ELEVATED SERUM AMINOTRANSFERASES

1. By: Haitham Sulaiman A Habtar
University No. : 432800200
S/N : 103

2. AminotransferaseAminotransferase
What is the Aminotransferase ???
Aminotransferases are enzymes , (proteins that
help speed up chemical reactions in the body) .
Where it’s found ???
found mainly in the liver, but also in other tissues,
such as muscles.
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3. Mechanism of Aminotransferase
It’s an enzyme that catalyzes a type of
reaction between an amino acid and an -α
keto acid.
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4. Why Aminotransferase is importantWhy Aminotransferase is important
 important in the synthesis of amino acids,
which form proteins.
 in medicine, they are an important indicator of
liver damage. And there is two important
indicator :
a. aspartate aminotransferase ( AST )
b. alanine aminotransferase ( ALT )
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5. AST & ALTAST & ALT
How to measure the AST & ALT
The ALT and AST levels are obtained directly
from a blood sample that is sent to the
laboratory for measurement.
[ The results are usually available within hours to
days ]
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6.  Normal rang for AST & ALT
• Normal levels of AST and ALT may slightly vary
depending on the individual laboratory's
reference values and area .
AST ALT
Male 14–20 U/L 10–40 U/L
Female 10–36 U/L 7–35 U/L
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7. ELEVATED SERUMELEVATED SERUM
AMINOTRANSFERASESAMINOTRANSFERASES
 In the setting of hepatocyte damage,
alanine aminotransferase (ALT) and
aspartate aminotransferase (AST) are
released from hepatocytes, leading to
increased serum levels.
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8.  Acute liver failure :
 Acute liver failure is characterized by acute
hepatocellular injury with LFTs typically more
than 10 times the upper limit of normal,
 Marked elevation without liver failure :
Patients with marked elevations in their liver
function tests (approximately 15 times the
upper limit of normal or higher) often have
acute hepatitis, though in some cases, there may
be underlying chronic liver disease
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9.  Elevated Levels of AST and ALT
Elevated levels of liver enzymes in general signify
some form of liver (or hepatic) damage or injury
These levels may be elevated acutely (short term)
indicating sudden injury to the liver, or they may be
elevated chronically (long term) suggesting ongoing
liver injury.
In addition to the duration, the level of abnormal
elevation of the aminotransferases is also significant.
In some conditions the elevation could be mild,
consistent with a mild injury or inflammation of the
liver.They can also be severely elevated, possibly up
to 10 to 20 times the normal values, suggesting
more significant damage to the liver.
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10. DiseasesThat Cause Elevation
Levels of AST and ALT
Common
• Acute viral hepatitis
• Chronic viral hepatitis
• Cirrhosis of the liver
• Liver damage from alcohol abuse or alcoholic fatty liver
• Hemochromatosis
• Diminished blood flow to the liver (from shock or heart
failure)
Less Common
• Wild mushroom
• Wilson's disease
• Autoimmune hepatitis
• Gallstone
* Some Medications can cause elevation in AST & ALT
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• Pregnancy
• Muscle injury

11. What to do if i suspect the AST & ALT
high ??!!
• The most important step is to take a medical
history and perform a complete medical
examination. Record all the patient's
medications,Any history of blood transfusion,
history of intravenous injections , drug use or
needle sharing, tattoos, sexual contact with
someone with possible viral hepatitis, alcohol
consumption, foreign travel
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12. Symptoms & sing with elevation of AST &
ALT
• Symptoms and sing may vary from no
symptoms at all to generalized
• malaise,
• fatigue,
• fever,
• poor appetite,
• abdominal pain,
• jaundice (yellowing of skin),
• itching,
• nausea, or
• vomiting.
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13. Haitham S Habtar 13
Typical serum aspartate aminotransferase (AST) or alanine aminotransferase
(ALT) values for various diseases. Note that the horizontal axis is a log scale.
As shown, the amino-trans-ferases are often normal in patients with cirrhosis.
In patients with uncomplicated alcoholic hepatitis, the AST value is rarely
greater than 500 U per L and is usually no more than 200 to 300 U per L. The
highest peak aminotransferase values are found in patients with acute ischemic
or toxic liver injury. ( this figure from American Academy of Family Physicians )

14. Management
After taking complete medical history
and perform a complete medical
examination
If we don’t reach the correct diagnose we
have to do further investigation
Then treat the underlying cause
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15. ReferencesReferences
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