, Voltaren-XR)
• Phenylbutazone (Butazolidine)

Anti-seizure Medications

• Phenytoin (Dilantin)
• Valproic acid ( Depakote)
• Carbamazepine (Tegretol)
• Phenobarbital

Antibiotics

• Tetracyclines (Achromycin)
• Sulfonamides
• Isoniazid (Nydrazid, Laniazid)
• Sulfamethoxazole (Gantanol)
• Trimethoprim(Trimpex; Proloprim, Primsol)
• Nitrofurantoin (Macrodantin, Furadantin, Macrobid)
• Fluconazole (Dilflucan) and other anti-fungals

Cholesterol Lowering Drugs (Statins)

• Lovastatin (Mevacor, Altocor)
• Pravastatin (Pravachol)
• Atorvastatin (Lipitor)
• Fluvastatin (Lescol)
• Simvastatin (Zocor)
• Rosuvastatin (Crestor)
• Niacin

Cardiovascular Drugs

• Amiodarone (Cordaone)
• Hydralazine (Apresoline)
• Quinidine (Quinaglute, Quinidex)

Other Drugs

• Antidepressant drugs of the tricyclic type

With drug-induced liver enzyme abnormalities, the enzymes usually normalize weeks to months after stopping the medications. Typically, the physician will want to monitor the patient’s liver enzymes over time to confirm that the values are normalizing.

Diseases that can cause very high AST or ALT levels

AST and ALT serum levels in some liver conditions can range anywhere from ten times the upper limits of normal to thousands of units/liter.

The highest levels of AST and ALT are found with disorders that cause rapid death of numerous liver cells (extensive hepatic necrosis). Although this degree of liver enzymes elevation is not common, it can occur in such conditions as:

• Acute viral hepatitis A or B
• Profound liver damage inflicted by toxins as from an overdose of acetaminophen (brand-name Tylenol) or mushroom poisoning
• Prolonged collapse of the circulatory system (shock) when the liver is deprived of fresh blood providing oxygen and nutrients

Also, very high AST and ALT levels can be a result of severe muscle diseases.

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liver tests for liver enzymes

Contents

• 1 Liver tests: alat and asat in the blood – what does it mean and what conclusions can be drawn
  • 1. 1 Liver enzymes: what are they?
  • 1.2 Liver tests
  • 1.3 Alat and Asat: key indicators of liver enzymes
    • 1.3.1 What are Alat and Asat?
  • 1.4 Normal levels of Alat and Asat in the blood
  • 1.5 Causes of increased levels of Alat and Asat in the blood
    • 1.5.1 Pathological processes in the liver
    • 1.5.2 Injuries and toxic effects
    • 1.5.3 Diseases of other organs
    • 1.5.4 Pathology of muscle tissue
    • 1.5.5 Conclusions
  • Alat and Asat
  • 1.7 Symptoms of elevated levels of Alat and Asat
  • 1.8 Analysis for Alat and Asat: Preparation and conducting
    • 1.8.1 Preparation for analysis
    • 1.8.2 Analysis
    • 1.8.3 Decoding of results
  • 1.9Preparation for the analysis for Alat and Asat
  • 1.10 Interpretation of the results of the analysis of ALAT and ASAT in the blood
    • 1.10.1 What are ALAT and ASAT?
    • 1. 10.2 What does elevated blood levels of ALAT and ASAT mean?
    • 1.10.3 What do low blood levels of ALAT and ASAT mean?
    • 1.10.4 How to interpret the test results?
  • 1.11 What to do in case of elevated levels of Alat and Asat?
  • 1.12 How can the level of Alat and Asat in the blood be reduced?
  • 1.13 Prevention of liver diseases
    • 1.13.1 1. Proper nutrition.
    • 1.13.2 2. Refusal of bad habits.
    • 1.13.3 3. Physical activity.
    • 1.13.4 4. Doctor’s instructions.
    • 1.13.5 5. Taking protective measures.
  • 1.14 How to keep the liver healthy?
  • 1.15 Conclusions
  • 1.16 Related videos:
  • 1.17 Q&A:
    • • 1.17.0.1 What are alat and asat?
      • 1.17.0.2 What values ​​of alat and asat in the blood can be considered normal?
      • 1.17.0.3 What are the reasons for the increase in the level of ALAT and ASAT in the blood?
      • 1.17.0. 4 How can I lower my ALAT and ASAT levels?
      • 1.17.0.5 What symptoms are signs of elevated levels of ALAT and ASAT?
      • 1.17.0.6 Who is at particular risk for elevated ALAT and ASAT?
      • 1.17.0.7 Can ALAT and ASAT levels fall back to normal without treatment?
      • 1.17.0.8 What is the significance of alat and asat in the diagnosis of diseases?

Alat and asat are liver enzymes that can be found in the blood when liver function is impaired. Find out how the test is done, what the results mean, and what diseases can be associated with elevated enzyme levels.

The liver is an organ that plays a key role in processing food and removing waste from the body. Under normal conditions, the liver produces enzymes that help break down the fats and proteins in food. If the liver is exposed to toxins, infection, or other type of stress, the concentration of these enzymes in the patient’s blood may increase.

The two most common enzymes measured in the blood for suspected liver disease are Alat and Asat. They are produced in the liver and can become “excessive” when liver cells become damaged or die. Therefore, the measurement of Alat and Asat levels is an important component in the diagnosis of many liver diseases.

In this article, we will look at why measuring the concentration of Alat and Asat in the blood can help in the diagnosis of liver diseases, what indications for such a study exist, and how to properly prepare for analysis and interpret the results.

Liver enzymes: what are they?

Liver enzymes are protein compounds that help carry out metabolic processes in the body. These enzymes are found in various liver cells and act as markers that may indicate the presence of pathologies in the organ or other possible diseases.

Some other liver enzymes such as lactate dehydrogenase (LDH) and gamma-glutamyl transferase (GGT) can also help determine liver health. LDH is normally found in high concentrations in various body tissues, including the liver. GGT, like ALAT and ASAT, is located in the liver and can be used to detect the presence of diseases in this organ.

• Important to remember: High levels of liver enzymes are not always indicative of disease. There are many factors that can increase the levels of these enzymes, such as the use of alcohol and certain medications. In any case, if you have elevated levels of liver enzymes, you need to consult a doctor for further examination and diagnosis.

Liver tests

The liver is one of the most important organs in our body. It performs many functions responsible for metabolism, blood purification and storage of the necessary substances. One way to monitor liver health is through liver tests.

Your doctor may order liver tests if the patient complains of abdominal pain, nausea, loss of appetite, fatigue, or jaundice. Tests can be used to determine the cause of elevated enzyme levels, which may be due to alcoholism, a viral infection, drug poisoning, or other causes. Liver function tests can also monitor the effectiveness of treatment and track changes over time.

Enzyme Normal level Increased level may indicate

If the patient is scheduled for a liver test, the patient should follow all of the doctor’s instructions, such as not eating before the blood test and avoiding alcohol. In addition, it is important to understand that elevated levels of these enzymes do not always mean liver disease; sometimes they can be elevated with other diseases or medications.

Alat and Asat: key indicators of liver enzymes

What are Alat and Asat?

Alat and Asat are important enzymes produced by the liver that can affect the health of the body. Alat (Alanine transaminase) and Asat (Aspartate transaminase) are associated with protein metabolism and are involved in the process of amino acid degradation.

High levels of Alat and Asat in the blood may indicate problems in the functioning of the liver. A key indicator of the level of Alat and Asat in the blood is used to determine the harmful effects of medications taken. It can also help in the diagnosis of various liver diseases such as hepatitis, cirrhosis and others.

1. Alat is mainly produced by the liver and, to a lesser extent, by the muscles and kidneys.
2. Asat is most commonly produced in the heart, liver and muscles.

If the level of Alat and Asat in the blood is increased, it is necessary to consult a doctor for additional studies and determination of the cause. Controlling your liver enzyme levels is an important part of your overall health and can help prevent various diseases.

The norm of the level of Alat and Asat in the blood

Alat and Asat are enzymes that are normally found inside liver cells. If the liver cells are damaged, these enzymes are released into the blood, causing their levels to rise to abnormal levels. However, the level of Alat and Asat can be increased in various diseases and even with regular intake of certain medications.

Alat and Asat levels may vary slightly depending on age, gender and other factors such as being obese or taking certain medications. In addition, different laboratories may use different methods and reagents, which may lead to some deviations in the measurement of Alat and Asat levels.

If the level of Alat and Asat exceeds the norm, this may indicate the presence of pathological processes in the liver. To determine the exact cause of the increase in the level of Alat and Asat, it is necessary to perform additional tests and examinations, which must be prescribed by a doctor.

Causes of increased levels of Alat and Asat in the blood

Pathological processes in the liver

Alat and Asat are enzymes that are found in large quantities in liver cells. Therefore, an increase in the level of Alat and Asat in the blood indicates violations of the liver. This can be caused by various pathological processes in the liver, such as cirrhosis, hepatitis, fatty degeneration, and others.

Injuries and toxic effects

Elevated levels of Alat and Asat can be caused by trauma to the liver, such as bruises, falls or car accidents. Also, increased rates can be caused by toxic effects on the liver, for example, when drinking alcohol, drugs, or when using drugs that have hepatotoxic properties.

Diseases of other organs

Sometimes elevated levels of Alat and Asat in the blood can be caused by diseases of other organs not related to the liver. For example, it may be associated with diseases of the heart, pancreas, or kidneys.

Pathology of muscle tissue

Increased levels of Alat and Asat can also be associated with pathology of muscle tissue, for example, in the destruction of muscle fibers during myopathies or during intense physical exertion, especially in untrained people.

Conclusions

An increase in the level of Alat and Asat in the blood is an unfavorable signal for health, as it may indicate various diseases. Therefore, with an increase in the level of these enzymes, you should consult a doctor to conduct an examination and find out the reason for the increase in the level of Alat and Asat.

Causes of low levels of Alat and Asat

Alat and Asat are liver enzymes that are present in the blood. Their elevated level indicates a violation of liver function. But what if the levels of these enzymes are low?

Vitamin B6 deficiency may be one of the reasons, since this vitamin is an important catalyst for the processes associated with Alat and Asat. A lack of vitamin B6 can cause a decrease in the level of these enzymes in the blood.

Another reason may be long-term use of drugs such as hepatoprotectors or antibiotics, which may have an inhibitory effect on liver function. Decreased levels of Alat and Asat can also be associated with anemia or certain infections such as viral hepatitis.

Finally, many people who lead a healthy lifestyle may have low levels of Alat and Asat, as these enzymes are associated with alcohol, fat and protein metabolism, which can be reduced with a healthy diet and exercise.

In any case, the decrease in Alat and Asat should be considered along with other tests and clinical findings to determine possible causes and necessary treatment measures.

Symptoms of elevated levels of Alat and Asat

Alat and Asat are enzymes produced in the liver and can be used to evaluate liver function. Elevated levels of these enzymes may indicate problems with the liver or other organs.

One of the most common symptoms of an increase in Alat and Asat is jaundice, which manifests itself in the form of yellow eyes and skin. There may also be an increase in the size of the liver and spleen, as well as discomfort or pain in the right upper quadrant of the abdomen.

Other symptoms of an increase in Alat and Asat can be fatigue, a constant feeling of weakness, loss of appetite and involuntary weight loss. In some cases, elevated levels of these enzymes may be asymptomatic and only show up on blood tests.

In any case, elevated levels of Alat and Asat require diagnosis and treatment under medical supervision. It is necessary to conduct regular medical examinations and monitor the condition of your body in order to detect and prevent health problems in a timely manner.

Analysis for Alat and Asat: preparation and conduct

Preparation for analysis

Before undergoing analysis for Alat and Asat, a number of simple rules must be observed. It is not recommended to take food and alcohol 8 hours before donating blood. Also, do not engage in physical activity, no matter how insignificant it may be. Before the analysis, it is necessary to clarify the family and medical history, as well as inform the attending physician about the use of any medications and supplements.

Testing

Testing for Alat and Asat is performed from a vein on an empty stomach. The specialist takes blood from a vein using a special syringe and sends it to the laboratory for analysis. The results of the analysis are usually ready in a day, sometimes in 2-3 days.

Decode results

Liver tests for liver enzymes are used to determine the level of Alat and Asat in the blood. The level of these enzymes may indicate possible diseases of the liver or gallbladder. The normal value of Alat is 5-40 IU / l, and Asat – 5-37 IU / l. However, the norms may vary slightly depending on the laboratory, so the results should only be interpreted in conjunction with the attending physician.

It is important to remember that the analysis for Alat and Asat is only an additional tool in the diagnosis of diseases. The results of the analysis should be evaluated in conjunction with other data – medical history, complete blood count, ultrasound and other studies. Only in this case, you can get an accurate diagnosis and start treatment.

Preparation for analysis for Alat and Asat

For correct diagnosis of the liver condition, it is necessary to take a blood test for Alat and Asat. These indicators reflect the work of this body, reveal the presence of violations in its functioning and establish the cause of the disease.

Preparation for analysis is carried out according to simple rules:

• 10-14 days before the analysis, do not take drugs that can affect liver function;
• Avoid alcoholic beverages, low-fat foods, and high-fat foods 3 days before the test;
• do not smoke, drink coffee, tea or chocolate a few hours before the test;
• On the day of the test, bring your passport and doctor’s referral;

Responsibly treat the preparation for the analysis for Alat and Asat, as this helps to more accurately determine the cause of the disease and prescribe the necessary treatment.

Interpretation of ALAT and ASAT blood test results

What are ALAT and ASAT?

ALAT (alanine aminotransferase) and ACAT (aspartate aminotransferase) are enzymes released by the liver into the blood. They are actively involved in metabolic processes and the production of proteins in the body.

What do elevated blood levels of ALAT and ASAT mean?

An increase in the levels of ALAT and ACAT in the blood may indicate a violation of liver function. This is usually associated with various pathologies, such as hepatitis, cirrhosis of the liver, fatty liver and other diseases.

However, elevated blood levels of these enzymes can also be caused by certain medications, alcohol, stress, and strenuous exercise.

What do low blood levels of ALAT and ASAT mean?

Decreased blood levels of ALAT and ACAT are not usually diagnostic of liver disease. This may indicate a violation of the functions of these enzymes, but may also be due to insufficient intake of necessary substances in the body and some other reasons.

How to interpret test results?

Interpretation of ALAT and ASAT blood test results should only be performed by a qualified physician based on a comprehensive analysis of the patient’s general condition, medical history and other factors.

Elevated levels of ALAT and ACAT in the blood may indicate the presence of liver disease, but require further examination and confirmation of the diagnosis. Constantly monitoring the blood levels of these enzymes can help diagnose liver problems early and take the necessary steps to treat them.

What to do in case of elevated levels of Alat and Asat?

High levels of Alat and Asat may indicate the presence of liver diseases such as hepatitis, cirrhosis, fatty degeneration and others. In this case, it is necessary to consult a gastroenterologist or hepatologist for further examination and treatment.

In addition, there are several recommendations that can help improve performance:

• maintain a healthy lifestyle: stop smoking, moderate alcohol consumption, eat healthy, exercise;
• take only medicines approved by your doctor;
• Monitor your cholesterol and blood sugar levels, as high levels can adversely affect the liver.

In any case, a more accurate diagnosis and prescription of treatment is possible only after examination by a doctor.

How can the level of Alat and Asat in the blood be reduced?

To reduce the level of Alat and Asat in the blood, you need to take a quality approach to your health. It is necessary to stop drinking alcohol and smoking, as this is the main source of increased levels of Alat and Asat.

You also need to pay attention to nutrition. The diet should contain foods rich in vitamins and minerals, such as vegetables, fruits, herbs, nuts, fish and meat.

It is important not to forget about an active lifestyle, as exercise will help improve blood circulation and reduce the level of Alat and Asat in the blood.

In addition, elevated levels of these enzymes should see a doctor. Treatment may include taking special medications and following a diet.

• Stop drinking alcohol and smoking
• Proper nutrition
• Active lifestyle
• Medical consultation and treatment

Prevention of liver diseases

1.

Proper nutrition.

One of the most important factors in the prevention of liver disease is proper nutrition. Red meat, heavy consumption of fatty and fried foods, alcohol, strong coffee and tea – all this adversely affects the functioning of the liver. The diet should contain a lot of fruits, vegetables, fish, dairy products and greens.

2. Refusal of bad habits.

Alcoholism and smoking are the main bad habits that damage the liver. It is necessary to completely abandon them in order to preserve the health of the liver.

3. Physical activity.

Regular exercise and exercise help strengthen the body and improve overall health, including the liver.

4. Doctor’s instructions.

Follow your doctor’s advice to prevent liver disease. In case of liver disease, it is necessary to strictly follow the prescribed treatment and undergo regular examinations.

5. Taking protective measures.

To avoid infection with viral hepatitis, you must follow the rules of personal hygiene, do not share other people’s personal belongings. Hepatitis A and B vaccinations are also recommended.

How can I keep my liver healthy?

The liver is a large and complex organ that performs many functions in our body. It is involved in metabolism, normalization of blood glucose levels, cleaning of toxins and much more. It is important to take care of the health of the liver in order to avoid various diseases and problems.

Some of the following tips can help you keep your liver healthy:

• Give up bad habits. Smoking, drinking alcohol and certain drugs can seriously damage the health of the liver. It is necessary to abandon such habits in order to avoid problems with the liver.
• Proper nutrition. Avoid fatty, spicy, fried and high-calorie foods. It is useful to eat vegetables, fruits, herbs, bread made from whole grain flour.
• Physical activity. Sports and exercise can help keep your liver healthy. They help facilitate the release of toxins and other harmful substances.
• Avoidance of harmful substances. Maintain a healthy lifestyle and avoid exposure to hazardous substances that can harm your liver.
• Treat diseases in time. You may develop a disease that can seriously damage the health of your liver. Treat diseases in time to avoid such problems.

By following these simple tips, you can keep your liver healthy, avoid problems and enjoy life to the fullest.

Conclusions

Alat and asat are liver enzymes that can be detected in the blood when the level of liver damage is high enough. The levels of these enzymes can give an indication of the level of damage, but do not always allow for an accurate diagnosis. Therefore, it is important to conduct additional research to determine the cause of the increase in the levels of these enzymes.

Elevated levels of alat may indicate liver damage, but may also be associated with other problems, such as increased physical activity or medication. Elevated levels of asat can also be associated with liver damage, as well as heart and muscle problems.

Therefore, additional investigations such as ultrasound, MRI or liver biopsy are necessary for an accurate diagnosis.

If an increase in the levels of alat and asat is detected, it is necessary to consult a doctor for additional studies and determine the cause of this phenomenon. Prompt treatment can help prevent further liver damage and preserve liver function.

Related videos:

Q&A:

What are alat and asat?

Alanine aminotransferase (ALAT) and Aspartate aminotransferase (ASAT) are enzymes made in the liver and used to break down amino acids in the body.

What values ​​of alat and asat in the blood can be considered normal?

Normal values ​​for ALAT can range from 0 to 45 units/L, and for ASAT from 0 to 35 units/L.

What are the reasons for the increase in the level of ALAT and ASAT in the blood?

Elevated levels of ALAT and ACAT may indicate the presence of liver diseases such as hepatitis, cirrhosis or fatty degeneration. They can also indicate the presence of heart disease, alcohol dependence or other metabolic disorders in the body.

How can I lower my ALAT and ASAT levels?

To lower the levels of ALAT and ASAT, you first need to find out the reason for their increase. Typically, this may be due to lifestyle changes, including avoiding alcohol and changing diet. In some cases, medication may be required.

What are the symptoms of elevated levels of ALAT and ASAT?

Elevated levels of ALAT and ASAT may not present with obvious symptoms. However, if they are caused by liver disease, symptoms such as jaundice, liver enlargement, fatigue, anemia, etc. are possible.

Who is at particular risk for elevated ALAT and ASAT?

People who have alcoholic or fatty liver disease, or who take medications that can damage the liver, are at increased risk of elevated blood levels of ALT and ACAT.

Can ALAT and ASAT levels return to normal without treatment?

If elevated levels of ALAT and ASAT are caused by lifestyle changes, they may return to normal without treatment. But if they are caused by a disease, then treatment is needed to return the levels of ALAT and ASAT to normal levels.

What is the significance of alat and asat in the diagnosis of diseases?

Measurement of ALAT and ASAT levels is a simple and inexpensive method for diagnosing possible liver-related diseases. However, for specific diagnosis and treatment, additional testing is usually required.

When the liver goes wrong: a gastroenterologist named 4 common reasons why ALT and AST are elevated in the blood

• Health

However, the growth of these main “liver” markers in a blood test does not always indicate problems.

April 25, 2022

Source:

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A biochemical blood test is considered one of the main ways to find out if the liver copes with the load of “wrong” nutrition, alcohol, and medication. This will be told by such indicators in the analysis as ALT (alanine aminotransferase) and AST (aspartate aminotransferase) – these liver enzymes are among the first to respond to malfunctions of the organ.

– If there is an increase in both ALT and AST, this means that the liver cells are destroyed and the enzymes from them enter the blood. (…) An increase in AST and ALT means that an inflammatory process is taking place in the liver and its cells are being destroyed. If the indicators are above the norm, you need to contact a gastroenterologist, – gastroenterologist Maria Lopatina wrote in her telegram channel, adding that the upper limits of the norm may differ in different laboratories and one must focus on those established where the analysis was taken.

The doctor named the 4 most common causes of increased liver values.

Chronic viral hepatitis

With an increase in ALT and AST in the blood, viral hepatitis B and C are always excluded first. This is very important, as they can be asymptomatic, while destroying the liver. Mandatory tests: HBsAg – hepatitis B and Anti-HCV – hepatitis C.

Non-alcoholic fatty liver disease

When fatty degeneration of liver cells destroys them, ALT and AST in the blood increase and steatohepatitis develops.

Fatty liver disease is suspected if:

• Waist circumference ≥94/≥80 cm in men/women;

• Blood pressure 130/85 mmHg And more, or the person is taking antihypertensive drugs;

• Fasting glucose level of 5.6 mmol/l or more, or the person is taking hypoglycemic drugs;

• Serum triglycerides more than 1.7 mmol/l;

• High-density lipoprotein (HDL) level less than 1.0/1.3 mmol/l in men/women.

Drug-induced liver injury

All drugs that we take by mouth pass through the liver. The more drugs we take, the more likely it is to be damaged. This group includes both herbal preparations and dietary supplements. Liver damage can occur immediately or after several weeks.

Alcohol

According to Russian clinical guidelines, a safe dose for the liver in women is 20 grams of ethanol per day, for men – 40 grams. Regular excess of this dose leads to the development of alcoholic hepatitis and an increase in ALT and AST.

Determining the ethanol content in 100 ml of a drink is very simple: the percentage of alcohol in the drink must be multiplied by 0.8. Thus, 100 ml of 40% vodka contains 40×0.8=32 grams of ethanol, and 100 ml of 12% wine contains 12×0.8=9.6 grams of ethanol.

The doctor explains that there are other reasons for the increase in ALT and AST in the blood, but these four are the most common.

Read also

When an increase in the indicator is not a cause for alarm

It happens that an increase in the level of “liver” indicators may not be associated with a problem in the work of our main “filter”. According to gastroenterologist Maria Lopatina, this may be the case if only the AST index is elevated.

– AST is found not only in the liver, but also in the heart, muscles, kidneys, brain and pancreas. If AST levels are elevated and ALT is normal, causes that are not related to damage to liver cells should be ruled out. For example, active training for all muscle groups, the doctor clarifies.

But if the liver values ​​are below normal in the blood test, in most cases this is not a cause for serious concern. According to the gastroenterologist, a decrease in their level can occur during pregnancy, starvation and a reduced content of vitamin B6.

What other indicators of a blood test can be used to understand that something is not right with the liver, read HERE.

Signs of liver problems that can be seen in the mirror

According to doctors, the liver does not hurt in the usual sense of the word, especially at first – the specific symptoms of the disease appear when things have gone too far. As the head of the MIBS outpatient department, gastroenterologist Iyri Alaya said, liver diseases are often accompanied by various digestive disorders:

• Increased gas formation;

• Feeling of fullness in the stomach;

• Rapid satiety after eating;

• Loss of appetite;

• Dryness and bitterness in the mouth;

• Attacks of nausea and vomiting;

• Constipation or diarrhoea.