Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The liver is the largest solid organ in the body. I think a lot of people
probably know that. But they may not know that it is also the largest gland in
the body. You see, the liver is also considered a gland because, among its
various functions, it makes and secretes bile. (Just for your reference, the
stomach and intestine are large hollow organs. Glands are organs or parts of
organs that make and secrete substances. And bile is a fluid that both aids in
digestion and transports fats as well as waste products into the intestine.)
The liver, located in the right upper portion of the abdominal cavity just
beneath the right side of the rib cage, has many vital functions. Briefly, some
of these functions are:
Detoxification of blood
Production of important clotting factor and other important proteins
Metabolizing (processing) medications and nutrients
Liver blood tests are some of the most commonly performed blood tests. These tests can assess liver functions or liver injury. An initial step in detecting liver damage is a simple blood test to determine the presence of certain liver enzymes (proteins) in the blood. Under normal circumstances, these enzymes 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 necessary chemical reactions in the body.
Among the most sensitive and widely used liver enzymes are the
aminotransferases. They include aspartate aminotransferase (AST or SGOT) and
alanine aminotransferase (ALT or SGPT). These enzymes are normally contained
within liver cells. If the liver is injured or damaged, the liver cells spill
these enzymes into the blood, raising the enzyme levels in the blood and
signaling liver disease.
Other blood tests pertaining to the liver are measurements of some of the other enzymes found the liver. In addition to AST and ALT,
alkaline phosphatase, 5' nucleotidase, and gamma-glutamyl transpeptidase (GGT) are other enzymes located in the liver. The focus of this article is mainly on the most common liver enzymes, AST and ALT.
What are the aminotransferases?
The aminotransferases 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.
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).
To put matters
briefly, AST = SGOT and ALT = SGPT.
Normally, where are the aminotransferases?
AST (SGOT) is normally found in a
variety of tissues
including liver, heart, muscle, kidney, and brain. It is
released into the serum when any one of these tissues is damaged. For example,
its level in serum rises in
heart
attacks or with muscle disorders. It is therefore, not a
highly specific indicator of liver injury as it can occur from 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 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.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Infectious mononucleosis is a virus infection in which there is an increase of white blood cells
that are mononuclear (with a single nucleus) "Mono" and "kissing
disease" are popular terms for this very common illness caused by the
Epstein-Barr virus (EBV).
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Celiac disease is a result of an immune reaction to gluten, a protein found in wheat or related grains and present in many foods that we eat. Celiac disease causes impaired absorption and digestion of nutrients through the small intestine. Signs and symptoms of celiac disease include malabsorbption (diarrhea, foul smelling gas, bloating, and increased amounts of fat in the stool) and malnutrition (weight loss, edema, anemia, bruising easily, neuropathy, and infertility). Treatment for celiac disease is a gluten free diet, and at times if necessary, medications
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
Tylenol liver damage (acetaminophen) can occur from accidentally ingesting too much acetaminophen, or intentionally. Acetaminophen is a drug contained in over 200 OTC and prescription medications from NyQuil to Vicodin. Avoiding unintentional overdoses include reading medication labels, write down the dosages of medications you are taking, do not drink excessive alcohol while taking acetaminophen. In severe cases, a liver transplant may be necessary.
Nonalcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver disease ranging from simple fatty liver (steatosis), to nonalcoholic steatohepatitis (NASH), to cirrhosis (irreversible, advanced scarring of the liver). All of the stages of NAFLD have in common the accumulation of fat (fatty infiltration) in the liver cells (hepatocytes).
Leprosy (Hansen's disease) is a disfiguring disease caused by infection with Mycobacterium leprae bacteria. The disease is spread from person to person through nasal secretions or droplets. Symptoms and signs of leprosy include numbness, loss of temperature sensation, painless ulcers, eye damage, loss of digits, and facial disfigurement. Leprosy is treated with antibiotics and the dosage and length of time of administration depends upon which form of leprosy the patient has.
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.
Hereditary hemochromatosis (iron overload) is an inherited disorder in which there is excessive accumulation of iron in the body. Individuals may have no symptoms or signs, or they can have severe symptoms and signs of iron overload. The most effective treatment for hemochromatosis is therapeutic phlebotomy.
Encephalopathy means brain disease, damage, or malfunction. Causes of encephalopathy are varied and numerous. The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors, and coma. Treatment of encephalopathy depends on the type of encephalopathy (anoxia, diabetic, Hashimoto's, hepatic, hyper - hypotensive, infectious, metabolic, infections, uremic, or Wernicke's) are examples of types of encephalopathy.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
Primary Biliary Cirrhosis is a chronic disease characterized by progressive inflammation and destruction of small bile ducts within the liver. The bile ducts transport bile from the liver to the intestine for the absorption of fat and elimination of waste products. The causes of Primary Biliary Cirrhosis may involve autoimmunity, infection, or genetic predisposition, acting alone or in combination. There are many medications and treatment options available for those with this and other associated diseases of Primary Biliary Cirrhosis.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Brucellosis is an infectious disease caused by the Brucella bacteria. Symptoms and signs include sweating, fever, fatigue, dizziness, headache, cough, chest, joint, and abdominal pain, and enlarged liver and/or spleen. Brucellosis is treated with antibiotics.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Rocky Mountain spotted fever (RMSF) is an infectious disease that's transmitted by the bite of a tick infected with the Rickettsia rickettsii bacterial organism. Initial symptoms of RMSF include fever, nausea, vomiting, muscle pain and severe headache. Later symptoms include rash, abdominal pain, joint pain, and diarrhea. Treatment usually involves a tetracycline antibiotic.
Alpha-1 antitrypsin deficiency is an inherited disorder that may cause liver and lung disease in adults. Signs and symptoms include shortness of breath, wheezing, weight loss, respiratory infections, fatigue, vision abnormalities. Advanced lung disease from alpha-1 antitrypsin deficiency include emphysema. Liver damage from alpha-1 antitrypsin deficiency causes a swollen abdomen, swollen legs or feet, and jaundice.
Schistosomiasis (snail fever), a disease caused by parasites, causes a variety of symptoms and signs, such as cough, rash and bloody diarrhea. Praziquantel is used in the treatment of schistosomiasis.
Rocky Mountain spotted fever is
caused by the bacterium Rickettsia rickettsii.
The bacterium is spread to
humans through the bite of infected ticks, and so the disease is most common in
months where ticks are active, such as summer.
Despite the name, the disease
is not limited to the Rocky Mountains but rather occurs throughout most of the
U.S.
Symptoms of headache,
fever, and fatigue begin about a week after exposure. A
few days later, a rash develops. The rash may be so mild that it is hard to see
or so dramatic that it progresses to gangrene. Other possible symptoms include
confusion, abdominal pain, and vomiting.
Most cases require hospitalization,
and severe cases require intensive care.
The disease is diagnosed by finding
high titers of antibodies in the blood or by seeing the organism under a
microscope in specially stained skin biopsies...
Healthy Living Tips
Health News Feed
