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This is a brief summary of lab value interpretation and is not intended in any way to be comprehensive or replace any conversation of your results with your doctor.

HEPATIC (LIVER) ENZYME VALUES

AST (Aspartate transaminase) also called SGOT (Serum Glutamic Oxalocetic Transaminase) or ASAT (Aspartate Aminotransferase) is similar to ALT (Alanine Transaminase). AST is an enzyme associated with liver parenchymal cells found primarily in the liver, heart, kidney, pancreas and muscles. It is seen in tissue damage, especially the heart and liver. The lab values are raised in acute liver damage, but is also present in red blood cells, cardiac and skeletal muscle and is therefore not actually specific to the liver.

The ratio of AST to ALT can be useful in differentiating between the causes of liver damage. Elevated AST levels are not 'specific' for liver damage because it can also be used as a cardiac marker.

Normal Adult Range: 5 - 40 IU/L

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ALT (Alanine Transaminase) also called SGPT (Serum Glutamic Pyruvic Transaminase) or or ALAT (Alanine Aminotransferase) is an enzyme present in hepatocytes (liver cells). Decreased ALT in combination with increased cholesterol levels is seen in cases of a congested liver. We also see increased levels in mononucleosis, alcoholism, liver damage, kidney infection, chemical pollutants or myocardial infarction.

When a cell is damaged it leaks this enzyme into the blood where it can then be measured. ALT rises dramatically in acute liver damage, such as viral hepatitis or paracetamol (acetaminophen) overdose. Elevations are often measured in multiples of the upper limit of normal (ULN).

Normal Adult Range: 7 - 56 IU/L

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Alkaline phosphatase (ALP) is an enzyme in the cells lining the biliary ducts of the liver. It is used extensively as a tumor marker and is also present in bone injury, pregnancy, or skeletal growth with elevated readings. Low levels are sometimes found in hypoadrenia, protein deficiency, malnutrition and a number of vitamin deficiencies

ALP levels in plasma will rise when large bile duct obstruction is present or there is intrahepatic cholestasis or infiltrative diseases of the liver. ALP is also present in bone and placental tissue, so it is higher in growing children as their bones are maturing and also in elderly patients who have Paget's disease.

Normal Adult Range: 30 - 120 IU/L

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GGT (Gamma Glutamyl Transpeptidase) Elevated levels may be found in liver disease, alcoholism, bile duct obstruction, cholangitis, drug abuse, and in some cases excessive magnesium ingestion. Decreased levels can be found in hypothyroidism, hypothalamic malfunction and low levels of magnesium.

Although GGT is specific to the liver and even a more sensitive marker for cholestatic damage than ALP, GGT may be elevated with even minor subclinical levels of liver dysfunction. It can also be helpful in identifying the cause of an isolated elevation in ALP. GGT is raised in chronic alcohol toxicity.

Normal Adult Range: 0 - 42 IU/L

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LDH (Lactic Acid Dehydrogenase) is an enzyme found in many body tissues, including the liver. Elevated levels of LDH may indicate liver damage. Increases are usually found in cellular death and/or leakage from the cell or in some cases it can be useful in confirming myocardial or pulmonary infarction (only in relation to other tests). Decreased levels of the enzyme may be seen in cases of malnutrition, hypoglycemia, adrenal exhaustion or low tissue or organ activity.

Normal Adult Range: 45 - 90 U/L

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TOTAL BILIRUBIN (TBIL) Elevated in liver disease, mononucleosis, hemolytic anemia, low levels of exposure to the sun, and toxic effects to some drugs, decreased levels are seen in people with an inefficient liver, excessive fat digestion, and possibly a diet low in nitrogen bearing foods.

Bilirubin is a breakdown product of heme and heme is a part of hemoglobin in red blood cells. The liver is responsible for clearing the blood of bilirubin. Bilirubin is taken up into hepatocytes, conjugated (modified to make it water-soluble), and secreted into the bile, which is then excreted into the intestine.

Normal Adult Range 0.2 - 1.2 mg/dL

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