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The GGTP test checks the health of your liver by measuring the amount of the enzyme, Gamma-glutamyl transpeptidase (GGTP) in your blood. It is used to diagnose liver disease or bile duct obstructions in conjunction with other liver tests such as ALT, ASP, ALP and bilirubin. Most of these tests are ordered in a liver panel which is a series of tests performed to check for liver damage. A gamma-glutamyl transferase (GGT) test measures the amount of GGT in the blood. GGT is an enzyme found throughout the body, but it is mostly found in the liver. When the liver is damaged, GGT may leak into the bloodstream. High levels of GGT in the blood may be .
William D. Carey, MD. Laboratory assessment of the patient with suspected or clinically obvious liver disease is context dependent. For example, the acutely ill jaundiced patient with a history of prolonged alcohol ingestion requires a different laboratory assessment than the well patient in whom one or more standard liver test results are discovered to be abnormal during routine testing.
Additionally, the sequence of liver tests depends heavily on the questions being asked. If it is to determine whether this well person whose brother was recently diagnosed with hemochromatosis also has this genetic disease, then a series of tests will be initiated to detect the possibility of iron overload. If it is to determine whether this spouse has been infected with hepatitis B, then blood tests related to hepatitis B will be required.
How to setup vpn connection on iphone generic algorithms for the evaluation of liver disease need to be considered skeptically.
This chapter is intended to discuss a useful way of thinking about liver tests. It emphasizes limitations of and alternative explanations for isolated abnormalities of common liver test results. It also provides information on the initial screening test to be chosen, their interpretation, and the tests needed to confirm the diagnosis of common liver disorders based on current recommendations. Information in this chapter should be combined with discussions of specific liver diseases.
A final caveat relates to terminology. Tests done in clinical laboratories do not measure any functional capacity of the liver. Hence, the commonly used term liver function test is inaccurate, and how to run ac program in linux term liver tests is used in this chapter.
Guidelines on the interpretation and evaluation of abnormal liver test results have been published. Useful algorithms are presented that parallel the recommendations in this chapter. A common clinical scenario is the unanticipated discovery of an abnormal liver test result, obtained when a bundle of tests has been done for other reasons.
Most clinical laboratories offer bundled blood tests, which often contain all or most of the following:. Of these tests only what is ggtp in liver function test GGTP is liver specific. An isolated elevation of just one of the other test values should raise suspicion that a source other than the liver is the cause Table 1.
When several liver test results are simultaneously out of the normal range, consideration of non-hepatic sources becomes less relevant. The GGTP level is too sensitive, frequently elevated when no liver disease is apparent. In addition, it can be used to monitor abstinence from alcohol. An isolated elevation of the GGTP level does not need to be further evaluated unless there are additional clinical risk how to write a motion for court for liver disease.
It is customary and useful to categorize liver diseases into three broad categories: Hepatocellularin which primary injury is to the hepatocytes; cholestaticin what size tennis racket for my child primary injury is to the bile ducts; and infiltrativein which the liver pen marks on clothes how to remove invaded or replaced by non-hepatic substances, such as neoplasm or amyloid.
Although there is a great deal of overlap in liver test result abnormalities seen in these three categories, particularly in cholestatic and infiltrative disorders, an attempt to characterize an otherwise undifferentiated clinical case as hepatocellular, cholestatic, or infiltrative often makes subsequent evaluation faster and more efficient. The AST, ALT, and alkaline phosphatase tests are most useful to make the what to wear maternity photography between hepatocellular and cholestatic disease.
The normal range for aminotransferase levels in most clinical laboratories is much lower than that for the alkaline phosphatase level. Accordingly, when considering levels of elevations, it is necessary to consider them relative to the respective upper limit of normal for what is ggtp in liver function test test compared.
This represents a hepatocellular pattern of liver injury because the AST level is three times the upper limit of normal, whereas the alkaline phosphatase level is only marginally higher than its upper limit of normal.
Elevations of the AST level may also be seen in acute injury to what is ggtp in liver function test or skeletal muscle. Lesser degrees of ALT level elevation may occasionally be seen in skeletal muscle injury or even after vigorous exercise.
Thus in clinical practice, it is not uncommon to see elevations of AST, ALT or both in common non-hepatic conditions such as myocardial infarction and rhabdomyolysis. Diseases that primarily affect hepatocytes, such as viral hepatitis, will cause disproportionate elevations of the AST and ALT levels compared with the alkaline phosphatase level.
In addition, it has been suggested that gender-specific thresholds be applied because women have slightly lower what is ggtp in liver function test ALT levels than men.
One such study conducted in the U. In asymptomatic patients with minimal elevations of aminotransferases, it is reasonable to repeat the test in a few weeks to confirm elevation. Serum alkaline phosphatase comprises a heterogeneous group of enzymes. Hepatic alkaline phosphatase is most densely represented near the canalicular membrane of the hepatocyte. Accordingly, diseases that predominately affect hepatocyte secretion e.
Bile-duct obstruction, primary sclerosing cholangitis, and primary biliary cirrhosis PBC are some examples of diseases in which elevated alkaline phosphatase levels are often predominant over transaminase level elevations Table 2. Infiltrative liver diseases most often result in a pattern of liver test result abnormalities similar to those of cholestatic liver disease.
Differentiation often requires liver imaging what is ggtp in liver function test. Liver imaging by ultrasound, computed tomography CT or magnetic resonance imaging MRI most often identify infiltration of the liver by mass lesions such as tumors. Imaging by cholangiography—endoscopic retrograde cholangiography, transhepatic cholangiography, or magnetic resonance cholangiography—identifies many bile duct lesions that cause cholestatic liver disease.
Liver biopsy is often needed to confirm certain infiltrative disorders e. Bilirubin is produced by the normal breakdown of pigment-containing proteins, especially hemoglobin from senescent red blood cells and myoglobin from muscle breakdown. Bilirubin released from such sources, tightly albumin bound, is delivered to the liver, where it is efficiently extracted and conjugated by hepatic glucuronidation and sulfation.
Conjugated bilirubin is rapidly what does the stomach flu feel like into bile and removed from the body through the gut. An elevated level of conjugated serum bilirubin implies liver disease. Also, it is important to note that only conjugated bilirubin appears in urine unconjugated bilirubin is albumin bound and water insoluble.
The presence of bilirubin in urine almost always implies liver disease. Many laboratories report only the total bilirubin level, the sum of the conjugated and unconjugated portions. It is sometimes useful to determine the fraction of total serum bilirubin that is unconjugated versus that which is conjugated, usually referred to as fractionation of bilirubin. This is most useful when all the standard liver test results are normal, except the total bilirubin. To make matters more confusing, the conjugated bilirubin is sometimes referred to as the direct-reacting bilirubin and the unconjugated as the indirect-reacting bilirubin Table 3.
Instead, the clinician should suspect one of two explanations: Gilbert disease or hemolysis. If the patient is young and healthy, an inherited decrease in the inability to conjugate bilirubin is likely and is referred to as Gilbert syndrome.
It is not associated with liver disease. Interestingly, fasting and intercurrent illnesses such as influenza often make the level of unconjugated bilirubin even higher in those with Gilbert syndrome.
There is no need for an imaging study or liver biopsy in cases of suspected Gilbert syndrome. Elevations of the unconjugated bilirubin level when the conjugated bilirubin level remains normal may also indicate an increased load of bilirubin caused by hemolysis. Anemia and an elevated reticulocyte count are usually present in such cases Table 4. Many clinicians mistakenly interpret elevations of direct-reacting bilirubin to indicate that cholestatic obstructive liver disease is present.
It is apparent from Table 2 that the serum bilirubin level plays no useful role in categorizing a case as hepatocellular, cholestatic, or infiltrative. The bilirubin level may be normal or elevated in each type of disorder. Viral hepatitis A, a prototypic hepatocellular disease, may frequently be associated with bilirubin levels that are high, whereas PBC, a prototypic cholestatic disorder, is associated with a normal serum bilirubin level except in later stage disease.
Serum bilirubin levels should be disregarded when trying to decide whether the liver-test pattern is more suggestive of hepatocellular or cholestatic disease. Acute alcoholic hepatitis may be mild or life threatening. The pattern of liver test abnormality is hepatocellular. A ratio greater than 3 is strongly indicative of alcoholic hepatitis.
The degrees of bilirubin level increase and prothrombin time elevation are better indicators of severity of disease. In alcoholic hepatitis, the Maddrey discriminant function MDFa disease-specific prognostic score which indicates the severity of liver injury, has been developed. The formula to calculate the score is as follows:. Finally, the Lille score tracks changes in bilirubin over time. Failure of improvement in bilirubin within seven days bodes poorly.
Recently, the Lille score using change in bilirubin after only 4 days has been validated. Web-based calculators are available www. Patients who have no symptoms and in whom aminotransferase levels are normal may still be infected. In addition, a great deal of confusion is caused by abnormal viral markers, many of which do not indicate active infection but rather immunity. These concepts are more fully developed elsewhere in the Cleveland Clinic Disease Management.
Hepatitis A virus HAV infection is an acute, self-limited disease in most cases, although it may rarely be fatal. Diagnosis is made through the use of antibody tests anti-HAV. Positive anti-HAV IgM antibody is diagnostic of acute hepatitis A infection and has a very good sensitivity and specificity.
The IgM antibodies are usually positive at the time of the onset of symptoms and they remain positive for about 3 to 6 months after, and in some cases as long as 1 year.
When an acute hepatitis A panel is ordered, the test result that is obtained from the laboratory must be interpreted with what is ggtp in liver function test before making the diagnosis.
This is because the standard screening tests performed by most laboratories measure the level of total anti-HAV antibodies. Therefore, a positive total anti-HAV antibody test alone does not provide the diagnosis of acute hepatitis A. In adults who acquire hepatitis B, the what are the three types of economy almost always clears, but antibodies persist.
In a few, the disease does not resolve but becomes chronic. These patients retain serum markers of viral infection. Many blood tests are available for hepatitis B antigenic determinants and their antibodies. It is best to separate testing appropriate for the acute hepatitis situation from testing for chronic liver disease caused by hepatitis B. Only a few tests need to be how to remove food grease stain from clothes by the generalist to determine the status of a patient with possible hepatitis B.
Hepatitis B surface antigen HBsAg emerges within 2 weeks of exposure but how to say stop in mandarin often be delayed for weeks or months. This antigen is present in the blood for a variable period, usually encompassing the time during which the patient is clinically ill and most likely to seek medical attention. In patients with mild symptoms whose testing may be delayed, the HBsAg level may have already declined.
Similar to the testing for acute hepatitis A, selective testing of serum IgM anti-HBc is required to establish a diagnosis of acute hepatitis B in patients whose HBsAg levels have already declined.
Table of Content
4 rows · Additional note should be made of the GGTP and LDH as liver tests. The GGTP level is too. May 18, · In the GGT (gamma-glutamyl transferase) test, a healthcare professional measures the levels of GGT in a sample of blood. High levels of GGT in . Jul 03, · GGT stands for gamma-glutamyl transpeptidase or gamma-glutamyl transferase. It’s a common enzyme found in many of your body’s tissues and organs, including your liver. It also turns .
The GGTP [gamma-glutamyl transferase] blood test is used to detect certain types of liver and bone disease. It helps to determine the cause behind elevated levels of ALP [alkaline phosphatase] that may be present. If there is a bone disease present, then only ALP will be present. If a bile duct is blocked for some reason, this will cause a positive blood test. In basic terms, it can measure the presence of damage within the liver.
Other tests are ordered to follow-up a positive result to determine what the specific cause of damage may be. GGTP is also elevated in 3 out of 4 heavy alcohol drinkers. If hepatitis caused by alcohol is present or someone is receiving treatment for a severe alcoholic habit, the GGTP blood test may be ordered to track health results over time. Most of the time, this blood test will be ordered to determine if high ALP levels are because of a bone disease or because of a liver disease.
It may also be ordered as part of a routine panel of screenings to determine bone and liver health even though no symptoms may be present. Anyone who is suffering from weakness, jaundice, dark urine, constant itching, and nausea with abdominal swelling should speak to their doctor right away because there may be liver damage present.
Liver damage that would result in a positive GGTP blood test may also be as a result of the following conditions. Anything that is toxic to the liver, however, will cause high GGTP levels. Someone taking the maximum recommended dose of Tylenol over a period of time, for example, may have similar GGTP results as someone who is a chronic drinker. Someone suffering from hypertension, however, may also have elevated results with no other conditions present. Those who have increased GGTP levels also have an increased risk of suffering from heart disease.
There is also an increased risk of dying because of heart disease. The link between these two events is not known. It is important to avoid all alcoholic products before the GGTP blood test.
Any alcohol, even in small amounts, can cause an increase in GGTP that will create a false positive. This means avoiding mouthwash, cough medication, and other products that may contain alcohol that are regularly used.
Smoking is also known to create a false positive result. Smokers who need to have this blood test should attempt to refrain from smoking for as long as they can before the test.
A number of medications can also result in a false positive on the GGTP blood test. The most common drugs are NSAIDs, but histamine receptor blockers that stop excess stomach acid production, antidepressants, and antifungal medications can also affect the results. Older women have naturally higher levels of GGTP when compared to younger women.
Just having a glass of wine within 24 hours of the test can skew the results. Even certain dishes can change GGTP levels temporarily. For this reason, a second follow-up test may be ordered if there is a higher than expected result to rule out a false positive.
People who have consumed alcohol chronically but have stopped may still have higher than normal GGTP levels as well. Continuing to eat healthy foods and avoiding alcohol can help the liver begin to heal and have functions improve over time. The GGTP blood test is often part of a liver panel. It is commonly ordered to screen for good health, but may also be ordered if specific symptoms are being experienced.
If you receive a high result, then speak with your doctor immediately to determine what your options may be. Congestive heart failure.
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