& CBC Analysis. Getting the Most from the. Session 3. Foundations of Functional Blood Chemistry Analysis Session 3 Dr.

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1 Functional Blood Chemistry & CBC Analysis Session 3 Li L:iver and Gallbladder Markers SGOT/AST, SGPT/ALT & GGTP Getting the Most from the Liver Panel 1

2 Liver Panel Reference Ranges Test Standard Reference Value Optimal Value Alarm Ranges SGOT/ 0 40 U/L > 100 AST SGPT/ 0 45 U/L > 100 ALT GGTP 0 85 U/L >100 AST, ALT & GGTP Location SGOT/AST SGPT/ALT GGTP Skeletal muscle Liver Liver/Gall Heart Skeletal muscle bladder Liver Heart Prostate Kidney Lungs Kidney Pancreas 2

3 Liver Dysfunction A moderate rise in SGPT/ALT can alert us to a more functional problem within the liver: Developing liver dysfunction Liver congestion (fatty liver) Detoxification/ Oxidative stress issues Conjugation problems Liver cell damage Fatty Liver Early Development Pattern Early development of fatty liver is possible if: SGPT/ALT is decreased (<10) with Decreased albumin (<4.0 or 40) Increased dtotal t cholesterol l( (> 180 or >4.66), Increased LDL (>100 or >2.6 ) Increased triglycerides (>80 or >0.90) Decreased HDL (<55 or <1.42) 3

4 Fatty Liver Late Stage If the SGPT/ALT is increased above the SGOT/AST and GGTP levels, liver dysfunction due to advanced fatty liver is probable. Advanced steatosis will cause the SGPT/ALT to be elevated as much as 4 times the upper limit of normal. Gallbladder and Liver Markers Getting to the Bottom of Your Patients Gallbladder and Liver Dysfunctions 4

5 Gallbladder Function Reference Ranges GGTP Optimal Range Alk Phos Bilirubin- total Bilirubin- direct or mmol/l or mmol/l GGTP Clinical Implications HIGH Dysfunction located outside the liver and inside the biliary tree Biliary stasis/insufficiency Biliary obstruction Liver cell damage Alcoholism (GGTP production induced by alcohol) Acute/chronic Pancreatitis Pancreatic insufficiency Obesity (elevated as high as 50%) 5

6 Alk Phos Clinical Implications HIGH Biliary obstruction Liver cell damage Bone: loss/increased turnover or bone growth and/or repair Leaky gut syndrome Herpes zoster Metastatic carcinoma of the bone Total Bili Clinical Implications HIGH Biliary stasis Biliary tract obstruction or calculi Oxidative stress Thymus dysfunction Liver dysfunction RBC hemolysis Gilbert s syndrome 6

7 Hepato Biliary Dysfunction Biliary Insufficiency and Stasis Hepato Biliary and Fatty Acid Dysfunction Biliary dysfunction Biliary insufficiency Biliary stasis Pattern for both: GGT >30, Bilirubin >1.2 or 20.5 mmol/l, Alk phos > 100 Complications of Biliary Stasis and Insufficiency 7

8 Biliary Dysfunction: S/Sxs Pain between shoulder blades Stomach upset by greasy foods Loose, bulky and offensive stools Greasy or shiny stools Nausea Sea, car, airplane or motion sickness History of morning sickness Light or clay colored stools Dry skin, itchy feet or skin peels on feet Headache over eyes History of gallbladder attacks Bitter taste in mouth, especially after meals Dark orange urine Biliary Dysfunction: PE Nutritional Physical Exam Findings Functional Physical Exam Findings Check for a positive Murphy s sign Check chronic gallbladder sign Check Liver Reflex Point Check for tenderness in the Chapman reflex for the livergallbladder Functional Urinalysis Increased urinary sediment levels 8

9 Liver Reflex Point Chapman s Liver/ GB Point 9

10 Intrahepatic Biliary Obstruction Pattern Elevated total bilirubin (>1.2 or >20.5 mmol/l) Increased GGTP (>30), Increased SGPT/ALT (>30), Increased alk phos (>100) and/or Increased LDH (>200). Extrahepatic Biliary Obstruction Pattern GGTP (>85) Alk Phos (>140) Normal or increased SGOT/AST (>55) Normal or increased SGPT/ALT (>55) 10

11 Alcohol Use Increased GGT (>30) with Additional Patterns Increased Triglycerides (>110 or >0.9 mmol/l) May see elevated SGOT/AST and SGPT/ALT levels (>30), but the GGTP will usually be higher. Fatty Acid Insufficiency Decreased triglycerides (<70 or < 0.79 mmol/l) and/or Decreased total cholesterol (<160 or < 4.14 mmol/l) Albumin Liver Dysfunction and Oxidative Stress 11

12 Oxidative Stress Reference Ranges Optimal Range Cholesterol or mmol/l Albumin Albumin Clinical Implications LOW Liver dysfunction Oxidative stress Hypochlorhydria Vitamin C need Edema Digestive dysfunction 12

13 Oxidative Stress Chem. screen as an assessment of oxidative burden Cholesterol as an antioxidant RBC Hemolysis and Oxidative Stress Oxidative Stress Pattern Total cholesterol level suddenly below its historical level and seen with: Decreased albumin (<4.0) Decreased platelet level (<150) Decreased lymphocyte y count (<20) Increased total globulin (>2.8 or 28) Increased Uric acid level (>5.9 or >351 men and >5.5 or 327 women) May also see increased Ferritin, bilirubin and LDL levels 13

14 Uric Acid Poor Detoxification Poor Detoxification Reference Ranges Optimal Value Uric acid Males: or mmol/l Females: or mmol/l 14

15 Poor Detox Pattern Poor detoxification associated with: Decreased uric acid level ( <3.0 or <178 mmol/l, < 3.5 or < 208 mmol/l) Normal MCV ( ) Normal MCH ( ) 15