Alt/ast

[Eirene, ASN, RN]

hello everyone! i've missed allnurses, but have been so busy with school that i've hardly had time to breathe.

i had a patient who was admitted for an exacerbation of diverticulitis. he was a healthy 40yo male. bowel resection 4 years ago d/t this diverticulitus.

no hx. of smoking, alcohol, drugs.

all of his labs were okay except for his alt and ast. his wbc was a little below normal at 3.9. however, his alt was 132 and ast 131. on assessment i palpated a normal sized liver. no findings on assessment to indicate liver disease.

i've looked over his meds and none cause hepatoxicity.

i have no clue what to write on my lab trending sheet to why his levels are so elevated. could he have hepatitis and not know about it? no other tests were run to look into this more.

thanks so much for any help you can offer.

dani

[BBFRN, BSN, PhD]

Diverticulitis can cause liver abcesses. But, I guess you would expect elevated WBCs in that case. Have you seen his abdominal CT results?

The only other thing I can think of right now that hasn't been mentioned is gallstones. I think the key may be in his CT results, though.

[Eirene, ASN, RN]

aha! that might be the case. he had a ct scan ordered the next morning, unfortuately i wasn't there to see the results.

thanks so much for your help.

dani

[Daytonite, BSN, RN]

Could be a tumor.

ALT (alanine aminotransferase) [formerly called SGPT (serum glutamic-pyruvic transaminase)]:

Is done to determine if there is liver damage. It will be elevated in the following conditions:

• hepatitis
  
• hepatic necrosis
  
• hepatic ischemia
  
• cirrhosis
  
• cholestasis
  
• a hepatic tumor
  
• presence of hepatotoxic drugs
  
• obstructive jaundice

You can find information on this blood test at:

• http://www.labtestsonline.org/understanding/analytes/alt/glance.html
  
• http://adam.about.com/encyclopedia/ALT.htm?once=true
  
• http://www.medicinenet.com/liver_blood_tests/article.htm
  
• http://www.nlm.nih.gov/medlineplus/ency/article/003473.htm

AST (aspartate aminotransferase) [formerly called SGOT (serum glutamic-oxaloacetic transaminase)]:

Is done to determine if there is hepatocellular disease or coronary occlusive disease. AST is release when cells lyse (break open). It will be increased in the following conditions:

• Liver diseases:
  • hepatitis
    
  • hepatic cirrhosis
    
  • drug-induced liver injury
    
  • hepatic metastasis
    
  • nepatic necrosis (intial stages only)
    
  • hepatic surgery
    
  • Infectious monomucleosis with hepatitis
    
  • hepatic infiltrative process (e.g., tumor)

  [*]Heart diseases:

  • myocardial infarctgion
    
  • cardiac operations
    
  • cardiac catherization and angioplasty

  [*]Skeletal muscle diseases

  • skeletal muscle trauma
    
  • recent noncardiac surgery
    
  • multiple traumas
    
  • sever, deep burns
    
  • progressive muscular dystrophy
    
  • recent convulsions
    
  • heat stroke
    
  • primary muscle diseases (e.g., myopathy, myositis)

  [*]Other diseases

  • acute hemolytic anemia
    
  • acute pancreatitis

You can find information on this blood test at:

• http://www.labtestsonline.org/understanding/analytes/ast/glance.html
  
• http://adam.about.com/encyclopedia/AST.htm?once=true
  
• http://www.nlm.nih.gov/medlineplus/ency/article/003472.htm

[elizabells, BSN, RN]

Okay, WITH the disclaimer that I'm coming from a NICU point of view: has he been NPO on TPN for any period of time? Because in the babies we often see TPN cholestasis with elevated LFTs.

Please feel free to tell me that doesn't even happen in adults, it's just the only thing I could think of.