Liver Blood Tests (cont.)
How are healthy people evaluated for mild to moderate
rises in aminotransferase levels?
Evaluation of healthy patients with abnormal liver
enzymes needs to be individualized. A doctor may ask for
blood test data from old records for comparison. If no old
records are available, the doctor may repeat blood tests in
weeks to months to see whether these abnormalities
persist. The doctor will search for risk factors for
hepatitis B and C, including sexual exposures, history of
blood transfusions, injectable drug use, and occupational
exposure to blood products. A family history of liver
disease may raise the possibility of inherited diseases
such as hemachromatosis, Wilson's disease, or alpha-1-
antitrypsin deficiency.
A complete list of routine medications including over-the-counter medications needs to be reviewed as well. A complete physical examination by the doctor is another important part of the evaluation of abnormal liver tests.
The pattern of liver enzyme abnormalities can provide
useful clues to the cause of the liver disease. For
example, the majority of patients with alcoholic liver
disease have enzyme levels that are not as high as the
levels reached with acute viral hepatitis, and the AST tends
to be above the ALT. Thus, in alcoholic liver disease, AST
is usually under 300 units/liter while the ALT is usually
under 100 units/ liter.
If alcohol or medication is responsible for the abnormal
liver enzyme levels, stopping alcohol or the medication
(under a doctor's supervision only) should bring the enzyme
levels to normal or near normal levels in weeks to months.
If obesity is suspected as the cause of fatty liver, weight
reduction of 5% to 10% should also bring the liver enzyme
levels to normal or near normal levels.
If abnormal liver enzymes persist despite abstinence
from alcohol, weight reduction, and stopping certain
suspected drugs, blood tests can be performed to help
diagnose treatable liver diseases. The blood can be tested
for the presence of hepatitis B and C virus and their
related antibodies. Blood levels of iron, iron saturation,
and ferritin (another measure of the amount of iron stored
in the body) are usually elevated in patients with
hemachromatosis. Blood levels of a substance called
ceruloplasmin are usually decreased inpatients with
Wilson's disease. Blood levels of certain antibodies (anti-
nuclear antibody or ANA, anti-smooth muscle antibody, and
anti-liver and kidney microsome antibody) are elevated in
patients with autoimmune hepatitis.
Ultrasound and CAT scan of the abdomen are sometimes
used to exclude tumors in the liver or other conditions
such as gallstones or tumors obstructing the ducts that
drain the liver.
Liver biopsy is a procedure where a needle is inserted
through the skin over the right upper abdomen to obtain a
thin strand of liver tissue to be examined under a
microscope. The procedure is oftentimes performed after
ultrasound study has located the liver. Not everybody with
abnormal liver enzymes needs a liver biopsy. The doctor
will usually recommend this procedure if:
- the information
obtained from the liver biopsy will likely be helpful in
planning treatment,
- the doctor needs to know the extent
and severity of liver inflammation/damage,
- to evaluate the effectiveness of treatment, or
- no obvious cause of elevated liver tests has been found despite thorough investigation.
Liver biopsy is most useful in confirming a diagnosis of
a potentially treatable condition. These potentially
treatable liver diseases include chronic hepatitis B and C,
hemachromatosis, Wilson's disease, autoimmune hepatitis,
and alpha-1-antitrypsin deficiency.
Next: How about monitoring aminotransferase levels? »
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