The liver is one of the largest organs. It takes a direct part in the metabolism, cleans 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. Similar 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.
Groups of liver enzymes:
- Indicator Their level deviates from the norm in the case when the destruction of organ cells occurs. These enzymes include: ALT (alanine aminotransferase), AST (aspartate aminotransferase), LDH (lactate dehydrogenase), GDH (glumate dehydrogenase), GGT (gamma glutamyl transpeptidase). The greatest clinical significance are the enzymes ALT and AST.
- Secretory. Designed to maintain blood coagulation. These include: prothrombinase, cholinesterase.
- Excretory. Clinically significant is an indicator of alkaline phosphatase. With its deviation up or down, it is customary to talk about violations in the work of the biliary system.
In the conclusion of the biochemical analysis of blood, not all enzymes are reflected, but only those that are of the greatest importance in the diagnosis of pathological processes.
Norm indicators
First, doctors evaluate the level of AST and ALT enzymes. Moreover, the first is found not only in the liver. AST can be found in skeletal muscle, myocardium, and kidneys. ALT is an enzyme that is found exclusively in the liver. A normal indicator of AST is one that is not less than 10 and not more than 30 units / liter. 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 more than the second, it is customary to talk about alcohol dependence. If, on the contrary, AST is higher than ALT, this indicates the presence of cirrhosis. These are the main reasons for the increase in the blood of liver enzymes belonging to the indicator group.
Clinically significant are the enzymes GGT, LDH and alkaline phosphatase. The norm of gammaglutamyltranspeptidase in the blood is not more than 40 units / liter. GGT is found not only in the liver, but also in the kidneys, walls of the bile duct and pancreas. The enzyme is the most highly sensitive indicator, especially in children and during the period of gestation. For example, if the toxic effects of AST and ALT are within normal limits, then GGT will definitely be increased.
The LDH enzyme is not only in the liver. For this reason, it is additionally identified using numbers from 1 to 5. If you suspect a malfunction of the biliary system, a blood test for LDH-5 is indicated. The norm of the enzyme is 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 is up to 270 units / liter.
Causes of increased liver enzymes in the blood
Not in all cases, a 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. Antipyretic and analgesic drugs, as well as medicines related to statins and sulfonamides, have the greatest influence on indicators.
In addition, elevated liver enzymes in the blood sometimes indicate alcohol poisoning and abuse of excessively 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 funds based on hay, scutellaria and ephedra helps to increase liver enzymes in the blood.
Other possible causes of deviation of indicators from the norm:
- Pathologies in the form of cirrhosis, acute hepatitis, organ tissue necrosis, fatty degeneration, obstructive jaundice. In such cases, 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 in a large direction may also deviate against the background of hepatitis, obstructive jaundice and cirrhosis.
Levels of LDH and alkaline phosphatase increase against all of the above diseases.
Clinical manifestations
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:
- A significant decrease in the degree of performance.
- The rapid onset of fatigue.
- Constant feeling of tiredness.
- Impaired appetite.
- Pain in the abdomen.
- Itching and yellowness of the skin.
- Bruises appearing for no apparent reason.
- Yellowness sclera.
- Frequent episodes of nosebleeds.
In some cases, an increase in liver enzymes is not associated with the onset of any symptoms.
Diagnostics
The level of enzymes is displayed in the conclusion of the biochemical analysis of blood. This type of research is a laboratory diagnostic method, with which the doctor can assess the degree of functioning of the internal organs and obtain the most complete information regarding metabolic processes.
A biochemical blood test is a mandatory step in a comprehensive examination of the patient, even if the latter does not have clinical manifestations of a disease.
Before the delivery of biological material (venous or capillary liquid connective tissue), some rules must be observed. Blood sampling is carried out on an empty stomach, in connection with which the last meal should take place no later than 8 hours before visiting the laboratory. Psycho-emotional instability and physical stress can lead to false results. The day before the blood donation, it is recommended to avoid any kind of stress. Just before the biomaterial is taken, 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 series of laboratory and instrumental studies. The list of necessary diagnostic measures is compiled by a specialist on the basis of patient complaints, medical history and biochemical analysis results.
Drug treatment
It is important to understand that an increase in liver enzymes is a symptom of one of the diseases of the organ. Only after identifying the root cause does the doctor draw up the most effective treatment regimen.
Each of the liver diseases requires a specific approach. The cirrhosis treatment regimen includes the following items:
- Reception of antiviral, immunomodulating 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 medicines for the use of which there are no obvious indications. It is also necessary to follow a therapeutic diet and completely abandon alcohol-containing drinks.
Treatment of acute hepatitis involves the following measures:
- Intravenous administration of a solution of glucose and ascorbic acid.
- Vitamin Therapy
- Taking or administering drugs that accelerate the release of harmful compounds from the body (with toxic hepatitis).
- Hemodialysis.
- Reception of antihistamines ("Zodak", "Zirtek", "Fenistil").
- The introduction 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 organ fatty degeneration consists of the following steps:
- Reception of essential phospholipids (Essential Forte, Phospholipiale). Drugs belonging to this group contribute to the restoration of liver cells.
- Reception of the strongest hepatoprotectors (Rezalyut, Antral, Phosphogliv). They have a powerful positive effect on the body.
- Reception of immunomodulators ("Kogotsel", "Amiksin", "Arbidol").
- The use of choleretic drugs ("Allohol", "Flaming").
- The use of dietary supplements (Zosterin-Ultra, Tantalum, Silymarin).
Therapy of obstructive jaundice involves detoxification, antibacterial and infusion therapeutic measures. With their ineffectiveness, surgical intervention is indicated. In the presence of this ailment, it is also necessary to follow a strict diet and completely eliminate the use of alcohol-containing drinks.
The treatment regimen for cholestasis includes the following items:
- Taking medications whose active ingredient is ursodeoxycholic acid (Ursofalk, Ursodez, Ursosan).
- The use of cytostatics ("Casodex", "Cisplacel").
- Reception or intravenous administration of hepatoprotectors.
- Vitamin Therapy.
- Reception of antihistamines.
Thus, the tactics of treating patients with elevated liver enzymes (AST, ALT, alkaline phosphatase, LDH, etc.) directly depends on the root cause of the pathological condition. In all cases, the doctor, not waiting for the results of a comprehensive examination, recommends making adjustments to the diet and diet. The goal of following a therapeutic diet is to reduce the burden on the affected organ, accelerate the withdrawal of harmful compounds, and prevent fat deposition.
Recovery period: nutritional features
For liver diseases, doctors prescribe table number 5. This is a fairly tough, but at the same time balanced diet. Its main principle is the exclusion from the diet of food products, which contain a large amount of fat, "bad" cholesterol, purine and oxalic acid. These substances negatively affect the liver and interfere with the restoration of its cells.
The basic principles of the diet:
- It is necessary to grind as much as possible (it is better to grind) plant foods rich in fiber. The meat must be cut into small portioned portions.
- You need to eat up to 5 times a day. Moreover, the size of one serving should not exceed 200 g.
- It is permissible to eat only warm food. Cold or overly hot meals are not recommended.
- Products are allowed to cook, bake, steam or stew. Fried foods should be excluded from the diet.
- The maximum allowable amount of salt per day is 10 g.
It is important to observe the drinking regimen. Every day you need to consume up to 2.5 liters of pure still water.
During the treatment of liver diseases, it is recommended to give preference to the following foods:
- Bread (rye or bran).
- Unsweetened liver.
- Yeast-free baking.
- Rice, semolina, oatmeal and buckwheat porridge.
- Pasta.
- Berries.
- Fruit.
- Marshmallows.
- Marmalade.
- Zucchini.
- Cabbage (cauliflower and Beijing).
- Pumpkin
- Beetroot.
- Carrots.
- Cucumbers.
- String Beans.
- Sweet pepper.
- Dill.
- Parsley.
- Compote.
- Skim milk.
- Decoction of wild rose.
- Ryazhenka.
- Kefir.
- Natural yogurt.
- Curd.
- Cheese.
- Low-fat meats and fish.
- Chicken and quail eggs.
- Olive oil.
During treatment and during the recovery period, it is forbidden to use products that irritate liver cells and increase the burden on healthy hepatocytes. It is mandatory to exclude from the menu:
- Baking.
- Yeast baking.
- Products from puff pastry.
- Fresh bread.
- Legumes.
- Corn, barley and pearl barley porridge.
- Halvah.
- Sunflower seeds.
- Chocolate.
- Nuts.
- Ice cream.
- Ginger.
- Olives.
- Chives.
- Radish.
- Mushrooms.
- Parsley.
- Spinach.
- Salted cucumbers.
- Tomatoes
- White cabbage (not thermally processed).
- Raspberries.
- Grapes
- Figs
- Black and green tea, as well as hibiscus tea.
- Packaged juices.
- Coffee.
- Sparkling water.
- High-fat dairy products.
- Sauces.
- Meat and fish of fatty varieties.
All soups should be on 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 the use of unconventional 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 them with 1.5 liters of boiling water. Put the container on medium heat and cook for about 20 minutes. Allow fluid to cool. Drink the resulting broth daily at 200 ml. The course of treatment is 20 days.
- Take 200 ml of honey. Add ground cinnamon in an amount of 20 g. Mix the ingredients thoroughly. Take the drug on an empty stomach twice a day (morning and evening) for 1 tsp. The duration of treatment is not limited.
- Take elecampane root, wash and grind it thoroughly. Pour 5 g of raw material with boiling water in an amount of 200 ml. Let it brew for 1 hour. Filter the liquid and take the product 4 times a day.
After a few days, the symptoms of general malaise disappear. 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 hepatitis. During the period of carrying the child, the organ experiences an increased load and a small increase in the dosage even of the drug prescribed by the doctor leads to severe intoxication. If liver enzymes are elevated during pregnancy, it is necessary to adjust the dosage regimen or to stop taking medication. Antibiotics, glucocorticosteroids, NSAIDs, anticonvulsants and anti-tuberculosis drugs, diuretics can provoke a deviation of indicators from the norm.
Elevated liver enzymes in a child can also be a consequence of taking medications (painkillers, statins, sulfonamides). In addition, fatty foods can provoke a deviation from the norm. To exclude serious diseases, the pediatrician prescribes a comprehensive examination. If the child has elevated liver enzymes, a hepatitis test is mandatory.
Finally
In the diagnosis of many diseases, biochemical blood testing is important. It is possible to evaluate the functioning of the liver thanks to the indicators of the enzymes it synthesizes. They are divided into the following groups: indicator, excretory, secretory. Clinically significant in assessing the functioning of the body are 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 causes of 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.