Alanine transaminase

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glutamic-pyruvate transaminase

Identifiers

Symbol GPT

Entrez 2875

HUGO 4552

OMIM 138200

RefSeq NM_005309

UniProt P24298

Other data

EC number 2.6.1.2

Locus Chr. 8 q24.2-qter

Alanine transaminase

Identifiers

EC number 2.6.1.2

CAS number 9000-86-6

Databases
 IntEnz IntEnz view

BRENDA BRENDA entry

ExPASy NiceZyme view

KEGG KEGG entry

MetaCyc metabolic pathway

PRIAM profile

PDB structures RCSB PDB PDBe PDBsum

Gene Ontology AmiGO / EGO

[show]Search

Alanine transaminase or ALT is a transaminase enzyme (EC 2.6.1.2). It is also called serum
glutamic pyruvic transaminase (SGPT) or alanine aminotransferase (ALAT).

ALT is found in serum and in various bodily tissues, but is most commonly associated with the
liver. It catalyzes the two parts of the alanine cycle.

Contents
[hide]

 1 Function
 2 Clinical significance
o 2.1 Elevated levels
 3 See also
 4 References
 5 External links

[edit] Function
It catalyzes the transfer of an amino group from alanine to α-ketoglutarate, the products of this
reversible transamination reaction being pyruvate and glutamate.
 glutamate + pyruvate ⇌ α-ketoglutarate + alanine

Alanine transaminase

[edit] Clinical significance

It is commonly measured clinically as a part of a diagnostic evaluation of hepatocellular injury,
to determine liver health. When used in diagnostics, it is almost always measured in international
units/liter (U/L).[1][2] While sources vary on specific normal range values for patients, 10-40 U/L
is the standard normal range for experimental studies.[1] Alanine transaminase shows a marked
diurnal variation.

[edit] Elevated levels

Patient type Reference ranges[3]

Female 5–38 IU/L
Male 10–50 IU/L

Significantly elevated levels of ALT(SGPT) often suggest the existence of other medical
problems such as viral hepatitis, diabetes, congestive heart failure, liver damage, bile duct
problems, infectious mononucleosis, or myopathy. For this reason, ALT is commonly used as a
way of screening for liver problems. Elevated ALT may also be caused by dietary choline
deficiency. However, elevated levels of ALT do not automatically mean that medical problems
exist. Fluctuation of ALT levels is normal over the course of the day, and ALT levels can also
increase in response to strenuous physical exercise.[4]

When elevated ALT levels are found in the blood, the possible underlying causes can be further
narrowed down by measuring other enzymes. For example, elevated ALT levels due to liver-cell
damage can be distinguished from biliary duct problems by measuring alkaline phosphatase.
Also, myopathy-related ALT levels can be ruled out by measuring creatine kinase enzymes.
Many drugs may elevate ALT levels, including Zileuton, anti-inflammatory drugs, antibiotics,
cholesterol medications, and anti-convulsants.[citation needed] Consider advanced schizophrenia.

For years, the American Red Cross used ALT testing as part of the battery of tests to ensure the
safety of its blood supply by deferring donors with elevated ALT levels. The intent was to
identify donors potentially infected with Hepatitis C because there was no specific test for that
disease at the time. Prior to July 1992, widespread blood donation testing in the USA for
Hepatitis C was not carried out by major blood banks. With the introduction of second-
generation ELISA antibody tests for Hepatitis C, the Red Cross changed the ALT policy. As of
July 2003, donors previously disqualified for elevated ALT levels and no other reason may be
reinstated as donors by contacting the donor counseling department of their regional Red Cross
organization.[5]
Radioactive iodine uptake
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Radioactive iodine uptake (RAIU) is a test of thyroid function. It measures how much
radioactive iodine is taken up by the thyroid gland in a given time period.

See also:Thyroid scan

How the Test is Performed

You are asked to swallow a liquid or capsule containing radioactive iodine.

After a certain period of time (usually 6 and 24 hours later), you must return to the testing center
so that the amount of radioactivity in the thyroid gland can be measured. This is done using a
device called a gamma probe.

The probe is placed over your thyroid gland along the outside of your neck. You will be asked to
lie on a table while the scanner moves over your neck.

The scan takes about 30 minutes.

How to Prepare for the Test

Do not eat for 8 hours before the test.

Your health care provider will instruct you, if necessary, to stop taking drugs that may interfere
with the test.

Drugs that increase results include:

 Barbiturates
 Estrogen
 Lithium
 Phenothiazines
 Thyroid stimulating hormone

Drugs that decrease results include:

  ACTH
 Antihistamines
 Antithyroid drugs
 Corticosteroids
 Lugol's solution
 Nitrates
 Saturated solution of potassium iodide
 Thyroid drugs
 Tolbutamide

Tell your doctor if you have any of these factors:

 Diarrhea (may decrease absorption of the radioactive iodine)

 Recent x-ray test using iodine-based contrast (within the past 2 weeks)
 Too little or too much iodine in your diet

How the Test Will Feel

There is no discomfort. You can eat beginning about 1 - 2 hours after swallowing the radioactive
iodine. You can go back to a normal diet when the test is finished.

Why the Test is Performed

This test is done to evaluate thyroid function. It is often done when blood tests of thyroid
function (such as T3 or T4) show abnormal results.

Normal Results
 6 hours: 3 - 16%
 24 hours: 8 - 25%

Note: Some laboratories only measure at 24 hours. Values may vary depending on the amount of
iodine in your diet. Normal value ranges may vary slightly among different laboratories. Talk to
your doctor about the meaning of your specific test results.

The examples above show the common measurements for results for these tests. Some
laboratories use different measurements or may test different specimens.

What Abnormal Results Mean

Increased levels may be due to:

 Hashimoto's thyroiditis (early)

 Hyperthyroidism
 Goiter
Decreased levels may be due to:

 Hypothyroidism
 Factitious hyperthyroidism
 Iodine overload
 Subacute thyroiditis

Additional conditions under which the test may be performed:

 Colloid nodular goiter

 Graves disease
 Painless (silent) thyroiditis
 Toxic nodular goiter

Risks
The amount of radioactivity is very small, and there have been no documented side effects. The
amount of iodine used is less than the amount of iodine in a normal diet. However, as with any
radiation exposure, this test is not recommended for women who are pregnant or breastfeeding.

People with a history of allergy to dietary iodine or shellfish may not be able to have this test. A
history of allergy to iodine (contrast dye) does not necessaily mean you can't have this test. Talk
to your health care provider.

Considerations
The radioactive iodine leaves your body through your urine. You may need to take special
precautions, such as flushing twice after urinating, for 24 - 48 hours after the test. Ask your
health care provider or the radiology/nuclear medicine employee performing the scan.

Alternative Names
Iodine uptake test; RAIU

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diagnosis or treatment of any medical condition. A licensed physician should be consulted for
diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.
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authorized in writing by ADAM Health Solutions.

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Page last updated: 30 May 2012

Paracentesis
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Jump to: navigation, search

Paracentesis
 Intervention

ICD-9-CM 54.91

MeSH D019152

Paracentesis is a medical procedure involving needle drainage of fluid from a body cavity,[1]
most commonly the peritoneal cavity in the abdomen ("cent" means "pierce").

A related procedure is thoracocentesis, which is needle drainage of the chest cavity.

Pericardiocentesis involves taking fluid in the area of the pericardium.

Contents
[hide]

 1 Indications
 2 Paracentesis for Ascites
 3 Ascitic fluid analysis
 4 Contraindications
 5 References
 6 External links

[edit] Indications
It is used for a number of reasons:

 to relieve abdominal pressure from ascites

 to diagnose spontaneous bacterial peritonitis and other infections (e.g. abdominal TB)
 to diagnose metastatic cancer
 to diagnose blood in peritoneal space in trauma
 to puncture the tympanic membrane for diagnostic purposes, such as taking a bacterial
swab from the middle ear (tympanocentesis).
 to reduce intra-ocular pressure in central retinal artery occlusion (oculocaentesi) and any
hyphaema in the anterior chamber of the eye where blood does not get obsorbed in a
week's time.

[edit] Paracentesis for Ascites

The procedure is often performed in a doctor's office or an outpatient clinic. In an expert's hands
it is usually very safe, although there is a small risk of infection, excessive bleeding or
perforating a loop of bowel. These last two risks can be minimized greatly with the use of
ultrasound guidance.

The patient is requested to urinate before the procedure; alternately, a Foley catheter is used to
empty the bladder. The patient is positioned in the bed with the head elevated at 45-60 degrees to
allow fluid to accumulate in lower abdomen. After cleaning the side of the abdomen with an
antiseptic solution, the physician numbs a small area of skin and inserts a large-bore needle with
a plastic sheath 2 to 5 cm (1 to 2 in) in length to reach the peritoneal (ascitic) fluid. The needle is
removed, leaving the plastic sheath to allow drainage of the fluid. The fluid is drained by gravity,
a syringe or by connection to a vacuum bottle. Several litres of fluid may be drained during the
procedure; however, if more than two litres are to be drained it will usually be done over the
course of several treatments. If fluid drainage is more than 5 litres, patients may receive
intravenous serum albumin (25% albumin, 8g/L) to prevent hypotension (low blood pressure).
After the desired level of drainage is complete, the plastic sheath is removed and the puncture
site bandaged. The plastic sheath can be left in place with a flow control valve and protective
dressing if further treatments are expected to be necessary.

The procedure generally is not painful and does not require sedation. The patient is usually
discharged within several hours following post-procedure observation provided that blood
pressure is otherwise normal and the patient experiences no dizziness.[2][3][4]

[edit] Ascitic fluid analysis

The serum-ascities albumin gradient can help determine the cause of the ascites. The ascitic
white blood cell count can help determine if the ascites is infected.

[edit] Contraindications
Mild hematologic abnormalities do not increase the risk of bleeding.[5] The risk of bleeding may
be increased if:[6]

 prothrombin time > 21 seconds

 international normalized ratio > 1.6
 platelet count < 50,000 per cubic millimeter.

Absolute contraindication is acute abdomen that requires surgery. Relative contraindications are:

 Pregnancy
 Distended urinary bladder
 Abdominal wall cellulitis
 Distended bowel
 Intra-abdominal adhesions.[7]
Lipid Profile

Also known as: Lipid Panel; Coronary Risk Panel

Formal name: Lipid Profile

Related tests: Cholesterol; HDL-C; LDL-C; Triglycerides; Direct LDL-C; VLDL-

C; Cardiac Risk Assessment; Lp-PLA2

Overview | Risk Factors | Results | Treatment | FAQs | Related Pages

What is a lipid profile?

The lipid profile is a group of tests that are often ordered together to determine risk of coronary heart
disease. They are tests that have been shown to be good indicators of whether someone is likely to have
a heart attack or stroke caused by blockage of blood vessels or hardening of the arteries (atherosclerois).
The lipid profile typically includes:

 Total cholesterol

 High density lipoprotein cholesterol (HDL-C) — often called good cholesterol

 Low density lipoprotein cholesterol (LDL-C) —often called bad cholesterol

 Triglycerides

An extended profile may also include:

 Very low density lipoprotein cholesterol (VLDL-C)

 Non-HDL-C
Sometimes the report will include additional calculated values such as the Cholesterol/HDL ratio or a risk
score based on lipid profile results, age, sex, and other risk factors. Talk to your doctor about what these
other reported values may mean for you.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm. Sometimes a drop of blood is
collected by puncturing the skin on a fingertip. This fingerstick sample is typically used when a lipid profile
is being measured on a portable testing device, for example, at a health fair. You need to fast for 9-12
hours before having your blood drawn; only water is permitted.

How is a lipid profile used?

The lipid profile is used to help determine your risk of heart disease and to help guide you and your health
care provider in deciding what treatment may be best for you if you have borderline or high risk. The
results of the lipid profile are considered along with other known risk factors of heart disease to develop a
plan of treatment and follow-up. Depending on your results and other risk factors, treatment options may
involve life-style changes such as diet and exercise or lipid-lowering medications such as statins.

When is it ordered?
It is recommended that healthy adults with no other risk factors for heart disease be tested with a fasting
lipid profile once every five years. You may be screened using only a cholesterol test and not a full lipid
profile. However, if the cholesterol test result is high, you may have follow-up testing with a lipid profile.

If you have other risk factors or have had a high cholesterol level in the past, you should be tested more
regularly and you should have a full lipid profile.

For children and adolescents at low risk, lipid testing is usually not ordered routinely. However, screening
with a lipid profile is recommended for children and youths who are at an increased risk of developing
heart disease as adults. Some of the risk factors are similar to those in adults and include a family history
of heart disease or health problems such as diabetes, high blood pressure (hypertension), or being
overweight. High-risk children should have their first lipid profile between 2 and 10 years old, according to
the American Academy of Pediatrics. Children younger than 2 years old are too young to be tested.

A lipid profile may also be ordered at regular intervals to evaluate the success of lipid-lowering lifestyle
changes such as diet and exercise or to determine the effectiveness of drug therapy such as statins.
What do the results mean?
In general, your doctor will take into consideration the results of each component of a lipid profile plus
other risk factorsto determine whether treatment is necessary and, if so, which treatment will best help
you to lower your risk of heart disease. The National Cholesterol Education Program offers the following
guidelines for adults for classifying results of the tests:

LDL Cholesterol
Optimal: Less than 100 mg/dL (2.59 mmol/L)
Near/above optimal: 100-129 mg/dL (2.59-3.34 mmol/L)
Borderline high: 130-159 mg/dL (3.37-4.12 mmol/L)
High: 160-189 mg/dL (4.15-4.90 mmol/L)
Very high: Greater than 190 mg/dL (4.90 mmol/L)

Total Cholesterol
Desirable: Less than 200 mg/dL (5.18 mmol/L)
Borderline high: 200-239 mg/dL (5.18 to 6.18 mmol/L)
High: 240 mg/dL (6.22 mmol/L) or higher

HDL Cholesterol
Low level, increased risk: Less than 40 mg/dL (1.0 mmol/L) for men and less than 50 mg/dL (1.3 mmol/L)
for women
Average level, average risk: 40-50 mg/dL (1.0-1.3 mmol/L) for men and between 50-59 mg/dl (1.3-1.5
mmol/L) for women
High level, less than average risk: 60 mg/dL (1.55 mmol/L) or higher for both men and women

Fasting Triglycerides
Desirable: Less than 150 mg/dL (1.70 mmol/L)
Borderline high: 150-199 mg/dL(1.7-2.2 mmol/L)
High: 200-499 mg/dL (2.3-5.6 mmol/L)
Very high: Greater than 500 mg/dL (5.6 mmol/L)

The risk categories for children and adolescents are different than adults. Talk to your child's pediatrician
about your child’s results.