Evaluation of Children who have mildly or moderately elevated liver transaminase levels

Öz

There are number of pitfalls in the interpretion of elevated liver transaminase levels, that can challenge experienced clinicains. Mild or moderate elevation of liver transaminase levels can reveal transient and benign etiologies or serious conditions. Viral hepatitis, medications, herbal products or steatosis are potential causes of elevated transaminase levels. Detailed histroy and family history are essential. If elevations persist after four to six months of observaton n asymptomatic patient, further augmented tests and referral to a specialist are needed.

Anahtar Kelimeler

• Children, Liver, Transaminase elevation, liver enzymes

HAFİF VE ORTA DERECEDE YÜKSEK KARACİĞER TRANSAMİNAZI SAPTANMIŞ PEDİATRİK HASTAYA YAKLAŞIM

Öz

Yüksek karaciğer transaminaz sevyelerini değerlendirmede birçok zorlu tuzak deneyimli klinisyenlere meydan okumaktadır. Hafif ve orta derecede karaciğer transaminaz değerleri geçici ve iyi huylu etiyolojilerde ortaya çıktığı gibi, ciddi durumları da bildirir. Viral hepatitler, ilaçlar, bitkisel ürünler veya steatoz potansiyel nedenlerdir. Ayrıntılı anamnez ve aile öyküsü esansiyeldir. Asemptomatik hastada 6 aylık takipte ısrar eden yükseklik durumunda ileri testler ve bir uzmana danışma gerekli olur.

Anahtar Kelimeler

• Çocuk, Karaciğer, Transaminaz yüksekliği, karaciğer enzimleri

Kaynakça

1. Tarantino G. From bed to bench: which attitude towards the laboratory liver tests should health care practitioners strike? World journal of gastroenterology : WJG. 2007;13(37):4917-23. Epub /09/15.
2. Dufour DR, Lott JA, Nolte FS, Gretch DR, Koff RS, Seeff LB. Diagnosis and monitoring of hepatic injury. II. Recommendations for use of laboratory tests in screening, diagnosis, and monitoring. Clinical chemistry. 2000;46(12):2050-68.
3. Nathwani RA, Pais S, Reynolds TB, Kaplowitz N. Serum alanine aminotransferase in skeletal ;41(2):380-2. Epub 2005/01/22. diseases. Hepatology.
4. Saha B, Maity C. Alteration of serum enzymes in primary hypothyroidism. Clinical chemistry and laboratory medicine : CCLM / FESCC. ;40(6):609-11. Epub 2002/09/05.
5. Healey CJ, Chapman RW, Fleming KA. Liver histology in hepatitis C infection: a comparison between patients with persistently normal or abnormal transaminases. Gut. 1995;37(2):274-8. Epub 1995/08/01.
6. Haber MM, West AB, Haber AD, Reuben A. Relationship of aminotransferases to liver histological status in chronic hepatitis C. The American ;90(8):1250-7. Epub 1995/08/01. of gastroenterology.
7. Johnston DE. Special considerations in interpreting liver function tests. American family physician. 1999;59(8):2223-30. Epub 1999/04/30.
8. Limdi JK, Hyde GM. Evaluation of abnormal liver function tests. Postgraduate medical journal. 2003;79(932):307-12. Epub 2003/07/04.

9. Gopal DV, Rosen HR. Abnormal findings on liver function tests. Interpreting results to narrow the diagnosis and establish a prognosis. Postgraduate medicine. 2000;107(2):100-2, 5-9, 13-4. Epub /02/26. enzyme alteration: a guide for clinicians. CMAJ :
10. Canadian Medical Association journal = journal de l'Association medicale canadienne. 2005;172(3):367- Epub 2005/02/03. on the evaluation of liver chemistry tests. Gastroenterology. /10/03.
11. How are abnormal results for liver function tests dealt with in primary care? Audit of yield and impact. BMJ. 2001;322(7281):276-8. Epub 2001/02/07. abnormal liver-enzyme results in asymptomatic patients. The New England journal of medicine. ;342(17):1266-71. Epub 2000/04/27. Epub
12. Sherwood P, Lyburn I, Brown S, Ryder S. Pratt DS, Kaplan MM. Evaluation of liver tests. In: Feldman M, Friedman LS, Sleisengar MH, Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 7th ed. Philadelphia, Pa: Saunders; 2002. p. 1227-38.
13. Sette LH, Mello LA, Moreira RC, et al. Determination of the cut-off value of serum alanine aminotransferase hemodialysis, to identify biochemical activity in patients with hepatitis C viremia. Journal of clinical virology : the official publication of the Pan American ;35(3):298-302. Epub 2005/11/18. chronic liver disease: costs and benefits. The Gastroenterologist. /03/01.
14. Kingham JG. A prospective study of the causes of notably raised aspartate aminotransferase of liver origin. Gut. 1999;45(1):129-33. Epub 1999/06/16. ratio--an indicator of alcoholic liver disease.
15. Digestive diseases and sciences. 1979;24(11):835-8. Epub 1979/11/01.
16. M, İnan M, Öner N, et al. Çocukluk Çağında Serum Transaminazlarını Biyokimya Dergisi. 2008;33(4):175-81.
17. Saunders Elsevier Philadelphia; 2007. transaminase levels in the asymptomatic patient.
18. American family physician. 2005;71(6):1105-10. Epub 2005/03/29.
19. Turkdogan M, Abuhandan M. Seroepidemiology of hepatitis B virus infection in children in the Eastern Anatolia. East J Med. 2001;6(2):40-2.
20. İstanbul Sağlık Müdürlüğü; 2011 [cited 2011 21-12- ; http://www.istanbulsaglik.gov.tr/w7sb/bh/asilarbulasici asp.
21. E, Sagliocca L, Fargion S, et al. Consensus recommendations persistent non-virus non-alcohol related elevation of aminotransferase levels: suggestions for diagnostic procedures and monitoring. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 2008;40(7):585-98. Epub /04/09. for Society Clinical Virology.
22. Quinn PG, Johnston DE. Detection of ;5(1):58-77. Epub Whitehead MW, Hawkes ND, Hainsworth I, Cohen JA, Kaplan MM. The SGOT/SGPT Çeltik C, Erbaş H, Kurşun ÖS, Bostancıoğlu Nedenler. Türk Kliegman R. Nelson textbook of pediatrics: Giboney PT. Mildly elevated liver Uner A, Kirimi E, Tuncer I, Ceylan A, Ülkemizde aşılama çalışmalarının seyri. from: Morisco F, Pagliaro L, Caporaso N, Bianco for managing asymptomatic