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ELEVATED SERUM AMINOTRANSFERASES
- 1. By: Haitham Sulaiman A Habtar University No. : 432800200 S/N : 103
- 2. AminotransferaseAminotransferase What is the Aminotransferase ??? Aminotransferases are enzymes , (proteins that help speed up chemical reactions in the body) . Where it’s found ??? found mainly in the liver, but also in other tissues, such as muscles. Haitham S Habtar 2
- 3. Mechanism of Aminotransferase It’s an enzyme that catalyzes a type of reaction between an amino acid and an -α keto acid. Haitham S Habtar 3
- 4. Why Aminotransferase is importantWhy Aminotransferase is important important in the synthesis of amino acids, which form proteins. in medicine, they are an important indicator of liver damage. And there is two important indicator : a. aspartate aminotransferase ( AST ) b. alanine aminotransferase ( ALT ) Haitham S Habtar 4
- 5. AST & ALTAST & ALT How to measure the AST & ALT The ALT and AST levels are obtained directly from a blood sample that is sent to the laboratory for measurement. [ The results are usually available within hours to days ] Haitham S Habtar 5
- 6. Normal rang for AST & ALT • Normal levels of AST and ALT may slightly vary depending on the individual laboratory's reference values and area . AST ALT Male 14–20 U/L 10–40 U/L Female 10–36 U/L 7–35 U/L Haitham S Habtar 6
- 7. ELEVATED SERUMELEVATED SERUM AMINOTRANSFERASESAMINOTRANSFERASES In the setting of hepatocyte damage, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are released from hepatocytes, leading to increased serum levels. Haitham S Habtar 7
- 8. Acute liver failure : Acute liver failure is characterized by acute hepatocellular injury with LFTs typically more than 10 times the upper limit of normal, Marked elevation without liver failure : Patients with marked elevations in their liver function tests (approximately 15 times the upper limit of normal or higher) often have acute hepatitis, though in some cases, there may be underlying chronic liver disease Haitham S Habtar 8
- 9. Elevated Levels of AST and ALT Elevated levels of liver enzymes in general signify some form of liver (or hepatic) damage or injury These levels may be elevated acutely (short term) indicating sudden injury to the liver, or they may be elevated chronically (long term) suggesting ongoing liver injury. In addition to the duration, the level of abnormal elevation of the aminotransferases is also significant. In some conditions the elevation could be mild, consistent with a mild injury or inflammation of the liver.They can also be severely elevated, possibly up to 10 to 20 times the normal values, suggesting more significant damage to the liver. Haitham S Habtar 9
- 10. DiseasesThat Cause Elevation Levels of AST and ALT Common • Acute viral hepatitis • Chronic viral hepatitis • Cirrhosis of the liver • Liver damage from alcohol abuse or alcoholic fatty liver • Hemochromatosis • Diminished blood flow to the liver (from shock or heart failure) Less Common • Wild mushroom • Wilson's disease • Autoimmune hepatitis • Gallstone * Some Medications can cause elevation in AST & ALT Haitham S Habtar 10 • Pregnancy • Muscle injury
- 11. What to do if i suspect the AST & ALT high ??!! • The most important step is to take a medical history and perform a complete medical examination. Record all the patient's medications,Any history of blood transfusion, history of intravenous injections , drug use or needle sharing, tattoos, sexual contact with someone with possible viral hepatitis, alcohol consumption, foreign travel Haitham S Habtar 11
- 12. Symptoms & sing with elevation of AST & ALT • Symptoms and sing may vary from no symptoms at all to generalized • malaise, • fatigue, • fever, • poor appetite, • abdominal pain, • jaundice (yellowing of skin), • itching, • nausea, or • vomiting. Haitham S Habtar 12
- 13. Haitham S Habtar 13 Typical serum aspartate aminotransferase (AST) or alanine aminotransferase (ALT) values for various diseases. Note that the horizontal axis is a log scale. As shown, the amino-trans-ferases are often normal in patients with cirrhosis. In patients with uncomplicated alcoholic hepatitis, the AST value is rarely greater than 500 U per L and is usually no more than 200 to 300 U per L. The highest peak aminotransferase values are found in patients with acute ischemic or toxic liver injury. ( this figure from American Academy of Family Physicians )
- 14. Management After taking complete medical history and perform a complete medical examination If we don’t reach the correct diagnose we have to do further investigation Then treat the underlying cause Haitham S Habtar 14
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