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Evaluation Of Elevated Liver Enzymes

Yıl 2012, Cilt 12, Sayı 3, 129 - 135, 01.03.2012

Öz

There are numerous causes of elevated liver enzyme levels in both symptomatic and asymptomatic patients. As previously mentioned, ALT and AST are enzymes released from damaged hepatocytes into the blood, following hepatocellular injury or death, although they can originate from other tissues. Historical information and the physical examination are essential for the initial evaluation to determine the underlying etiology, associated systemic illnesses and to determine whether the liver injury is acute or chronic,. Aminotransferase elevations of up to five times gretar than normal may be seen in numerous chronic liver diseases as well as in acute hepatic processes. Elevations of hepatic alkaline phosphatase may be associated with cholestatic conditions. Cholestatic diseases can be categorized as to anatomic obstructions of bile flow (extrahepatic cholestasis) or as functional impairments of bile formation by the hepatocytes (intrahepatic cholestasis). Alkaline phosphatase elevations may be caused by diseases in organ systems outside the hepatobiliary system. 

Kaynakça

  • 1. Pratt DS, Kaplan MM. Evaluation of abnormal liver enzyme results in asymptomatic patients. N Engl J Med 2000;342:1266–71.
  • 2. Pratt DS, Kaplan MM. Laboratory tests. In: Schiff ER, Sorrell MF, Maddrey WC, eds. Schiff’s diseases of the liver. 8th Ed. Vol 1. Philadelphia: Lippencott-Raven, 1999: 205–44.
  • 3. Piton A, Poynard T, Imbert-Bismut F, et al. Factors associated with serum alanine transaminase activity in healthy subjects: consequences for the definition of normal values, for selection of blood donors, and for patients with chronic hepatitis C. Hepatology 1998;27:1213-9.
  • 4. Kundrotas LW, Clement DJ. Serum alanine aminotransferase (ALT) elevation in asymptomatic US Air Force basic trainee blood donors. Dig Dis Sci 1993;38:2145-50.
  • 5. Lott JA, Wolf PL. Alanine and aspartate aminotransferase (ALT and AST). Clinical enzymology: a case-oriented approach. Chicago, Year Book Medical Publishers, 1986,111-138.
  • 6. Green RM, Flamm S. AGA technical review on the evaluation of liver chemisty tests. Gastroenterology 2002;123:1367-1384.
  • 7. American gastroenterological association medical position statement: Evaluation of liver chemisty tests. Gastroenterology 2002;123:1364-1366.
  • 8. Management of hepatitis C. National Institutes of Health Consensus Development Conference, 1997.
  • 9. Saadeh S, Cammell G, Carey WD, Younossi Z, Barnes D, Easley K. The role of liver biopsy in chronic hepatitis C. Hepatology 2001;33:196–200.
  • 10. Perrillo RP. The role of liver biopsy in hepatitis C. Hepatology 1997;26(suppl 1):57S–61S.
  • 11. Ahmed A, Keeffe EB. Treatment strategies for chronic hepatitis C: update since the 1997 National Institutes of Health Consensus Development Conference. J Gastroenterol Hepatol 1999;14(suppl):S12–S18.
  • 12. Wong JB, Koff RS. Watchful waiting with periodic liver biopsy versus immediate empirical therapy for histologically mild chronic hepatitis C. A cost-effectiveness analysis. Ann Intern Med 2000;133:665–675.
  • 13. Schiff ER, Sorrell MF, Maddrey WC. Hepatitis B. Schiff’s diseases of the liver. 8th ed. Philadelphia: Lippincott Williams &Wilkins, 1999:757–758.
  • 14. Michielsen PP, Van Damme P. Viral hepatitis and pregnancy. Acta Gastroenterol Belg 1999;62:21–29.
  • 15. Alter MJ, Mast EE. The epidemiology of viral hepatitis in the United States. Gastroenterol Clin North Am 1994;23:437–455.
  • 16. Redlich CA, Beckett WS, Sparer J, et al. Liver disease associated with occupational exposure to the solvent dimethylformamide. Ann Intern Med 1988;108:680–686.
  • 17. Petersen P, Bredahl E, Lauritsen O, Laursen T. Examination of the liver in personnel working with liquid rocket propellant. Br J Ind Med 1970;27:141–146.
  • 18. Hoet P, Graf ML, Bourdi M, et al. Epidemic of liver disease caused by hydrochlorofluorocarbons used as ozone-sparing substitutes of chlorofluorocarbons. Lancet 1997;350:556–559.
  • 19. Reid AE. Nonalcoholic steatohepatitis. Gastroenterology 2001;121:710–723.
  • 20. Ballew C, Bowman BA, Russell RM, Sowell AL, Gillespie C. Serum retinyl esters are not associated with biochemical markers of liver dysfunction in adult participants in the third National Health and Nutrition Examination Survey (NHANES III), 1988–1994. Am J Clin Nutr 2001;73:934–940.
  • 21. Bacon BR, Farahvash MJ, Janney CG, et al. Non-alcoholic steatohepatitis: an expanded clinical entity. Gastroenterology 1994;107:1103–1109.
  • 22. Palmer M, Schaffner F. Effective weight reduction on hepatic abnormalities in overweight patients. Gastroenterology 1990;99:1403–1408.
  • 23. Adams PC, Kertesz AE, Valberg LS. Clinical presentation of hemochromatosis: a changing scene. Am J Med 1991;90:445–449.
  • 24. Powell LW, George DK, McDonnell SM, Kowdley KD. Diagnosis of hemochromatosis. Ann Intern Med 1998;129:925–931.
  • 25. Bassett ML, Halliday JW, Ferris RA, et al. Diagnosis of hemochromatosis in young subjects: predictive accuracy of biochemical screening tests. Gastroenterology 1984;87:628–633.
  • 26. Czaja AJ. Autoimmune hepatitis: evolving concepts and treatment strategies. Dig Dis Sci 1995;40:435–456.
  • 27. Krawitt EL. Autoimmune hepatitis. N Engl J Med 1996;334:897– 903.
  • 28. Crystal RG. Alpha-1 antitrypsin deficiency, emphysema, and liver disease: genetic basis and strategies for therapy. J Clin Invest 1990;85:1343–1352.
  • 29. Ludwig J, Moyer TP, Rakela J. The liver biopsy diagnosis of Wilson’s disease. Methods in pathology. Am J Clin Pathol 1994;102:443–446.
  • 30. Brewer GJ, Yuzbasiyan-Gurkan V. Wilson’s disease. Medicine 1992;71:139–164.
  • 31. Loudianos G, Gitlin JD. Wilson’s disease. Semin Liver Dis 2000;20:353–364.
  • 32. Yuce A, Demir H, Kocak N, Gurakan F, Ozen H. Antiendomysium and antigliadin antibodies for the diagnosis of celiac disease. Am J Gastroenterol 2000;95:1366–1367.
  • 33. Mugica F, Aranzadi MJ, Recasens M, et al. Adult celiac disease and hypertransaminasemia. Rev Esp Enferm Dig 2000;92:78–85.
  • 34. Naschitz JE, Yeshurun D, Zuckerman E, Arad E, Boss JH. Massive hepatic steatosis complicating adult celiac disease: report of a case and review of the literature. Am J Gastroenterol 1987;82:1186–1189.

Karaciğer Enzim Yüksekliğinin Değerlendirilmesi

Yıl 2012, Cilt 12, Sayı 3, 129 - 135, 01.03.2012

Öz

Semptomatik ve asemptomatik hastalarda karaciğer enzim yüksekliğinin sayısız nedenleri vardır. ALT ve AST diğer dokulardan kaynaklanabilmesine rağmen, hepatosellüler hasarı veya ölümü takiben kanda hepatosit hasarından salınan enzimlerdir. Karaciğer hasarının akut veya kronik olduğunu, altta yatan etiyolojiyi ve sistemik hastalıklarla ilişkisini anlamak için ilk değerlendirme hastanın öyküsünün alınması ve fizik muayene yapılmasıdır. Normalin beş katından daha fazla aminotransferaz yüksekliği, akut karaciğer hasarında olduğu gibi sayısız kronik karaciğer hastalığında da görülebilir. Karaciğer alkalen fosfatazın yükseklikleri kolestatik durumlarla ilişkili olabilir. Kolestatik hastalıklar hem safra akımının anatomik obstrüksiyonuna göre (ekstra hepatik kolestaz), hem de hepatosit tarafından safra formasyonunun fonksiyonel bozukluklarına göre (intra hepatik kolestaz) kategorize edilebilir. Alkalen fosfataz yükseklikleri hepatobiliyer sistem dışındaki organ sistemlerinin hastalıklarında oluşabilir. 

Kaynakça

  • 1. Pratt DS, Kaplan MM. Evaluation of abnormal liver enzyme results in asymptomatic patients. N Engl J Med 2000;342:1266–71.
  • 2. Pratt DS, Kaplan MM. Laboratory tests. In: Schiff ER, Sorrell MF, Maddrey WC, eds. Schiff’s diseases of the liver. 8th Ed. Vol 1. Philadelphia: Lippencott-Raven, 1999: 205–44.
  • 3. Piton A, Poynard T, Imbert-Bismut F, et al. Factors associated with serum alanine transaminase activity in healthy subjects: consequences for the definition of normal values, for selection of blood donors, and for patients with chronic hepatitis C. Hepatology 1998;27:1213-9.
  • 4. Kundrotas LW, Clement DJ. Serum alanine aminotransferase (ALT) elevation in asymptomatic US Air Force basic trainee blood donors. Dig Dis Sci 1993;38:2145-50.
  • 5. Lott JA, Wolf PL. Alanine and aspartate aminotransferase (ALT and AST). Clinical enzymology: a case-oriented approach. Chicago, Year Book Medical Publishers, 1986,111-138.
  • 6. Green RM, Flamm S. AGA technical review on the evaluation of liver chemisty tests. Gastroenterology 2002;123:1367-1384.
  • 7. American gastroenterological association medical position statement: Evaluation of liver chemisty tests. Gastroenterology 2002;123:1364-1366.
  • 8. Management of hepatitis C. National Institutes of Health Consensus Development Conference, 1997.
  • 9. Saadeh S, Cammell G, Carey WD, Younossi Z, Barnes D, Easley K. The role of liver biopsy in chronic hepatitis C. Hepatology 2001;33:196–200.
  • 10. Perrillo RP. The role of liver biopsy in hepatitis C. Hepatology 1997;26(suppl 1):57S–61S.
  • 11. Ahmed A, Keeffe EB. Treatment strategies for chronic hepatitis C: update since the 1997 National Institutes of Health Consensus Development Conference. J Gastroenterol Hepatol 1999;14(suppl):S12–S18.
  • 12. Wong JB, Koff RS. Watchful waiting with periodic liver biopsy versus immediate empirical therapy for histologically mild chronic hepatitis C. A cost-effectiveness analysis. Ann Intern Med 2000;133:665–675.
  • 13. Schiff ER, Sorrell MF, Maddrey WC. Hepatitis B. Schiff’s diseases of the liver. 8th ed. Philadelphia: Lippincott Williams &Wilkins, 1999:757–758.
  • 14. Michielsen PP, Van Damme P. Viral hepatitis and pregnancy. Acta Gastroenterol Belg 1999;62:21–29.
  • 15. Alter MJ, Mast EE. The epidemiology of viral hepatitis in the United States. Gastroenterol Clin North Am 1994;23:437–455.
  • 16. Redlich CA, Beckett WS, Sparer J, et al. Liver disease associated with occupational exposure to the solvent dimethylformamide. Ann Intern Med 1988;108:680–686.
  • 17. Petersen P, Bredahl E, Lauritsen O, Laursen T. Examination of the liver in personnel working with liquid rocket propellant. Br J Ind Med 1970;27:141–146.
  • 18. Hoet P, Graf ML, Bourdi M, et al. Epidemic of liver disease caused by hydrochlorofluorocarbons used as ozone-sparing substitutes of chlorofluorocarbons. Lancet 1997;350:556–559.
  • 19. Reid AE. Nonalcoholic steatohepatitis. Gastroenterology 2001;121:710–723.
  • 20. Ballew C, Bowman BA, Russell RM, Sowell AL, Gillespie C. Serum retinyl esters are not associated with biochemical markers of liver dysfunction in adult participants in the third National Health and Nutrition Examination Survey (NHANES III), 1988–1994. Am J Clin Nutr 2001;73:934–940.
  • 21. Bacon BR, Farahvash MJ, Janney CG, et al. Non-alcoholic steatohepatitis: an expanded clinical entity. Gastroenterology 1994;107:1103–1109.
  • 22. Palmer M, Schaffner F. Effective weight reduction on hepatic abnormalities in overweight patients. Gastroenterology 1990;99:1403–1408.
  • 23. Adams PC, Kertesz AE, Valberg LS. Clinical presentation of hemochromatosis: a changing scene. Am J Med 1991;90:445–449.
  • 24. Powell LW, George DK, McDonnell SM, Kowdley KD. Diagnosis of hemochromatosis. Ann Intern Med 1998;129:925–931.
  • 25. Bassett ML, Halliday JW, Ferris RA, et al. Diagnosis of hemochromatosis in young subjects: predictive accuracy of biochemical screening tests. Gastroenterology 1984;87:628–633.
  • 26. Czaja AJ. Autoimmune hepatitis: evolving concepts and treatment strategies. Dig Dis Sci 1995;40:435–456.
  • 27. Krawitt EL. Autoimmune hepatitis. N Engl J Med 1996;334:897– 903.
  • 28. Crystal RG. Alpha-1 antitrypsin deficiency, emphysema, and liver disease: genetic basis and strategies for therapy. J Clin Invest 1990;85:1343–1352.
  • 29. Ludwig J, Moyer TP, Rakela J. The liver biopsy diagnosis of Wilson’s disease. Methods in pathology. Am J Clin Pathol 1994;102:443–446.
  • 30. Brewer GJ, Yuzbasiyan-Gurkan V. Wilson’s disease. Medicine 1992;71:139–164.
  • 31. Loudianos G, Gitlin JD. Wilson’s disease. Semin Liver Dis 2000;20:353–364.
  • 32. Yuce A, Demir H, Kocak N, Gurakan F, Ozen H. Antiendomysium and antigliadin antibodies for the diagnosis of celiac disease. Am J Gastroenterol 2000;95:1366–1367.
  • 33. Mugica F, Aranzadi MJ, Recasens M, et al. Adult celiac disease and hypertransaminasemia. Rev Esp Enferm Dig 2000;92:78–85.
  • 34. Naschitz JE, Yeshurun D, Zuckerman E, Arad E, Boss JH. Massive hepatic steatosis complicating adult celiac disease: report of a case and review of the literature. Am J Gastroenterol 1987;82:1186–1189.

Ayrıntılar

Birincil Dil Türkçe
Konular Fen
Bölüm Derlemeler
Yazarlar

Osman ERSOY Bu kişi benim

Yayımlanma Tarihi 1 Mart 2012
Yayınlandığı Sayı Yıl 2012, Cilt 12, Sayı 3

Kaynak Göster

Bibtex @araştırma makalesi { amj21459, journal = {Ankara Medical Journal}, eissn = {2148-4570}, address = {}, publisher = {Ankara Yıldırım Beyazıt Üniversitesi}, year = {2012}, volume = {12}, number = {3}, pages = {129 - 135}, title = {Karaciğer Enzim Yüksekliğinin Değerlendirilmesi}, key = {cite}, author = {Ersoy, Osman} }
APA Ersoy, O. (2012). Karaciğer Enzim Yüksekliğinin Değerlendirilmesi . Ankara Medical Journal , 12 (3) , 129-135 . Retrieved from https://dergipark.org.tr/tr/pub/amj/issue/1743/21459
MLA Ersoy, O. "Karaciğer Enzim Yüksekliğinin Değerlendirilmesi" . Ankara Medical Journal 12 (2012 ): 129-135 <https://dergipark.org.tr/tr/pub/amj/issue/1743/21459>
Chicago Ersoy, O. "Karaciğer Enzim Yüksekliğinin Değerlendirilmesi". Ankara Medical Journal 12 (2012 ): 129-135
RIS TY - JOUR T1 - Karaciğer Enzim Yüksekliğinin Değerlendirilmesi AU - Osman Ersoy Y1 - 2012 PY - 2012 N1 - DO - T2 - Ankara Medical Journal JF - Journal JO - JOR SP - 129 EP - 135 VL - 12 IS - 3 SN - -2148-4570 M3 - UR - Y2 - 2022 ER -
EndNote %0 Ankara Medical Journal Karaciğer Enzim Yüksekliğinin Değerlendirilmesi %A Osman Ersoy %T Karaciğer Enzim Yüksekliğinin Değerlendirilmesi %D 2012 %J Ankara Medical Journal %P -2148-4570 %V 12 %N 3 %R %U
ISNAD Ersoy, Osman . "Karaciğer Enzim Yüksekliğinin Değerlendirilmesi". Ankara Medical Journal 12 / 3 (Mart 2012): 129-135 .
AMA Ersoy O. Karaciğer Enzim Yüksekliğinin Değerlendirilmesi. Ankara Med J. 2012; 12(3): 129-135.
Vancouver Ersoy O. Karaciğer Enzim Yüksekliğinin Değerlendirilmesi. Ankara Medical Journal. 2012; 12(3): 129-135.
IEEE O. Ersoy , "Karaciğer Enzim Yüksekliğinin Değerlendirilmesi", Ankara Medical Journal, c. 12, sayı. 3, ss. 129-135, Mar. 2012