The Correlation of Transaminases and Liver Diseases | Alanine Transaminase | Hepatitis

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  1 THE CORRELATION OF TRANSAMINASES AND LIVER DISEASES Bastianus Alfian Juatmadja, I Wayan Putu Sutirta Yasa, DAP Rasmika Dewi, Bagus Komang Satriyasa Department of Clinical Pathology Faculty of Medicine Udayana University / Sanglah Hospital ABSTRACT The symptoms of liver diseases are very diverging, from the mild one till the severe one. Sometimes we may find that severe heart disorders but the symptoms are too less. We need some tools to make a good diagnosis. We can not only use a good anamnesis, but also have to use good physical examination and the other support test. Transaminase also called aminotransferase. This aminotransferase catalyzes the transfer of the amino group (−NH2) of an amino acid to a carbonyl compound. The liver contains specific transaminases for the transfer of an amino group from glutamic acid to α -keto acids that correspond to most of the other amino acids. Other transaminases catalyze reactions in which an amino group is transferred from glutamic acid to other compounds. Transamination is one of the principal mechanisms for the formation of necessary amino acids in the metabolism of proteins. Transaminase as a sign to cell damage may divided into Serum Glutamic Oxalocetic Transaminase  ( SGOT), Serum Glutamic Pyruvic Transaminase (SGPT), and Lactic Dehydrogenase (LDH). Gamma GT and alkali fosfatase correlate with cholestasis. Cholinestrase correlate with liver synthesis capacity. Keywords: Transaminase, amino group, α -keto acids Introduction Early detection to these liver diseases is absolutely needed to decrease the morbidity and mortality. Early detection means early treatment. A good and precise treatment may decrease the diseases progressivity and may cure the diseases 1 . Among the most sensitive and widely used blood tests for evaluating patients with hepatitis are the liver enzymes, called aminotransferases. They include aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT). These enzymes normally are contained within liver cells. If the liver is injured (as in viral  2 hepatitis), the liver cells spill the enzymes into the blood, raising the enzyme levels in the  blood and signaling that the liver is damaged 1 . The most useful aminotransferase are SGPT, gamma GT and CHE. SGPT is used to find the cell damage, gamma GT is used as a sign of cholestasis and CHE is used as a sign of liver synthesis disorder  1 . The Abnormalities of ALT Alanine transaminase (ALT) is an enzyme found in the highest amounts in the liver. Injury to the liver results in release of the substance into the blood.   The normal range of values for ALT is from 7 to 56 units per liter of serum. An increase in ALT levels may be due to Acute pancreatitis, Celiac disease, Cirrhosis, Death of liver tissue (liver necrosis), Hepatitis (viral, autoimmune), Hereditary hemochromatosis , Infectious mononucleosis, Lack of  blood flow to the liver (liver ischemia), Liver disease, Liver tumor, Use of drugs that are  poisonous to the liver  2 . The Abnormalities of AST AST (aspartate aminotransferase) is an enzyme found in high amounts in heartmuscle and liver and skeletal muscle cells. It is also found in lesser amounts in other tissues. The normal range of values for AST is from 5 to 40 units per liter of serum. An increase in AST levels may indicate acute hemolytic anemia, acute pancreatitis, acute renal failure, Cirrhosis, heart attack, hepatitis, hereditary hemochromatosis,infectious mononucleosis, lack of blood flow to the liver (liver ischemia), liver necrosis, Liver tumor, multiple trauma,  3  primary muscle disease, progressive muscular dystrophy, recent cardiac catheterization or angioplasty, recent convulsion, recent surgery, severe deep burn, skeletal muscle trauma, use of drugs that are poisonous to the liver  3 . The Abnormalities of Cholinesterase Serum cholinesterase is a test that looks at blood levels of certain enzymes (acetylcholinesterase and pseudocholinesterase) that help the nervous system work properly. Acetylcholinesterase (also known as RBC cholinesterase) and pseudocholinesterase (also known as butyrylcholinesterase or plasma cholinesterase) help break down a chemical that nerves need to send signals. Decreased pseudocholinesterase levels may be due to acute infection, chronic malnutrition, heart attack, liver damage, metastasis, obstructive jaundice,  poisoning from organophosphates (chemicals found in some pesticides), and smaller decreases may be due to pregnancy, use of birth control pills. Acetylcholinesterase is found in nerve tissue and red blood cells. Pseudocholinesterase is found primarily in the liver  3 . The Abnormalities of LDH Lactate dehydrogenase (LDH) is found in many body tissues like the heart, liver, kidney, skeletal muscle, brain, blood cells, and lungs. LDH exists in 5 forms, which differ slightly in structure. LDH-1 is found primarily in heart muscle and red blood cells. LDH-2 is concentrated in white blood cells. LDH-3 is highest in the lung. LDH-4 is highest in the kidney, placenta, and pancreas. LDH-5 is highest in the liver and skeletal muscle. All of these can be measured in the blood 4 .  4  Normally, the level of LDH-2 is greater than LDH-1.   Greater-than-normal LDH levels may suggest heart attack, hemolytic anemia, hypotension, infectious mononucleosis, intestinal ischemia (blood deficiency) and infarction (tissue death), liver disease such as hepatitis, muscle injury, muscular dystrophy, pancreatitis, lung tissue death, stroke, and ischemic cardiomyopathy 4 . The Abnormalities of GGT The normal of gamma-glutamyl transpeptidase (GGT) range is 0 to 51 international units  per liter (IU/L) but normal value ranges may vary slightly among different laboratories. Greater-than-normal levels of GGT may indicate congestive heart failure, cholestasis (congestion of the bile ducts), cirrhosis, hepatitis, liver ischemia (blood flow deficiency), liver necrosis, liver tumor, use of hepatotoxic drugs (drugs toxic to liver) 2 . Possible Diseases that Signed by The Increasing of Transaminases Elevated blood levels of AST and ALT only means that the liver is inflamed, and elevations can be caused by many agents other than hepatitis viruses, such as medications, alcohol,  bacteria, fungus, etc. In order to prove that a hepatitis virus is responsible for the elevations,  blood must be tested for antibodies to each of the hepatitis viruses as well as for their genetic material 2 . We may use few classifications to simplify the understanding about these transaminases and liver diseases. These classifications are transaminases disorders in (1) acute viral hepatitis, (2) liver toxicity, (3) chronic hepatitis, (4) bile duct disease and cirrhosis bilier, (5) fatty liver, and (6) liver tumor  1 .
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