Hello doctor,
I am 55 years old male, height 168 cm, and weight 74 kg. I do not drink or smoke. Presently, I am not under any medications. Previously, I took medicines for suspected acid reflux symptoms for six months but stopped since one year. I used to undergo comprehensive blood tests on a yearly basis. The query is about results of lab reports taken from two different labs. I am worried about the values of SGOT (AST) and SGPT (ALT). Does it indicate the damage to the liver? (The level of AGST and SGPT were normal up to last year). You are requested to advise me regarding the future course of action on this query.
Hi,
Welcome to icliniq.com.
I note that your query is related to abnormal LFTs (blood liver function tests) SGOT (AST- aspartate transaminase) and SGPT (ALT- alanine transaminase). From the information you provided (attachment removed to protect patient identity), I understand that:
- You are asymptomatic (currently no symptoms) and that the abnormal blood results were picked up incidentally on the routine annual checkup.
- You are not on any medications currently or recently (within last three months).
There are many possible causes of transaminitis (raised ALT/AST) and identification of the underlying cause in you requires a detailed medical history and a series of blood tests.
The Probable causes:
The most important usual cause of hepatitis (inflammation in the liver cells) are:
1. Viral hepatitis.
2. Drug (medication) induced, including allopathic or herbal medicines or supplements.
3. Fatty liver (NASH or Non-alcoholic steato-hepatitis).
4. Alcoholic hepatitis.
5. Auto-immune hepatitis, etc.
I will recommend that you see a hepatologist or medical gastroenterologist. The initial steps to be taken are as follows:
1. Repeat blood tests for LFTs (liver function tests) in a standard laboratory.
2. Ultrasound abdomen.
If the blood tests LFTs are still abnormal, a further blood test to evaluate the cause for this will include:
1. Hepatitis A IgM to check for hepatitis A infection.
2. HBsAg, HBcAg (IgM) for hepatitis B infection.
3. HCV Antibodies to check for hepatitis C infection.
4. Liver autoantibodies (ANA anti-nuclear antibody, ASMA anti-smooth muscle antibody, AMA anti-mitochondrial antibody), etc.
Based on the above results, further evaluation may be required like a liver fibroscan or a liver biopsy.
1. Viral hepatitis.
2. Drug induced hepatitis.
Make a note of all the medicines you could have taken in the last few months including allopathic drugs, eg., statins (cholesterol medication), painkillers (Paracetamol, NSAIDs- non-steroidal anti-inflammatory drugs), herbal remedies or any other supplements. Discuss this with your doctor or write back to me if you have any further queries.
Regarding follow up:For more information consult a medical gastroenterologist online.--->https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist
Many thanks for your reply.
The results of the tests undergone are attached.
Submitted for your valuable advice.
Thanking you sir,
The blood tests show that you are not diabetic and that you do not have Hepatitis B or C infection.
Investigations to be done:
FIBROSCAN
Repeat blood tests for LFTs (liver function tests) including SGOT and SGPT
Check blood test for full lipid profile (includes cholesterol, triglycerides etc)
NASH (Non Alcoholic Steato Hepatitis)
Treatment plan:Lifestyle modifications - daily physical activity ( 45 minutes brisk walking), even a small loss of weight by 2 or 3 kg will be helpful. Avoid alcohol consumption. Have blood cholesterol checked and take medications for cholesterol control if high.
Preventive measures:Your body mass index (BMI) suggests that you are slightly overweight. Have a low fat diet and adopt a healthy lifestyle.
Regarding follow up:Fatty liver is reversible, but any damage already occurred called fibrosis is not. Fibroscan can accurately assess what degree of fibrosis you have. Please try and get this done with a Gastroenterologist. You can get further info on NASH from website www.international-nash-day.com
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