Re: Elevated SGPT

Posted By HFHSM.D.mg on August 06, 1998 at 20:32:59:

In Reply to: Elevated SGPT posted by Michael on August 04, 1998 at 10:17:56:






I am a 26 yr old non-smoker, non-drinker, drug-free mild to moderately active male.
Over the past several years my SGPT levels have been elevating to
around 135 currently.  I have had extensive Hep. testing, (A, B and C- all negative)
as well as liver function testing which have also turned out normal.  My G.I.
has suggested that I have a Liver Biopsy performed for "peace of mind".
In your opinion, is a liver biopsy the next logical step?
Are there alternative tests which might be less-invasive?  
What generally might be found from such a proceedure?
Is it a painful proceedure? My specialist said "no" but I wonder?
Any thoughts would be greatly appreciated!
_
Dear Michael,
The cause of mild elevations in serum aminotransferase levels (SGPT or SGOT) in asymptomatic patients varies depending on the geography and patient selection.  For example, hepatitis B, schistosomiasis, and malaria are common causes in the Far East, Egypt, and Africa, respectively.  In most western countries, however, hepatic steatosis (or fatty liver, which may be present in only modestly overweight patients) and alcohol-related liver disease are among the most common causes.  Other common explanations include hepatitis C, hepatitis B, alpha1-antitrypsin deficiency, hemochromatosis (both are inherited diseases), and drug-induced hepatitis.
The evaluation for your problem is guided by clinical history, physical examination, and nature of the test abnormalities.  In addition to the labs you mentioned (Hepatitis profile, liver function tests), other blood tests are available to rule out potentially treatable conditions.  For example, iron studies to address the possibility of hemochromatosis, ceruloplasmin level to detect Wilson disease, markers of autoimmune liver disease, and alpha1-antitrypsin levels.
If the above studies are all negative, the next step would be to abstain from alcohol and discontinue any unnecessary medications (including those that are available over-the-counter).  You state that you are a non-drinker and drug-free, but perhaps you are taking over-the-counter medications that are hepatotoxic.  If you are overweight, aggressive weight loss is advisable because the biochemical abnormalities associated with hepatic steatosis (aka fatty liver) may improve and the risks, cost, and discomfort of further evaluation may be avoided.  If these interventions have little or no effect and your SGPT level remains elevated, then a liver biopsy should be considered.
The procedure is relatively safe and associated with mild discomfort (the level of discomfort is very subjective).  There are different methods to perform this test but to give you a rough idea, I will describe the way we perform the procedure at our institution.  The patient is placed in the supine position (lying on your back) with the right arm extended over your head (or right hand placed under your head).  This position helps spread the rib cage on the right side under which the liver lies.  The doctor will percuss or tap along your right side to precisely locate your liver and mark a spot between the ribs.  He/she will then clean the area with medicated soap and cover the surrounding area with a sterile drape.  Under sterile technique, the area marked will be injected with a numbing medicine--some patients claim this is the worst part of the procedure.  The numbing medicine will feel like a bee sting (similar to what the dentist injects in your mouth to numb your teeth).  After numbing the area, the doctor will instruct you how to breath when he/she passes the needle for biopsy.  The liver lies right under the diaphragm which moves up and down whenever you take a breath; therefore, while passing the needle for biopsy, typically the breath is held.  The time needed to actually obtain the liver biopsy is literally seconds.  After the biopsy, you may be asked to remain in the lying position for several hours, perhaps lying on your right side to decrease the risk of bleeding.  Although this procedure is relatively safe there are possible risks including, but not limited to, bleeding, infection, local pain, pneumothorax (collapsed lung), or injuring other internal organs.  Monor bleeding not requiring any treatment is the most common complication occurring in about 1in a 1000 cases.  The other complications are much less frequent.
This information is presented for educational purposes only.  Always consult your personal physician for specific medical questions.
HFHSM.D.-mg
*keywords: hepatitis, liver tests, liver biopsy
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