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Abnormal Liver test

  • Abnormal Liver test
    • In my liver test, my SGPT level is 78 and my SGOT level is 52. Are these normal, or is there a serious problem?
      • You have to provide the normal lab values for these tests. But considering the normal value of 40 IU/L in most Indian labs, these are abnormal.
      • Is this the full picture?  No. I would advise a complete LFT including bilirubin ,alkaline phosphatase, albumin and prothrombin time to know the full story.
      • If only these are 2 abnormal values, then these are definitely abnormal but not alarming. Considering these, possible causes include viral illness, viral hepatitis, steatohepatitis or related to medications.
      • The first step would be to repeat these tests again after 2 weeks to confirm that they are indeed elevated. If so, you need to consult a gastroenterologist.
      • Again, doctors treat the patient and not the report. Full interpretation of reports is always done in context to the clinical setting and cannot be made on isolated lab values.
    • What is the normal size of the liver, and is it dangerous if the liver is 19.5 cm in size?
      • The normal size of liver based on ultrasound is 13–14 cm
      • 19.5 cm is an enlarged liver.
      • However, this is only an ultrasound assessment. The severity cannot be decided merely on size but we have to study the level of liver enzymes and the cause. Sometimes it is only fatty liver, which can be revered on stopping alcohol or with lifestyle measures.
    • My SGPT levels are 1571 and SGOT levels are 1257. What should I do?
      • SGPT and SGOT are liver injury markers. These become elevated when liver cells-hepatocytes are getting destroyed.
      • Your SGOT and SGPT levels are nearly 50–100 times the normal level.
      • This is commonly seen in viral infections. Like viral hepatitis A and E.
      • Fortunately, viral hepatitis is self resolving. The level of elevation does not necessarily correlate with the outcome or prognosis. I suggest doing PT/INR for that.
      • You will require workup to diagnose which type of virus is present and whether it is non-viral. Sometimes this could be autoimmune, Wilson’s or a medicine induced reaction.
      • The treatment depends on which causative factor is identified.
    • What causes high SGPT?
      • There is an entire list of causes that can cause elevation of SGPT. Some of these are transient and come back to normal e.g. viral illness. Some other them are more sinister e.g. cirrhosis. Other causes could be hepatitis B and hepatitis C, Autoimmune liver disease, steato-hepatitis (fatty liver) or some genetic diseases.
      • The first step would be to repeat these tests again after 2 weeks to confirm that they are indeed elevated. If so, you need to consult a gastroenterologist.
      • Again, doctors treat the patient and not the report. Full interpretation of reports is always done in context to the clinical setting and cannot be made on isolated lab values
    • What is the best way to lower SGOT/SGPT levels?
      • There is no specific exercise or food that targets the liver. Fortunately to keep your liver healthy, you need to eat a balanced diet, high in antioxidants and exercise regularly. Keep your weight in check and stay away from alcohol.
      • Do’s:
      • Exercise regularly: This will add more years to your liver. Fatty liver disease is reaching epidemic proportions. Maintain a healthy lifestyle to prevent it.
      • Consume more green leafy vegetables: These contain numerous micronutrients, fiber and antioxidants.
      • Eat probiotics: Curd is a natural probiotic and contains good bacteria. It improves gut immunity and general health.
      • Dont’s:
      • Avoid Alcohol: It is the no.1 enemy of your liver. Keep it at a minimum.
      • Avoid fatty foods: Highly processed foods and items with high fructose corn syrup are to be avoided. These lead to fat and in turn toxin accumulation within the liver.
      • Avoid sugary foods
      • This was the preventive aspect.
      • If your SGOT/SGPT is already high, you need to be investigated to detect the cause of the abnormality and then treat it. No matter what you hear there is no single medicine or natural remedy that is useful across all liver diseases that has been proven effective.
    • Which test shall be done to check the condition of liver?
      • There are a number of tests for the liver.
      • The liver is a very important organ of the body and serves > 100 metabolic functions. So when liver gets damaged, it affects a large number of test results.
      • The most basic blood report is LFT which consists of bilirubin, AST, ALT, ALP, Albumin and prothrombin time. Other tests can be done as required.
      • Testing for infections like hepatitis B and C can be done. These are highly prevalent in our country.
      • The size and structure can be studies by ultrasound, CT scan or MRI.
    • Is it true that some people with chronic liver disease have absolutely normal liver function tests?
      • Yes, it is possible.
      • The interpretation of liver function tests is very tricky. It does not represent liver function per se, but shows ongoing liver damage. A “normal” level is a wide range and it depends on many variables. LFT within acceptable range can be seen in normal individuals, those with chronic viral hepatitis (because abnormalities can be intermittent) and also in those with cirrhosis.
      • That is why doctors don’t treat reports but treat patients. The final interpretation is done on a combination of clinical examination, ultrasound and LFT and sometimes special tests like Fibroscan, liver biopsy etc.
  • Hepatitis B
    • I am hepatitis B positive. Can I go abroad for work?
      • To answer your question, we need to know the status of the virus and your liver. Based on these, if you are a healthy carrier, you can work abroad.
      • The problem lies in the middle eastern countries, which require you to be non reactive to hepatitis B to become eligible to work. While this is not the right approach, they don’t heed. It is very important to know that once you are hepatitis B positive, there are no medicines that can change it to negative. (with exceptions)
      • If you are refused work based on your hepatitis B status alone, this would amount to discrimination in India.
      • For sensitive jobs that may harbour a risk of transmission, e.g. employment in healthcare, it is recommended to keep a low viral load to <200 IU/ml. This requirement differs in each country.
    • Is it possible that the positive hepatitis b surface antigen becomes negative?
      • The Hepatitis B virus integrates into the DNA of the body and hence it is difficult to eradiate it.
      • It can happen in 1% with current medicines.
      • Please watch the video below to know the difference between cure (eradication) of the virus vs the control (what present treatments achieve)
      • https://www.youtube.com/watch?v=_UeKgDvNHP8
    • Is there a cure for hepatitis B?
      • There is a difference between cure and control of hepatitis B.
      • The reason it cannot be cured is that the virus integrated into our DNA.
      • With current medicines only 1% can be cured.
      • https://www.youtube.com/watch?v=_UeKgDvNHP8
    • Is it safe to vaccinate a pregnant lady for hepatitis B?
      • Yes, it is safe to be administered in a pregnant lady.
    • When should I have my final hepatitis B blood test after a potential exposure, to rule out that I am not infected?
      • It you had a potential exposure to hepatitis B, HBsAg will be positive by 6 months from exposure.
      • So it means it you are still negative by a test done by a good lab, you aren’t infected.
      • Please get a test for hepatitis B immediately (to know if you were positive beforehand) and later at 6 months (to confirm that you have not got the virus)
      • Hepatitis B is transmitted by >90% efficacy through unsafe blood transfusion but risk is only about 30% with unsafe sexual practices.
      • Please vaccinate yourself if you are negative at 6 months.
    • Can you transfer Hepatitis B to your partner?
      • Yes it is possible to transmit hepatitis B.
      • Get your partner testes and vaccinate if negative.
      • Please refer to the below video for information on various routes of transmission.
      • https://www.youtube.com/watch?v=VbAuW6-d_Mg
    • Is it compulsory to check the antibody titre afer hep b vaccine? And who are the people for whom hep b vaccine doesnt work and why?
      • No it is not compulsory but it is preferred to check for the titer.
      • HepB vaccine works for >95% of the time. It is very safe and efficacious. It has lower effectiveness for patients with immunosuppressant states (diseases or medicines that reduce the body’s natural immunity). These include chronic kidney disease, HIV etc. It still works at double the dose.
    • I’m hepatitis B positive. Can I marry and have children?
      • Don’t let Hepatitis B come between your love.
      • Be smart
      • Test, disclose, and vaccinate your partner.
      • Please protect your loved ones by vaccinating them after a thorough check-up. It is possible to prevent transmission to spouse and to children.
      • It is also possible to lead a normal life if you are a carrier. Treatment of hepatitis B is simple. Regular visits to your doc is a must.
      • Please talk to your physician so your reports can be double checked to ensure you are indeed only a carrier.
    • What prevention should I take to have a 2nd baby, i.e. I am a hepatitis B patient?
      • The primary concern in a pregnant patient is prevention of transmission of hepatitis B from mother to baby.
      • For the mother:
      • Get yourself tested with HBV DNA levels at 24–28 weeks of pregnancy. You maybe required to be started on medications to control the virus if a high load is present so that it maybe reduced to a safe level at the time of delivery.
      • For the baby:
      • The vaccination and an immunoglobulin dose has to be given to the baby after birth as soon as possible- ideally within 12 hours. Both these have to be given together and are effective in 97% of cases. Breastfeeding is safe with hepatitis B and also safe if you are on medications.
      • For the spouse:
      • Test, disclose and vaccinate!
      • Be smart! Avoid hepatitis-B
      • #SafeLiver
  • Fatty Liver disease
    • How severe is a grade 3 fatty liver?
      • Hepatomegaly with fatty liver grade 3 is the sonography assessment of the liver.
      • Just like you don’t judge a book by its cover, you cant judge the liver purely on basis of sonography.
      • Unfortunately, the sonographic grading (grade 3 in this case) does not correspond to the actual severity.
      • It takes a corroboration of clinical findings, biochemical tests like LFT, sonography and in some cases special tests to get the complete picture.
    • How do I know what stage my fatty liver is?
      • The two main causes of fatty liver are:
      • Alcohol and
      • NAFLD- Non alcoholic fatty liver disease
      • The underlying cause of NAFLD is a faulty lifestyle and is a part of metabolic syndrome (consisting of obesity, hypertension, high sugar, elevated lipids)
      • NAFLD is further divided into NAFL (simple fatty liver) and NASH (steatohepatitis).
      • NAFL is only fatty liver with normal enzymes. NASH consists of inflammation in the liver with high enzymes (SGOT and SGPT).
      • NASH is further divided into stages based on amount of inflammation and degree of fibrosis. Fibrosis is from F0 meaning none to F4 meaning cirrhosis.
      • The best method to stage the fatty liver is a liver biopsy. But it is invasive and can lead to complications.
      • There are indirect methods to stage it. You can predict stage based on your platelets, LFT, INR, GGT, ultrasound and fibroscan.
      • Please consult a gastroenterologist/ hepatologist to help you.
      • Early intervention is successful before permanent damage sets in.
    • How much time does it take to reverse fatty liver grade 2?
      • Grade 2 fatty liver is a sonographic severity of the amount of fat deposition in the liver. It does not correlate to the actual severity.
      • Treatment consists of lifestyle interventions.
      • Medications are required in a some patients.
      • Reversal of fatty liver can occur in 6–12 months if proper lifestyle changes and medications are followed. Treatment may go on for 2 years in some patients. But the lifestyle changes have to be applied for a lifetime.
    • How much time does it take from Fatty liver to Cirrhosis?
https://qph.fs.quoracdn.net/main-qimg-6ebc710821bbe0cef4cd2c77e3f46fac
  • NASH: Non- alcoholic steatohepatitis
  • HCC: Hepatocellular carcinoma
  • The progression is slow. There are four stages of fibrosis from fatty liver to cirrhosis. Each stage takes approximately 7 years (in another study). But 10% of people are rapid progressors and reach cirrhosis faster.
  • C:\Users\DELL\Desktop\Social media\Fatty liver progression.jpg
  • How can one cure a fatty liver?
    • A change in lifestyle is effective in reversing fatty liver. There is no need to go for medicines of any discipline. The root cause of fatty liver is either alcohol or sedentary lifestyle. Adherence to a exercise regime and a balanced diet is the mainstay of the treatment. This is important as we have to target the root cause. This will also have a positive impact on other areas like obesity, high sugar, BP problems, sleep problems etc which also have their root cause in a faulty lifestyle.
    • Ideal goals to reverse fatty liver:
    • •At least 7% weight loss
    • •500 kcal deficit in daily energy consumption (This target is better than consuming a diet of a fixed amount of calories)
    • •150-200 min/week of moderate intensity aerobic physical activity
    • A number of medications are also available to help reverse fatty liver and have a complimentary role to lifestyle modifications.
    • C:\Users\DELL\Desktop\Social media\NAFLD.png
  • What does it mean when someone has a grade 2 fatty liver on an ultrasound but the LFT is normal?
    • The two main causes of fatty liver are:
    • Alcohol
    • NAFLD- Non alcoholic fatty liver disease
    • The underlying cause of NAFLD is a faulty lifestyle and is a part of metabolic syndrome (consisting of obesity, hypertension, high sugar, elevated lipids)
    • NAFLD is further divided into NAFL (simple fatty liver) and NASH (steatohepatitis).
    • NAFL is only fatty liver with normal enzymes.
    • NASH consists of inflammation in the liver from the fat deposition with high enzymes (SGOT and SGPT).
    • NASH is further divided into stages based on amount of inflammation and degree of fibrosis. Fibrosis is from F0 meaning none to F4 meaning cirrhosis.
    • The best method to stage the fatty liver is a liver biopsy. But it is invasive and can lead to complications.
    • There are indirect methods to stage it. You can predict stage based on your platelets, LFT, INR, GGT, ultrasound and fibroscan.
    • Based on your reports of fatty liver with normal LFT, the likely diagnosis is NAFL (simple fatty liver). This can progress to NASH, but if corrective measures are taken it can regress to normal too.
    • Remember, grade 2 is the sonographic grading of fatty liver and this does not correlate with actual severity of the fatty liver disease.
    • Doctors treat the patient and not the reports.
  • Cirrhosis
    • How long can a patient survive with liver damage?
      • Liver disease ranges from asymptomatic benign diseases (like fatty liver, hepatitis B carrier), to chronic hepatitis to cirrhosis and advanced cirrhosis with decompensation and rarely acute liver failure.
      • The question of survival is important only for those with cirrhosis. Since, I don’t have exact details of what type of liver damage we are talking about, I am assuming it is cirrhosis.
      • Life expectancy depends on how advanced the cirrhosis is and it’s cause
      • 1.Calculate the MELD score and child Pugh score. You can do it free online. After the score you will get the average life expectancy. Although it is good to know for a large group of patients, it is not very accurate for an individual patient. Keep your reports handy while calculating it and pay close attention to the units. Your doctor can help you calculate these scores
      • 2.Cause of liver disease. Some can be corrected, some cant. If they can be corrected, the prognosis is better. e.g. stopping alcohol, eradication of a virus. Look for any contributing causes that can be corrected.
      • A general rule is that cirrhosis have an average life expectancy of 8-10 years and once there is decompensation (like ascites, variceal bleed, encephalopathy, jaundice) the life expectancy is around 2 years. For very advanced cirrhosis with refractory ascites it is 6 months.
    • If a liver has been damaged more than 90%, is it possible that it repairs itself?
      • I am assuming your doctor has told that the liver is damaged by 90%. Now of course this is an educated guess and not an exact estimate. But for the subsequent discussion, I assume that the evaluation is correct and I am guessing you have cirrhosis and fluid in the abdomen.
      • Cirrhosis is when there is fibrosis throughout the liver. Fibrosis is the deposition of collagen. This process is usually irreversible. Take example of a scar on the skin to understand this. A scar has a similar mechanism of collagen deposition. A scar once developed does not go away. It is permanent. But it does fade over years.
      • Early cirrhosis can be reversed IF the primary cause can be detected and treated effectively. e.g. stopping alcohol in a person with cirrhosis due to alcohol. But it is not always easy to judge how advanced the cirrhosis is without a biopsy. In many cases, liver functioning can improve to a great deal. True reversal of cirrhosis is rare but has been reported
    • What is a coarsened liver echotexture?
      • Coarse liver echotexture is a sonography finding in patients with chronic liver disease.
      • The spectrum of chronic liver disease can include chronic hepatitis (which is long standing inflammation in the liver due to a variety of reasons) to cirrhosis (the end effect of repeated inflammation and collagen deposition leading to a scarred and grossly dysfunctional liver)
    • How should a patient suffering from liver cirrhosis maintain his or her diet?
    • Is human liver able to regenerate?
      • Behold the legend of Prometheus!!
      • The immortal Prometheus was bound to a rock as a punishment for theft, where each day an eagle, the emblem of Zeus, was sent to feed on his liver. The liver would then grow back overnight to be eaten again the next day.
      • This is a paradigm for the organ’s extraordinary ability to regenerate.
      • Patients with acute liver failure develop >90% impairment in liver function. But it is possible for the liver to recover completely from this after treatment.
      • Patient with cirrhosis develop failure after the recovery system is overwhelmed after months to years of relentless of going injury.
  • https://qph.fs.quoracdn.net/main-qimg-fbfcf98a0ff4b71ee9cb201ac29ca6a4
    • Can a person with liver cirrhosis still consume beer in a moderate amount?
      • Absolutely No!
      • Cirrhosis is the end stage result of long standing injury to the liver. For practical purposes, this is irreversible. Why would you risk furthering damage to the liver when it is already functioning at a fraction of what it should?
      • Even if you do not have any symptoms of cirrhosis, it should still be avoided. Alcohol is responsible for acute deterioration in cirrhosis in a sizeable number of patients.
      • For cirrhosis related to alcohol, complete abstinence is the only proven treatment to be effective and alters the natural history of the disease. Other treatments are only supportive. Providing a good micro-environment to the liver and supporting it is vital, and alcohol would lead to continuing injury.
      • Even if the cause of cirrhosis is something other than alcohol, e.g. hepatitis B or C, it is still to be avoided.
      • If you have craving for beer, you can be helped to reduce the craving.
    • What are the stem cells for cirrhosis of the liver?
      • Stem cells are the base cells that are derived from the bone marrow or cord blood. These cells have been used in cirrhosis with the assumption that they will transform into liver cells and take over the damaged liver and return the functioning back to normal.
      • This has been applied in few clinical studies. The use of stem cell therapy in cirrhosis is still evolving and is not the standard of care at present. Liver transplantation remains the best available mods of treatment for advanced cirrhosis.
      • From the limited experience, there has been some success. But the data is too small to recommend this treatment to anyone. It maybe tried as an experimental therapy with a readiness to accept that failure may happen. What the present studies have shown is that it is safe and feasible. Efficacy has not been established.
  • Jaundice
    • How much time does it take to cure regular jaundice in adults?
      • “Regular jaundice”, is usually viral hepatitis.
      • There are 5 types of hepatitis viruses named A, B, C, D and E. Of these, A and E viruses can cause jaundice in the community through contaminated water or food.
      • If you have these viruses, they are self-limiting in >95% of cases. You should be feeling better in 2–4weeks and jaundice should be gone in 4–6 weeks. LFT reports may take longer to normalise completely. The maximum time taken is 6 months- in few cases.
      • If you have other causes of jaundice, this does not apply.
    • Can a jaundice patient eat pulses?
      • Proteins are very important and as a matter of fact more proteins are required to help in the recovery from illnesses including viral hepatitis.
      • Proteins do not require bile for digestion. There is no evidence to suggest that patients with hepatitis cannot digest proteins.
      • It is a common myth. Also prevalent amongst doctors.
      • Even if the jaundice is due to cirrhosis, protein need to be consumed at least 1g/kg unless there is encephalopathy (brain edema).
    • Is jaundice contagious?
      • There are a number of causes of jaundice.
      • The most common cause are viral infections. Viruses causes inflammation in the liver and hence this is known as “viral hepatitis”.
      • The viruses are labelled from A to E.
      • If these hepatitis A and hepatitis E spread through contaminated food/water (i.e. feco-oral route). These viruses are contagious. They cause outbreaks and epidemics especially in summer and in places with poor sanitation.
      • Other hepatitis viruses like B, C and D spread through blood products, infected needles or syringes and unsafe sexual practices.
      • There are non infectious causes of “hepatitis” and jaundice like medications, alcohol, Wilson’s etc.

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