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Meg Mangin R.N.
Research Team (on leave)
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Posted: Wed Nov 15th, 2006 05:50 |
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My liver enzymes are elevated. Should I be concerned?
A laboratory report of elevated liver enzymes is common. It doesn't indicate a specific disease. Liver enzymes help maintain a variety of chemical and metabolic processes that occur in the liver. Normally, only very small amounts of these enzymes are present in your blood. Treatment of elevated liver enzymes depends on the underlying cause. It is important to tell your doctor about any nutritional or herbal supplements you are taking.
Th1 inflammation commonly affects the liver, although it may be subclinical and most liver diseases cause only mild symptoms initially. Patients may be told they have "fatty liver disease" or cirrhosis.
An initial step in detecting liver damage is a simple blood test to determine the presence of certain liver enzymes in the blood. Under normal circumstances, these enzymes reside within the cells of the liver. But when the liver is injured, these enzymes are spilled into the blood stream.
Liver function tests (LFTs or LFs), which include liver enzymes, are groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patient's liver.
Among the most sensitive and widely used of these liver enzymes are the aminotransferases. They include aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT). These enzymes are normally contained within liver cells. If the liver is injured, the liver cells spill the enzymes into blood, raising the enzyme levels in the blood and signaling the liver damage. AST and ALT are the two most useful liver enzymes.
ALT reference ranges:
10 to 32 U/L (men)
9 to 24 U/L. (women)
AST reference range:
8 to 20 U/L
Other enzymes sometimes tested are alkaline phosphatase (ALP), 5'-nucleotidase ("5 prime" nucleotidase), and gamma-glutamyltranspeptidase (GGT) .
ALP reference range:
44 to 147 IU/L
5'-nucleotidase reference range:
2 to 17 units per liter
GGT reference ranges:
5 to 27 U/L (females under age 45)
6 to 37 U/L (females over age 45 and males)
All reference ranges will very by lab and all results need expert interpretation.
See What do my lab tests mean?
It not unusual to see liver enzymes elevate while on the MP even if liver disease was not previously suspected because immunopathology is unavoidable during recovery. Your doctor should consider the risk/benefit ratio of treatment with the MP because liver damage will not resolve unless the CWD bacteria are killed.
We cannot define the upper limits of liver enzymes for someone on the MP who needs to recover liver function. The usual scenario that docs see is expected worsening of liver function whereas immunopathology, even if relatively severe, is temporary and probably justified in terms of expected long-term benefit. If this is pointed out to doc, s/he may not be so concerned.
"Any signs of damage to your liver are just that - signs. Any suggestion that there might be liver damage due to any of the MP drugs is totally unfounded in science."
~Trevor
Several members have reported that their doctors are comfortable with enzyme levels that are quite high while continuing to monitor them to assess the pattern as they fluctuate up and down.
If your doctor insists on maintaining enzyme levels closer to normal while the MP is working to resolve the liver inflammation, you should be able to accomplish this by controlling the rate of bacterial kill by managing the MP medications.
Angiotensin receptor blocking drugs, such as Benicar, are known to have organ-protective effects.
An angiotensin II type 1 receptor antagonist, olmesartan medoxomil, improves experimental liver fibrosis by suppression of proliferation and collagen synthesis in activated hepatic stellate cells.
Liver biopsy
To my knowledge, liver enzymes will fluctuate with immune system reactions, and moderate elevations are not a reason to stop; but they may be an indication to go slowly with the MP and have them measured periodically. To me, saying no to any invasive procedure is not too hard. Tell them you do not want to pursue that course at this time. As you know biopsies of highly vascular organs are not without risk. Your liver doc will know that liver enzymes are often elevated in chronic infection, but you can ask her/him how high a level s/he is comfortable with and if he feels a certain level will cause any liver damage. Remember that several studies have shown that Benicar and other ARB's protect the liver from fibrosis and damage in the higher doses we take. Your doc may be interested in these abstracts that can be found on
Pub Med 11584371,15082419, 12871826
16919500 Entrez PubMed
~P.B., RN
NSAIDs (non steroidal anti inflammatory drugs)
These commonly prescribed pain medications can increase liver enzymes. If pain medication is needed, an alternative should be considered. See What should I do for liver or gallbladder pain?
Members' experiences
-Prior to beginning the MP, most of my bloodwork results were skewed, including the liver enzymes. The cyst on my liver has remained stable, but the blood levels began to normalize within three to six months after beginning the protocol. ~Carole
-My liver function test was normal on 11/4/06 after being abnormal in 2004 and 2005. Documented. ~scooker48
-Had a liver scan via VA and it showed less fatiness than previous checks in past years and no other notable problems except for gall stones which was news but aren't causing any distress. ~thepantheist Aug08Last edited on Tue Aug 19th, 2008 00:25 by Meg Mangin R.N.
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Nothing contained in this site is or should be considered, or used as a substitute for, medical advice, diagnosis or treatment by your physician.
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Meg Mangin R.N.
Research Team (on leave)
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Posted: Fri Dec 1st, 2006 10:43 |
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Sarcoidosis liver studies
(filelink)
Whether you realize it or not, you are teaching your doctors a lot. Just remember that your goal is to get well, not to educate the doctors.
As your own patient advocate, you have to be willing to provide the docs with information (such as you already have, on how sarc influences test results) that doctors may not know about, since sarcoidosis is a rare disease. You also have to be able to say no to repeat or continuous testing when you decide it will serve no purpose (i.e.: when it will not change the outcome of the disease or will not change the treatment).
Since you probably want to know more about the hepatotoxic potential of minocycline, take a look at this article, "Evaluation of the hepatotoxic potential of minocycline," which indicates that *high dose* minocycline can result in elevated AST/SGOT.
Liver involvement is common in sarc patients. Here's an abstract you will want to read, because the authors found 44% of their cohort sarcoidosis patients had liver involvement, and 50% of those had elevated ALT.
Course of asymptomatic liver involvement in sarcoidosis: role of therapy in selected cases.
Although 57% of the patients received treatment, 52% of those remained unchanged. The authors concluded,
"The outcome of patients who receive treatment remains similar, as far as liver function is concerned, suggesting that most of the patients with liver involvement undergo natural remission. Unless the patient has progressive liver dysfunction, it is advisable to monitor liver enzymes periodically and obtain liver biopsies only if clinically indicated. In patients who need treatment, it is reasonable to try options other than steroids in view of severe corticosteroid related complications."
Here is a new article (Dec. 2006) with several eye-opening statements: Diagnosis and treatment of hepatic sarcoidosis.
These authors point out that the mere presence of granulomas (in the liver) does not dictate treatment. And their abstract concludes,
"Ultimately, in cases of overt liver failure, liver transplantation is the definitive treatment. Overall, treatment for hepatic sarcoidosis is targeted toward alleviation of symptoms but has no curative potential at this time. Focus should be on discovering the etiology of the disease to target therapy at prevention, not cure."
It seems that ultimately, the important question (that only you and your doctors can answer) is: how will testing or diagnosing sarcoid involvement in additional organs change your treatment?
~Belinda
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Nothing contained in this site is or should be considered, or used as a substitute for, medical advice, diagnosis or treatment by your physician.
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Meg Mangin R.N.
Research Team (on leave)
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Posted: Tue Dec 5th, 2006 04:27 |
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Cell death (apoptosis) elevates ALT and resolves fibrotic tissue
(filelink)
The sensitive enzyme ALT is elevated when there is liver inflammation and cell death (apoptosis). We know that when the immune system is effectively fighting infection, the result is cell death. But this is the road to recovery.
This article about research funded by the Wellcome trust will help you understand that cell death precedes cessation of fibrosis. The article explains that fibrotic damage can/will break down after the liver has regenerated. This research is in line with Dr. Marshall's thinking about fibrotic tissue reversion.
Macrophages, one type of white blood cell, have the duty of killing invaders like bacteria. Macrophages are phagocytes, or "eating cells." Macrophage are the "big eaters" of the immune system. Take a look at the video clip on this web source by clicking on "time-lapse movie" to see how a white blood cell engulfs an enemy. This is what happens to bacterial invaders.
But engulfing or "eating" the threatening pathogens doesn't finish the job. The macrophage has to die to kill the enemy. Otherwise, bacteria may be able to live and even replicate safely inside the macrophage and the human host will still be ill. This could be serious, considering that the life span of a macrophage may be months or even years. Even slowly-reproducing bacteria might establish a stronghold by living inside macrophages.
The MP supports the immune system macrophages that are holding bacteria they have eaten. Once the antibiotics weaken the intracellular bacteria, the immune system naturally kills them off, and in the process, the infected white blood cells die. Toxic chemicals spill into the host tissue and blood. The host suffers the effects of immunopathology by temporarily feeling worse, even though the cell death will result in better health now that the pathogen is dead.
ABC Australia has a three-part series in their "Great Moments in Science" called "Apoptosis" in this link. It explains the natural process of cell death for the greater good and health of the host.
~Belinda
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Nothing contained in this site is or should be considered, or used as a substitute for, medical advice, diagnosis or treatment by your physician.
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