The liver is one of the largest organs. It is directly involved in metabolism, cleanses the liquid connective tissue of toxic compounds, and also controls some biochemical processes. All these actions occur due to enzymes (enzymes) produced by the liver itself. Their indicators are clinically significant in the diagnosis of a disease. If liver enzymes are elevated, this indicates the development of a pathological process in the body. Such results of biochemical analysis are the basis for a comprehensive examination.
Enzyme groups
All enzymes produced by the liver have certain synthesizing features. The latter are the main classification criterion.
Liver enzyme groups:
- Indicator. Their level deviates from the norm in the event thatwhen cells are destroyed. These enzymes include: ALT (alanine aminotransferase), AST (aspartate aminotransferase), LDH (lactate dehydrogenase), GDH (glumatate dehydrogenase), GGT (gammaglutamyl transpeptidase). The enzymes ALT and AST have the greatest clinical significance.
- Secretory. Designed to maintain the blood clotting index. These include: prothrombinase, cholinesterase.
- Excretory. Clinically significant is the indicator of alkaline phosphatase. When it deviates up or down, it is customary to talk about violations in the biliary system.
The conclusion of the biochemical blood test does not reflect all enzymes, but only those that are of the greatest importance in diagnosing pathological processes.
Normal indicators
First, doctors evaluate the levels of AST and ALT enzymes. Moreover, the first is contained not only in the liver. AST can be found in skeletal muscle, myocardium, and kidneys. ALT is an enzyme found exclusively in the liver. A normal indicator of AST is one that is not less than 10 and not more than 30 U / l. For ALT it ranges from 10 to 40 U/L.
Doctors also evaluate the ratio of alanine aminotransferase and aspartate aminotransferase. If the liver enzyme ALT is elevated and equal to the level of AST, this indicates the development of acute hepatitis. When the first is 2 times greater than the second, it is customary to talk about alcohol addiction. If, on the contrary, AST is higher than ALT, this indicates the presence of cirrhosis. These are the main reasonsincrease in the blood of liver enzymes belonging to the indicator group.
GGT, LDH and ALP enzymes are also clinically significant. The norm of gamma-glutamyl transpeptidase in the blood is not more than 40 U / l. GGT is found not only in the liver, but also in the kidneys, the walls of the bile ducts and the pancreas. The enzyme is the most highly sensitive indicator, especially in children and during childbearing. For example, if AST and ALT are within the normal range during toxic exposure, then GGT will definitely be increased.
The LDH enzyme is not only found in the liver. For this reason, it is additionally identified using numbers from 1 to 5. If a violation of the biliary system is suspected, a blood test for LDH-5 is indicated. Enzyme rate - up to 250 U/L.
Alkaline phosphatase is an enzyme also found in the kidneys, bone structures, and walls of the bile ducts. Its increase indicates a violation of the functioning of the hepatobiliary system. The norm of alkaline phosphatase - up to 270 U/l.
Causes of increased liver enzymes in the blood
Not in all cases, the deviation of indicators from the norm indicates the development of a pathological process in the body. Elevated liver enzymes in the blood are sometimes the result of being overweight or taking certain medications. Antipyretics and painkillers, as well as medicines related to statins and sulfonamides, have the greatest impact on the indicators.
In addition, elevated liver enzymes in the blood sometimes indicate alcoholpoisoning and abuse of too fatty foods. Also, the deviation of enzymes from the norm in some cases occurs against the background of alternative treatment of a disease. It is important to know that the use of products based on hay, skullcap and ephedra contributes to an increase in liver enzymes in the blood.
Other possible causes of deviations from the norm:
- Pathologies in the form of cirrhosis, acute hepatitis, organ tissue necrosis, fatty degeneration, obstructive jaundice. In such cases, the liver enzymes ALT and AST are elevated.
- The presence of cholestasis, neoplasms, cholangitis, alcohol intoxication. These are the reasons for the increase in the liver enzyme GGT. The indicator of this enzyme upwards can also deviate against the background of hepatitis, obstructive jaundice and cirrhosis.
Levels of LDH and alkaline phosphatase increase against the background of all the above diseases.
Clinical manifestations
The deviation of these indicators from the norm is accompanied by the appearance of a number of symptoms in a person. Against the background of an increase in liver enzymes, the following alarming signs appear:
- Significant reduction in performance.
- Fast onset of fatigue.
- Permanent feeling of tiredness.
- Appetite disorders.
- Pain in the abdomen.
- Itching and yellowness of the skin.
- Bruises that appear for no apparent reason.
- Yellowness of the sclera.
- Frequent episodes of nosebleeds.
In some caseselevated liver enzymes are not associated with any symptoms.
Diagnosis
The level of enzymes is displayed in the conclusion of a biochemical blood test. This type of study is a laboratory diagnostic method with which a doctor can assess the degree of functioning of internal organs and obtain the most complete information regarding metabolic processes.
A biochemical blood test is a mandatory step in a comprehensive examination of a patient, even if the latter does not have clinical manifestations of any disease.
Before donating biological material (venous or capillary liquid connective tissue), some rules must be observed. Blood sampling is carried out on an empty stomach, and therefore the last meal should take place no later than 8 hours before visiting the laboratory. Psycho-emotional instability and physical overstrain can lead to false results. A day before donating blood, it is recommended to avoid any kind of exercise. Immediately before taking the biomaterial, it is advisable to sit for 15 minutes in a calm environment to normalize the psycho-emotional background.
To find out the cause of elevated liver enzymes in the blood, the doctor prescribes a number of laboratory and instrumental studies. The list of necessary diagnostic measures is compiled by a specialist based on the patient's complaints, anamnesis data and the results of biochemical analysis.
Medicated treatment
It is important to understand that increasing enzymesliver is a symptom of one of the diseases of the organ. Only after identifying the root cause, the doctor draws up the most effective treatment regimen.
Each of the liver diseases requires a specific approach. The treatment regimen for cirrhosis includes the following items:
- Taking antiviral, immunomodulatory or hormonal drugs (depending on the etiology of the disease).
- Injection or oral use of interferons ("Viferon", "Genferon", "Cycloferon").
- Vitamin therapy.
- Reception of hepaprotectors ("Gepabene", "Karsil", "Ursosan", "Heptral").
In addition, the doctor cancels all drugs for the use of which there are no clear indications. It is also necessary to follow a therapeutic diet and completely abandon alcohol-containing drinks.
Treatment of acute hepatitis involves the following activities:
- Intravenous administration of a solution of glucose and ascorbic acid.
- Vitamin therapy.
- Taking or administering drugs that accelerate the excretion of harmful compounds from the body (with toxic hepatitis).
- Hemodialysis.
- Taking antihistamines (Zodak, Zyrtec, Fenistil).
- Administration of anti-inflammatory and desensitizing agents.
Depending on the etiology of the disease and its severity, the doctor may make adjustments to the treatment regimen.
Treatment of fatty degeneration of an organ consists of the following steps:
- Reception of essential phospholipids ("Essentiale Forte", "Phospholipiale"). Preparations belonging to this group contribute to the restoration of liver cells.
- Reception of the strongest hepaprotectors ("Rezalyut", "Antral", "Phosphogliv"). They have a powerful positive effect on the body.
- Reception of immunomodulators ("Kogocel", "Amiksin", "Arbidol").
- Use of choleretic agents ("Allohol", "Flamin").
- Use of dietary supplements ("Zosterin-Ultra", "Tantalum", "Silymarin").
Therapy of obstructive jaundice involves detoxification, antibacterial and infusion therapeutic measures. If they fail, surgery is indicated. In the presence of this disease, it is also necessary to follow a strict diet and completely exclude the use of alcohol-containing drinks.
The treatment regimen for cholestasis includes the following items:
- Taking drugs whose active ingredient is ursodeoxycholic acid (Ursofalk, Ursodez, Ursosan).
- Use of cytostatics ("Casodex", "Cisplacel").
- Reception or intravenous administration of hepaprotectors.
- Vitamin therapy.
- Taking antihistamines.
Thus, the tactics of treating patients with elevated liver enzymes (AST, ALT, alkaline phosphatase, LDH, etc.) directly depends on the root cause that caused the pathologicalstates. In all cases, the doctor, without waiting for the results of a comprehensive examination, recommends making adjustments to the diet and diet. The purpose of following a therapeutic diet is to reduce the load on the affected organ, accelerate the removal of harmful compounds, and prevent fat deposition.
Recovery period: nutritional features
For liver diseases, doctors prescribe table number 5. This is a rather tough, but at the same time balanced diet. Its main principle is the exclusion from the diet of foods that contain a large amount of fat, "bad" cholesterol, purine and oxalic acid. These substances have a negative effect on the liver and prevent the restoration of its cells.
Basic principles of the diet:
- It is necessary to grind as much as possible (it is better to grind) plant foods rich in fiber. Meat should be cut into small portions.
- You need to eat up to 5 times a day. At the same time, the size of one serving should not exceed 200 g.
- Only warm food is allowed. Food that is cold or too hot is not recommended.
- Products are allowed to boil, bake, steam or stew. Fried foods should be excluded from the diet.
- The maximum allowable amount of s alt per day is 10 g.
It is important to observe the drinking regime. Up to 2.5 liters of pure non-carbonated water should be consumed daily.
During the treatment of liver diseases, it is recommended to give preference to the followingfood:
- Bread (rye or bran).
- Savory cookies.
- Yeast-free baking.
- Rice, semolina, oatmeal and buckwheat porridge.
- Pasta.
- Berries.
- Fruit.
- Zephyr.
- Marmalade.
- Zucchini.
- Cabbage (cauliflower and Beijing).
- Pumpkin.
- Beets.
- Carrots.
- Cucumbers.
- String beans.
- Sweet pepper.
- Dill.
- Parsley.
- Compote.
- Skim milk.
- Decoction of wild rose.
- Ryazhenka.
- Kefir.
- Natural yogurt.
- Cottage cheese.
- Cheese.
- Low-fat meats and fish.
- Chicken and quail eggs.
- Olive oil.
During treatment and during the recovery period, it is forbidden to eat foods that irritate liver cells and increase the load on he althy hepatocytes. It is mandatory to exclude from the menu:
- Muffin.
- Yeast baking.
- Puff pastry products.
- Fresh bread.
- Beans.
- Corn, barley and barley porridge.
- Halva.
- Seeds.
- Chocolate.
- Nuts.
- Ice cream.
- Ginger.
- Olives.
- Green onion.
- Radishes.
- Mushrooms.
- Parsley.
- Spinach.
- Pickles.
- Tomatoes.
- White cabbage (not thermally processed).
- Raspberries.
- Grapes.
- Fig.
- Black and green tea and hibiscus.
- Packaged juices.
- Coffee.
- Soda water.
- Dairy products with a high percentage of fat content.
- Sauces.
- Meat and fatty fish.
All soups should be in a weak broth. It is recommended to cook the meat separately, then cut it into small pieces and add to the finished dish.
Folk methods
Doctors do not prohibit turning to non-traditional methods of treatment. However, you must first consult with a specialist. This is due to the fact that some natural components can worsen the course of the underlying disease and, accordingly, further increase the level of liver enzymes.
The goal of alternative treatment is to prevent the destruction of hepatocytes. The most effective are the following recipes:
- Take 150 g of oat grains and pour 1.5 liters of boiling water over them. Put the container on medium heat and cook for about 20 minutes. Allow liquid to cool. Drink the resulting decoction daily, 200 ml. The course of treatment is 20 days.
- Take 200 ml of honey. Add ground cinnamon to it in an amount of 20 g. Mix the components thoroughly. Take the resulting remedy on an empty stomach twice a day (morning and evening) for 1 tsp. Treatment duration is unlimited.
- Take the root of elecampane, wash it thoroughly and chop it. Pour 5 g of raw materials with boiling water in an amount of 200 ml. Let it brew for 1 hour. Filter the liquid and take the resulting remedy 4 times a day.
The symptoms of general malaise disappear after a few days. If necessary, the course of treatment can be repeated.
Increased enzyme levels in pregnant women and children
During the period of gestation, it is necessary to take a biochemical blood test several times. If liver enzymes are elevated during pregnancy, this indicates the development of a pathological process or uncontrolled medication.
Most often expectant mothers are diagnosed with drug-induced hepatitis. During the period of bearing a child, the body experiences an increased load and a slight increase in the dosage of even a drug prescribed by a doctor leads to severe intoxication. If liver enzymes are elevated during pregnancy, it is necessary to adjust the dosing regimen or stop taking medications. Antibiotics, glucocorticosteroids, NSAIDs, anticonvulsants and antituberculosis drugs, diuretics can provoke a deviation from the norm.
Elevated liver enzymes in a child can also be the result of taking medications (painkillers, statins, sulfonamides). In addition, eating fatty foods can provoke a deviation from the norm. To exclude serious diseases, the pediatrician prescribes a comprehensive examination. If a child has elevated liver enzymes, a hepatitis test is mandatory.
In closing
In the diagnosis of many diseases, a biochemical blood test is important. It is possible to evaluate the functioning of the liver due to the indicators of the enzymes synthesized by it. They areare divided into the following groups: indicator, excretory, secretory. Clinically significant in assessing the functioning of the body are the indicators of ALT, AST, alkaline phosphatase, LDH.
If a pathological process is suspected, the doctor prescribes a series of studies and, based on their results, draws up the most effective treatment regimen. The main reasons for the deviation of liver enzymes from the norm are hepatitis, cirrhosis, obstructive jaundice, fatty degeneration, cholestasis. In pregnant women and children, an increase in enzymes is most often the result of taking medications. But at the same time, the development of dangerous pathologies cannot be ruled out.
