Is "possibly carrying a few kilograms" a symptom?
-----Original Message-----
From: VIVEKANANDAN SACHIDANANDAM [mailto:[log in to unmask]]
Sent: 26 July 2000 07:05
To: Neely Dermot (RR9) Biochemistry
Cc: 'Graham Jones'; 'ACB Clin Chem Gen'
Subject: RE: alcohol and GGT
If I remember the paper quoted by Dr.Neely Dermot is on abnormal LFT in
asymptomatic subjects. But the patient under discussion is
symptomatic. Please do not forget to read the latest release on LFT from
ACB publishers and NACB recommendations. The latter has got a nice
algorythm in a pt like this one.
Regards
Vivek
On Wed, 26 Jul 2000, Neely Dermot (RR9) Biochemistry wrote:
> Dear Graham
>
> Results similar to those you describe are encountered very frequently in
the
> Lipid Clinic, usually in association with a degree of central obesity and
> hypertriglyceridaemia, which is highly correlated with the degree of
hepatic
> steatosis. These people invariably have a bright liver on ultrasound and
> evidence of steatosis or steatohepatitis on biopsy, if they ever get that
> far. Note that the AST:ALT ratio is <1 in NASH, typically >1 in alcoholic
> hepatitis. NASH is now considered by some to be a disorder included in the
> "Syndrome X spectrum". Our liver specialist likes to "read them the riot
> act" on lifestyle which often results in the sort of improvements noted in
> your case. If not, a full work-up to exclude causes of chronic hepatitis
is
> required (see recent review in NEJM 2000 342(17): 1266-71 by Pratt,DS and
> Kaplan MM) before consideration of biopsy.
>
> Best wishes
>
> Dermot
>
> -----Original Message-----
> From: Graham Jones [mailto:[log in to unmask]]
> Sent: 25 July 2000 17:24
> To: [log in to unmask]
> Subject: alcohol and GGT
>
>
> Dear colleagues,
>
> I write concerning a patient identified as part of a collection for
> reference intervals. In return for their blood, we returned their results
> with a consultation if required.
>
> One male in his 50s, middle eastern background, possibly carrying a few
> kilograms (don't we all) turned up the following liver function test
> abnormalitites:
> GGT 132 U/L (reference interval <35 U/L), ALT 55 U/L (<30 U/L), AST 33 U/L
> (<30), other LFTs with current reference intervals.
> The only ingested agent which came to light on history was alcohol at
about
> 4 standard drinks per week.
> I suggested he abstain and we repeat the tests.
> The repeat GGT after 2 weeks was 70 U/L and ALT was 43 U/L.
> This is a least circumstantial evidence that alcohol may be a causative
> factor in his LFT derangement.
> My questions are as follows:
> 1. Can alcohol at this level (40 g/week) cause these LFT changes, and
> 2. If it can, does this indicate significant damage which should lead to
> alcohol abstinence.
>
> Thank you in advance for your assistance (John Whitfield especially may be
> able to provide some light).
>
> Graham
>
> Graham Jones
>
> Staff Specialist in Chemical Pathology
> St Vincent's Hospital, Sydney, Australia
> Ph: (02) 9361-2170 Fax (02) 9361-2489
>
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