Liver Enzymes Slightly Elevated

“The effect of thrombolytric drugs on cardiac enzymes, Creatine Phospho kinase and Creatine Kinase -MB, in myocardial Infarction”.

MYOCARDIAL INFARCTION

Myocardial infarction refers to a dynamic process by which one or more regions of the heart muscle experience a severe and prolonged decrease in oxygen supply because of insufficient coronary blood of subsequently, necrosis or death to the myocardial tissue occurs.

The onset of the myocardial infarction process may be sudden or gradual and the progression of the event to complete takes approximately 3 to 6 hours.

PREVALENCE

Myocardial infarction is the leading cause of death in the United States (US) as well as in most industrialized nations throughout the world. Approximately 800,000 people in the US are affected and in spite of a better awareness of presenting symptoms, 250,000 die prior to presentation to a hospital.4 The survival rate for US patients hospitalized with MI is approximately 90% to 95%. This represents a significant improvement in survival and is related to improvements in emergency medical response and treatment strategies.

In general, MI can occur at any age, but its incidence rises with age. The actual incidence is dependent upon predisposing risk factors for atherosclerosis, which are discussed below. Approximately 50% of all MI’s in the US occur in people younger than 65 years of age. However, in the future, as demographics shift and the mean age of the population increases, a larger percentage of patients presenting with MI will be older than 65 years.

Men are more susceptible than women, but the risk is more in female than in male after menopause.

CORONARY ARTERIES

The coronary arteries supply the capillaries of the myocardium with blood

The right coronary artery (RCA) supplies the right atrium and ventricle, the inferior portion of the left ventricle, the posterior septal wall and the SA and AV nodes

The left coronary artery (LCA) consists of two major branchiate left anterior descending (LAD) and the circumflex (LCX).

The LAD artery supplies below the anterior wall of the left ventricle, anterior ventricular septum and the apex of the left ventricle.

The LCX artery supplies blood to the lateral and posterior surfaces of the left ventricle. 

CARDIAC ENZYMES

Levels of cardiac markers rise overtime. Hence, enzymes are drawn in a serial pattern usually on admission and over 6-24 hrs until 3 samples are obtained.

 Enzymes commonly evaluated include CK, CKMB, LDH, TroponinT & I.

 CK-MB ratio indicates the extent of damage of the cardiac muscle. The more the ratio, the more the damage of the cardiac muscle. Troponins are  preferred markers of myocardial injury or they are very cardiac specific & are thought to rise before permanent injury develops.

Increased troponin concentrations should not be used by  themselves to rule out a heart  attack. Troponin will remain high for 1–2 weeks following MI allowing easy diagnosis if patient presents late with an old MI as other CE’s will not be raised unless reinfarction occurs.

Elevation of Cardiac Enzymes in Myocardial Infarction

Enzyme         Rises in        Peaks in      Normalizes in    Normal Value    CKMB ratio

CK                 12 hrs          16-30hrs      3-5 days            35-232IU/L

CKMB            4-8 hrs         24 hrs           72 hrs                < 51IU/L           <6% 

Troponin I    3-6 hrs         20 hrs           14 days              0.0-0.4 ng/ml 

Troponin T    2-4 hrs         8-12 hrs       14 days              0.0-0.1 ng/ml

LDH              12 hrs          12-24 hrs     10 days             100-190 IU/L

 

PATHOPHYSIOLOGY

The most common sites of MI are in the left ventricle, the chamber of heart which has the greatest work load. Tissue changes that occur in the myocardium are related to the extent to which the cells have been deprived of oxygen. Total deprivation results in an area of infarction in which the cells die and the tissue become necrotic.

Necrosis in this area is evident with in 5 to 6 hours after the occlusion. In response to this necrosis the body increases its products of leukocytes, which aid in the removal of dead cells. As collateral circulation enlarges, it brings fibroblasts, which form a connective tissue scar with in the area of infarction. Usually, the formation of fibrous scar tissue is complete with in 2 to 3 months.

Immediately surrounding the area of infarction is a less seriously damaged area of injury. It may deteriorate and thus extend the area of infarction or with adequate collateral circulation; it may regain its function with in 2 weeks.

The outer most area of damage is the zone of ischemia which borders the area of injury. The cells in this area are weakened by decreased oxygen supply, but function can return usually with in 2 to 3 weeks after the onset of occlusion.

RISK FACTORS

There are two types of risk factors for heart attack, including

  1. Inherited factors
  2. Acquired factors

Inherited factors

These are risk factors you are born with that cannot be changed, but can be improved with medical management and life style changes. Following are most at risk-

  • persons with inherited hypertension
  • persons with inherited low levels of HDL or high levels of LDL
  • persons with a family history of heart disease aging men and women
  • persons with diabetes mellitus [ type 1 diabetes ]
  • women, after the onset of menopause- generally, men are at risk, at an earlier age than women, but after the onset women are equally at risk

Acquired factors

These are risk factors that are caused by activities that we choose to include in our lives that can be managed through life style changes and clinical care. Following are most at risk-

  • Persons with acquired hypertension
  • persons with acquired low level of HDL or high level of LDL
  • cigarette smokers
  • people who are under a lot of stress
  • individual who lives a sedentary life
  • persons overweight by 30 % or more

 TYPE OF MYOCARDIAL INFARCTION

1.      Different degrees of damage occurs to the heart muscle-

Zone of necrosis: death to the heart muscle caused by extensive and complete oxygen deprivation that is, irreversible damage

Zone of injury: region of heart muscle surrounding the area of necrosis; inflamed and injured, but still viable if adequate oxygen can be restored.

Zone of ischemia: region of the heart muscle surrounding the area of injury, which is ischemic and viable; not endangered unless extension of the infarction occurs.

2.      According to the layers of the heart muscle involved, MI can be classified as-

Transmural or Q wave infarction; area of necrosis occurs throughout the thickness of the heart muscle. Subendocardial or non transmural infarction; area of necrosis is confined to the innermost layer of the heart muscle.

3.      Location of the MI is identified as location of the damaged heart muscle within the left ventricle inferior, anterior, lateral and posterior-

Left ventricle is the most common and dangerous location for MI, as it is the main pumping chamber of the heart

Right ventricular infarction commonly occurs I junction with damage to the inferior and or posterior wall of the left ventricle

4.      Region of the heart muscle that becomes damaged determine by the coronary artery that becomes obstructed

Left main coronary artery

Circumflex branch

Anterior ascending branch

Great cardiac vein

Middle cardiac vein

Right cardiac vein

CLINICAL MANIFESTATIONS

1)            Chest pain

  • not relieved by the rest over sublingual vasodilator therapy
  • severe steady sub sternal chest pain of a crushing and squeezing nature
  • may radiate to the arms, neck, jaw and shoulders
  • continuous more than 15 minutes
  • may produce anxiety and fear

2)            Diaphoresis

3)            Hypertension or hypotension

4)            Bradycardia or tachycardia

5)            Palpitation, severe anxiety, dyspnea

6)            Disorientation, confusion and restlessness

7)            Fainting, marked weakness

8)            Nausea, vomiting, hiccoughs

9)            Atypical symptoms such as epigastric pain abdominal distress, dull aching or tingling sensation, shortness of breath, extensive fatigue

DIGNOSTIC EVALUATION

1.      ECG changes

Generally occur within 2 – 12 hours, but may take 72 – 96 hours.

Necrotic, injured and ischemic tissue alter ventricular depolarization and repolarization

ST segment depression and T wave inversion indicate a pattern of ischemia

ST elevation indicates an injury pattern

  • Anterior small           V3 – V4 leads
  • Anterior extensive    V2 – V5 leads
  • Anteroseptal            V1- V3 leads
  • Posterior                  V1 – V2 leads, progressive R wave and ST depression
  • Anterolateral            V4 – V6, I, Avl leads
  • Apical                        V5 – V6 leads
  • Inferior                     lead ii, iii and avf [ reciprocal ]

2.      Elevation of serum enzymes and isoenzymes:

Enzymes are drawn in a serial pattern usually on admission and every 6 – 24 hours until 3 samples are obtained. Enzyme activity then is correlated to the extent of heart muscle damage

Enzymes commonly evaluated include are CK, LDH, CK-MB, AST, Troponin I, Troponin T. [Fig.4 ]

LDH 2 is normally greater than LDH 1 except when the heart muscle is damaged a reversal occurs

3.      Other findings:

White blood cell count and sedimentation rate elevates due to inflammatory process associated with damaged heart muscle.

Radionuclide imaging allows recognition of areas of decreased perfusion

Position emission tomography determines the presence of reversible heart muscle injury and irreversible or necrotic tissue, extends to which the injured heart muscle has responded to treatment also can be determined

MANAGEMENT

Thera 00004000 py is aimed at the protection of ischemic and injured heart tissue to preserve muscle function, reduce the infarct size, and prevent death. Innovative modalities provide early restoration of coronary blood flow , and the use of pharmacologic agents improve oxygen supply and demand, reduce and/or prevent disarrhythmias, and inhibit the progression of coronary artery disease.

1.      Opiate analgesic therapy: Morphine is used to relieve pain, improve cardiac hemodynamics by reducing preload and after load and to relieve anxiety.

Meperidine [Demerol] is useful for pain management in those patients contraindicated to morphine or sensitivity to respiratory depression.

2.      Anxiolytic agents: Benzodiazepines are used with analgesics when anxiety complicates chest pain and its relief

3.      Antiplatelet agents: Aspirin interfere with the function of the enzyme cyclooxygenase and inhibits the formation of thromboxane A2. Within minutes aspirin prevents additional platelet activation and interferes with platelet adhesion and cohesion

Other antiplatelet agents are, Clopidogrel, Ticlopidine, Dipyridamole, these agents, specifically Clopidogrel may be useful for patients who have a true allergy to aspirin and some times can be used with combination with Aspirin.

4.      Supplemental oxygen: Supplemental oxygen should be administered. The rationale for use is the assurance that erythrocytes will be saturated to maximum carrying capacity. Because MI impairs the circulatory function of the heart, oxygen extraction by the heart and by other tissue may be diminished.

5.      Nitrates: Intravenous Nitrates should be administered in MI, persistent ischemia, hypertension or large anterior wall MI. Nitrates are metabolized to nitric oxide in the vascular endothelium. Nitric oxide relaxes vascular smooth muscle and dilates the blood vessel lumen. Vasodilatation reduces both cardiac preload and after load, and decreases the myocardial oxygen requirements. Vasodilatation of the coronary arteries improves the blood flow through the partially obstructed vessels as well as through collateral vessels. When administered sublingually or intravenously, Nitroglycerin has a rapid onset of action.

6.      Beta adrenergic blocking agents: Beta blockers are recommended within 12 hours of MI symptoms and are continued indefinitely. Beta blockers decrease the rate and force of myocardial contraction and decreases overall myocardial oxygen demand. During the acute phase of MI beta blockers may be initiated intravenously

7.      Heparin: Unfractionated Heparin: intravenous unfractionated Heparin is recommended who undergo percutaneous revascularization. It is also recommended in patients who receive fibrinolytic therapy and non selective fibrinolytic agents such as urokinase, streptokinase and anistreplace. Heparin inhibits the additional formation and propagation of thrombi, effective when administered intravenous or subcutaneously.

Low-molecular-weight-Heparin: can be administered to MI clients not treated with fibrinolytic therapy

8.      Fibrinolytic or Thrombolytic agents: Fibrinolytic therapy is indicated with ST segment elevation. Plasminogen activators restore coronary vessels by dissolving obstructing thrombus. The plasminogen activators have been shown to restore coronary blood flow in 50% to 80% of MI patients. The successful use of fibrinolytic agents provides a definite survival benefit that is maintained for years. Reteplase has been shown to produce slightly higher 60- and 90-minute angiographic patency rates than accelerated alteplase, while adverse-event rates were equal.

However, the better early patency rate did not translate into any survival advantage at 30 days follow-up. The most critical variable in achieving successful fibrinolysis is time from symptom onset to drug administration. A fibrinolytic is most effective when the "door-to-needle" time is 30 minutes or less.

9.      Angiotensin converting enzyme inhibitors: Oral ACEI are recommended within the first 24 hours of the onset of the MI symptoms, decreases myocardial after load through vasodilatation.

10.  Anti dysarrhythmic agents: Lidocaine decreases ventricular irritability, which commonly occurs post MI.

11.  Calcium channel blockers: Improves the balance between the oxygen supply and demand by decreasing heart rate, blood pressure and dilating coronary vessels.

Diltiazem has been shown to decrease the incidence of reinfarction in patients with non-Q-Wave MIs.

12.  Percutaneous Coronary Intervention [Fig-15]: Mechanical opening of the coronary vessel can be performed during an evolving infarction. A balloon tipped catheter is introduced through a guide wire into a coronary vessel with a non calcified atheromatous lesion. The balloon of the catheter is the inflated, causing disruption of the intima and changes in the atheroma. The result is an increase in the diameter of the lumen of the coronary vessel and improvement of blood flow below the lesion.

Percutaneous coronary intervention is an alternative therapy to fibrinolysis Restoration of coronary blood flow in a MI can be accomplished mechanically by percutaneous coronary intervention (PCI). Mechanical revascularization by PCI is used as a primary therapy as an alternative to fibrinolysis when fibrinolysis is not clearly indicated or contraindicated. PCI can successfully restore coronary blood flow in 90% to 95% of MI patients.

13. Surgical Revascularization: Emergent or urgent coronary artery bypass graft surgery is warranted in the setting of failed percutaneous intervention in patients with hemodynamic instability and coronary anatomy amenable to surgical grafting. Surgical revascularization is also indicated in the setting of mechanical complications of MI such as ventricular septal defect, free wall rupture, or acute mitral regurgitation. Restoration of coronary blood flow with emergency Coronary Artery Bypass Grafting (CABG) can limit myocardial injury and cell death if it is performed within 2 or 3 hours of symptom onset. Emergency CABG carries a higher risk of perioperative morbidity (bleeding and MI extension) and mortality than elective CABG. The risk of operative mortality during emergency CABG is increased in patients, who are in cardiogenic shock, those with previous CABG surgery, and with multi-vessel disease. On the other hand, urgent CABG confers a survival benefit in patients with recurrent ischemia post-MI whose coronary anatomy is unsuitable for complete revascularization with PCI. Elective CABG improves survival in post-MI patients who have left main artery disease, three-vessel disease, or two-vessel disease that is not amenable to PCI. The timing of elective CABG post-MI is controversial, but retrospective studies indicate that when CABG is performed as early as 3 to 7 days post-MI, operative mortality is equivalent to CABG performed on non-MI patients.

14. Cardiac Stress Testing: Cardiac stress testing post-MI has established value in risk stratification and assessment of functional capacity. Stress testing is not recommended within several days post-MI. Only sub-maximal stress tests should be performed in stable patients 4 to 7 days after MI. Exercise testing identifies patients with residual ischemia for additional efforts at revascularization. Exercise testing also provides prognostic information and acts as a guide for post-MI exercise prescription and cardiac rehabilitation.

15. Lipid Management: All post-MI patients should be on an American Heart Association Step II diet (< 200 mg cholesterol/day, < 7% of total calories from saturated fats). Post-MI patients with LDL-cholesterol levels > 100 mg/dL on a Step II diet are recommended to be on drug therapy to lower LDL-cholesterol levels < 100 mg/dL. Post-MI patients with HDL-cholesterol levels < 35 mg/dL on a Step II diet are recommended to participate in a regular exercise program and on drug therapy designed to increase HDL-cholesterol levels.4 Recent data indicate the all MI patients should be on statin therapy, regardless of lipid levels or diet

16. Long-term Medications: Most oral medications instituted in the hospital at the time of MI will be continued long-term. Therapy with aspirin and beta-blockade is continued indefinitely in all patients. ACEI is continued indefinitely in patients with congestive heart failure, left ventricular dysfunction (ejection fraction < 0.40), hypertension, or diabetes. A lipid-lowering agent, specifically a statin, in addition to dietary modification is continued indefinitely 

17. Cardiac Rehabilitation: Cardiac rehabilitation provides a venue for continued education, re-enforcement of lifestyle modification, and adherence to a comprehensive prescription of therapies for recovery from MI, which includes exercise training. Participation in cardiac rehabilitation programs post-MI is associated with a decrease in subsequent cardiac morbidity and mortality. Other benefits include improvement in quality of life, functional capacity and social support. A minority of post-MI patients actually participate in formal cardiac rehabilitation programs due to either lack of structured programs, physician referrals, low patient motivation, non-compliance, or financial constraints.

NEED FOR THE STUDY

Reperfusion therapy, within which we include thrombolytic therapy and percutaneous coronary intervention (PCI), which includes angioplasty and stent placement, is the greatest advance in the treatment of acute myocardial infarction

Studies have shown that many patients with AMI who are eligible for reperfusion therapy do not receive it. Moreover, of those who do receive it, the time to administration of thrombolytic therapy, or "door-to-needle time" is often delayed, jeopardizing myocardium and leading to greater morbidity and mortality.

 Clinical criteria and simple ECG parameters have limited value for the non-invasive diagnosis of myocardial reperfusion. Other methods, such as ST segment monitoring and kinetic analysis of biochemical markers, may also be value of in early identification of IRA {Infarct Related Artery}, total CK activity, CK-MB isoenzymes appear to be the most promising biochemical markers.

In addition, the thresholds suggested for the diagnosis of reperfusion were generally derived from “time-to-peak” values. This rules out early diagnosis because peak CK plasma values are reached, on averages 9 -+ 6 hours after thrombolysis.

Determination of plasma total and MB CK concentration provides accuracy superior to any other currently available method for the diagnosis of acute MI.

 In addition to providing precise diagnosis of acute MI, quantitative MB CK assays can also be used to obtain an accurate estimate of infarct size. In recent years, accuracy in the diagnosis of acute MI has assumed even greater importance, since the choice and timing of a variety of diagnostic and therapeutic options following coronary care unit admission hinge on whether infarction has occurred. Furthermore, the advent of thrombolytic therapy of acute MI has emphasized the need for more sensitive biochemical markers of necrosis in the first hours. The eventual realization that the reestablishment of blood flow was the dominant mechanism for the diminution of infarct size led to a therapeutic approach dominated by thrombolysis and more literally by the use of interventions to open vessels and maintain them open.

The key observation is that benefit by the use of a drug could be demonstrated if the drug was given prior to the period of ischemia. 

Nevertheless, the greatest benefit in the management of patients with myocardial infarction ha unquestionably been the reestablishment of blood flow as early as possible after occlusion

The aim of this study is to determine the reperfusion of injury exacerbated by thrombolytic drugs in Myocardial Infarction through the process of elevation of cardiac enzymes which peaks and comes to normal levels within 24 hours, preventing prolonged injury and ischemia of myocardial tissue.

However, the aim was to evaluate prospectively biochemical markers for the diagnosis of coronary patency early after IV thrombolysis for Acute Myocardial Infarction.

STATEMENT OF THE PROBLEM

“The effect of thrombolytric drugs on cardiac enzymes, Creatine Phospho kinase and Creatine Kinase -MB, in myocardial Infarction”.

OBJECTIVES

  • To evaluate the effect of thrombolytic drugs on cardiac enzymes.
  • To compare the effect of thrombolytic drugs and non thrombolytic drugs on cardiac enzymes
  • To determine the importance of thrombolytics for a patient with myocardial infarction
  • To suggest teaching guidelines to public regarding early seeking of medical help at the onset of chest pain.

OPERATIONAL DEFIITIONS

Effect: Result or produce a result

Thrombolytic drugs: medications used to dissolve blood clots

CPK: A cardiac isoenzyme which releases into the blood in high levels when an injury occurs to the heart. It is also known as Creatine Kinase or Creatine Phophokinase.

CK-MB: It is also a cardiac isoenzyme releases into the blood from the heart muscle during an injury of the heart

Myocardial infarction: Necrosis of a region of the myocardium caused by an interruption in the supply of blood to the heart, usually as a result of occlusion of a coronary artery.

HYPOTHESIS

"Thrombolytic agents has effect on fall in peak levels on cardiac enzymes, CK and CK-MB"

LIMITATIONS

Coronary care unit: The data of this research is applicable in the settings of coronary care unit.

Age: Clients are selected only between 35 to 65 yrs of age.

Myocardial infarction: This is also applicable to the clients who were admitted in the hospital within 6 hours of the onset of the chest pain with myocardial infarction who received Inj. Metalyse.

Acute coronary syndrome: The clients who are admitted after 6 hours of the onset of the chest pain with acute coronary syndrome are included in the control group.

METHODOLOGY:

This study was done by an experimental method of research design in the settings of Coronary Care Unit in Dubai Hospital, U.A.E. A consecutive series of patients receiving IV Metalyse [ Tenecteplase ]  for MI from May 2006 to November 2006 were included in this study.

RESEARCH DESIGN:

This study uses the  comparative design.

TH 00002C80 E SETTINGS:

This study was conducted in patients irrespective of age, sex and nationality, who were admitted in Coronary Care Unit through Emergency Department in Dubai Hospital, U.A.E.

SAMPLE SIZE:

This study included 60 clients, men and women, irrespective of nationalities, between 35 years to 65 years of age.  Among 60 clients 30 were taken as experimental group and another 30 considered as control group.

SAMPLING TECHNIQUE:

The samples are selected as convenient sample, into two groups, the experimental and control groups. The clients who received thrombolytic agents within 6 hours of the onset of the chest pain are selected as an experimental group, and the clients who were presented late after 6 hours of the onset of the chest pain and not received thrombolytics, are selected as control group. All patients treated had the diagnosis of myocardial infarction confirmed by subsequent elevation of both Creatine Kinase [CK] and CK-MB isoenzymes levels. IV Metalyse is administered at a dose of 6000 units to 9000 units according to the weight of the patients. Patients with acute MI who were admitted to CCU more than 6 hours of onset of pain were also included.

 DATA COLLECTION PROCEDURE:

Data for the study is collected by an instrument, which consists of 22 items including sample number, age, and sex. Religion, nationality, occupation, food habits, life style onset of chest pain, date and time of admission, signs and symptoms, vital signs, type of MI, protocol of thrombolytic therapy, levels of cardiac enzymes, post thrombolytic treatment, drugs received and date of discharge.

Study reveals that, majority of the clients who had MI was from the Indian subcontinents, constituting 63.3 % and the minority constituting just 1.6 %, from Great Briton and Turkey. 3.3 % of the clients were Egyptians and Syrians. Bangladeshis comprised, 6.6 % and Pakistanis were about 21.6 %. Only 9.9 % of the clients who had MI were Dubai Nationals. Among them 46.6% of the clients were aged between 46 – 55 years and 41.6 % of the clients were between 36 – 45 years and the remaining 11.6 % of the clients are between 56 – 65 years of age.

36.2 % of the clients had acute coronary syndrome and were not given thrombolytics. Remaining of the clients was with true MI and most of them were thrombolysed. However, all clients have undergone coronary angioplasty. Out of these clients only one client had normal coronary vessels, two were with mild coronary stenosis for conservative medical treatment and 4 clients with major triple vessel block were posted for CABG. Rest of the clients was treated with Percutaneous Coronary Angioplasty to LAD [50%], RCA [21.6%] and Circumflex [13.5%].

It is also evident from the study that most of the Indians are affected with MI and the major contributing factors are smoking, stress and lack of knowledge about the disease condition.

Based on Chi-Square deviation the association between normalization of cardiac enzymes levels in the study groups are as follows-

In Experimental group, 30 clients have received Inj. Metalyse . among them except 4 clients, remaining 26 clients reports seen that cardiac enzymes are normalized within 24 hours after the admission and administration of thrombolytic agent.

In control group, 30 clients blood reports for normalization of cardiac enzymes were anlysed, where we found 27 clients reports shown the higher levels of cardiac enzymes after 24 hours of the admission.

  1. Critical Value 14.56,    P value < 0.05 and Null hypothesis rejected

Inj. Metalyse has a good effect on the cardiac muscle provided with Critical Value- 14.56, Probability Value- < 0.05, as evidenced by fall in peak levels of cardiac enzymes CK and CK-MB within 24 hours after received thrombolytic agent.

DISCUSSION

Tenecteplase [ Metalyse] is a recombinant fibrin-specific plasminogen activator. It binds to the fibrin component of the thrombus and selectively converts thrombus-bound plasminogen to plasmin, which degrades the fibrin matrix of the thrombus. Tenecteplase is cleared from the circulation by binding to specific receptors in the liver followed by catabolism to small peptides.

After single intravenous bolus injection of tenecteplase in patients with acute myocardial infarction, tenecteplase antigen exhibits biphasic elimination from plasma. There is no dose dependence of tenecteplase clearance in the therapeutic dose range.

The initial dominant half-life is 24+_5.5 [mean=/-SD] min. the terminal half-life is 129+_87 minutes, and plasma clearance is 119+_49 ml/min

The main finding of this study is the early peaking of the total CPK level and CK-MB

isoenzymes have identified with successful reperfusion after Metalyse therapy. The peak CPK levels reached in 12 hours and CK-MB levels were shifted in 6 hours. The study reveals that the cardiac enzymes levels peaked and normalized within 24 hours time in the experimental group who received Thrombolytic agents within 6 hours of the onset of the chest pain. Where as it took 3- 5 days for the enzyme levels to peak for clients in the control group, who did not receive thrombolytic agents due to late arrival to the hospital, resulting in more damage to the myocardium.

Thus, it is evident that the extent of injury to the myocardium as well as the oxygen demand is less in the experimental group of the clients. 

Finally, it may be used as a surrogate end point for angiographic demonstration of

patency in future clinical studies of reperfusion therapy. Diagnostic performance improved when the analysis was restricted to patients treated >6 hours after the onset of symptoms.

CONCLUSION

Clinical studies of fibrinolytic therapy in myocardial infarction show, that early thrombolytic treatment starting within 6 hours of the onset of the chest pain, significantly decreases the risk of further damage of the myocardium and oxygen demand, by the process of fall in peak levels of cardiac enzyme levels within 24 hours.

Inj. Metalyse has early peaking of cardiac enzymes in experimental group reflect the Infarction Related Artery opened, the clot has dissolved by Inj. Metalyse which means we have good thrombolytic effect, that is why we have early peaking levels.

Early identification of patients with persistent occlusion after thrombolyis during

Acute Myocardial Infarction also is important because it can pave the way for rescue interventions such as rescue Percutaneous Transluminal Coronary Angioplasty or repeated thrombolysis.

NURSING IMPLICATIONS:

SERVICE

Determine intensity of client’s angina

Observe for signs and symptoms

Place patient in a comfortable position

Administer oxygen if required

Obtain vital signs every 15 minutes for 2 hours, every half an hour for one hour and

every hour for two hours then as required

Obtain a 12 lead ECG

Monitor for relief of pain

Monitor patient’s response to drug therapy

Institute continuous cardiac monitoring and observe for- reperfusion, arrhythmias, rhythm changes, bradycardia and tachycardia

Interpret rhythm strips

Watch for complaints of headache with use of nitrates

Watch for recurrences of pain. Reinforce the importance of notifying nursing staff whenever pain is experienced.

Administer medications to relieve patient’s anxiety as directed such as sedatives and  tranquilizers

Provide complete bed rest for 24 hours

Determine level of activity that precipitated anginal pain occurs.

Identify specific activities patient may engage in that are below the level at which anginal pain occurs

Prepare for the diagnostic and treatment procedures such as coronary angiogram and PTCA [ Percutaneous Transluminal Coronary Angioplasty]

EDUCATION

Counsel on risk factors and life style changes such as-

Methods of stress reduction such as biofeedback and relaxation techniques

Low fat and low cholesterol diet

Avoid excessive caffeine intake

Do not use diet pills, nasal decongestants

Follow up visits to control diabetes and hypertension

Educate patient and family members regarding-

Prevention of recurrence of pain

Regular use of medications

Hazards of smoking

Prevention of other contributing factors

Regular follow up

Importance of dietary modifications

Avoiding activities which cause anginal pain such as sudden exertion, walking against the wind, extremes of temperature, emotionally stressful situations, refraining from engaging in physical activity for 2 hours after meals, reduce weight etc.

Appropriate use of medications

Side effects of medications

ADMINISTARTION

Lead interdisciplinary intervention programs

Education of nursing students and staff

Provide in-service nursing education

Maintenance of records and reports

Maintenance of statistics

Making of policies and procedures

Supervision and evaluation of staff performance

Recommendations for further study

A majority of post MI patients actually not participating in formal cardiac rehabilitation programs due to either lack of structured programs, physician

referrals, low patient motivation, non compliance and financial constraints.

Cardiac rehabilitation provides a venue for continued education, reinforcement

of life style modification and adherence to comprehensive prescriptions of

therapies for recovery for MI, which includes exercise training.

Participation in cardiac rehabilitation programs, post MI with a decrease in

subsequent cardiac morbidity and mortality.

Adequate education in the hospitals and work places on causative and contributing factors, preventive measures of heart attacks and re heart attacks, is necessary.

All forms of reperfusion, depending on local facilities, need to be available to patients. Protocols must be written and agreed for the strategy of reperfusion to be applied within a network. Early diagnosis of ST Elevation Myocardial Infarction is essential and is best achieved by rapid ECG recording and interpretation at first medical contact, wherever this contact takes place. 

Frequently Asked Questions

  1. QUESTION:
    What can i do for my slightly elevated liver enzymes?
    I went to the ER a few weeks ago. And they told me my liver enzymes are slightly elevated. Is there something i can do? Something i need to eat? Or do i need meds for it? Please help me…

    • ANSWER:
      If you take drugs, just stay off them and your liver will be fine. Obesity can also cause this problem, as will tylenol and a host of other pills; and, of course, hepatitis B and C can cause the problem, as well as drinking to much booze.

  2. QUESTION:
    What could cause slightly elevated liver enzymes in a 1 yr old dog?
    He has had all the vaccinations, he has been throwing up since Monday afternoon and just recently, as of Wednesday, started acting really “depressed”. I took him to the vet and the vet said he has very slightly elevated liver enzymes. He gave him a penicillin shot, and some anti-nausea shot as well as some amoxicillin. Is there anything else I can do for my dog? He was not around any sick dogs and our other dog is healthy and normal. Any ideas?
    He was vaccinated last year according the the vet’s reccomended schedule. Also, the vet told me, because I did ask, that there is really nothing we can do but try to make his comfortable and hopefully he will pull through it.

    • ANSWER:
      And when did he have all those vaccinations? Read the Wisconsin University weblinks

      http://svmweb.vetmed.wisc.edu/articles/68/5/39

      http://www.news.wisc.edu/releases/8413.html

  3. QUESTION:
    Can taking tylenol result in slightly elevated liver enzymes ?
    I have heard that tylenol can cause slightly elevated liver enzymes, my doctor told me to avoid taking tylenol and alcohol. I don’t drink alcohol or smoke, and I am trying not to eat junk food. I tried modifying my diet and exercising more. And I have also heard that the milk thistle is a natural way to bring down elevated liver enzymes. My doctor has asked me to come back for a follow up check up..

    • ANSWER:

  4. QUESTION:
    Can iron dietary supplements affect slightly elevated liver enzymes?
    Just went for a check-up and the tests came back that I had slightly elivated liver enzymes (never had before). I have recently started taking high potency vitimins with iron supplements. Could this affect the test? Trying to figure out what is causing this.

    • ANSWER:
      Liver function tests (LFTs or LFs), are groups of clinical biochemistry laboratory blood assays designed to give a doctor or other health professional information about the state of a patient’s liver. Most liver diseases cause only mild symptoms initially, while it is vital that these diseases are detected early. Hepatic involvement in some diseases can be of crucial importance.
      For more about treatment and products go at:

  5. QUESTION:
    35 weeks pregnant, slightly elevated liver enzymes, what does this mean?
    i am 35 weeks pregnant. on bed rest. the doctor keeps ordering NST’s on me and keeps making me go to ob triage for the last 2 weeks on and off. today i went to the doctor and she said she was a little concerned that maybe i have toxemia, because i told her ive been seeing floaters and having headaches a lot and also she seen i was swollen. so she ordered NST & blood work on me today.. i went & they told me baby & everything was fine except my liver enzymes were slightly elevated.. what does this mean?
    my blood pressure is usually normal and i dont take tylenol because it doesnt help my headaches and so id rather take nothing than alot of it..
    and yes they ordered more test. they want another NST tomorrow and more blood work.
    and i dont know if this is any help to your answers but my body is getting ready to have the baby. i am 50% effaced and the doctor said his head is down..

    • ANSWER:

  6. QUESTION:
    My liver enzymes are slightly elevated. What could cause that?
    I had an ultrasound and it was clear. All i take is vitamins and pain reliever when I have cramps.
    I do not drink at all ever. I am always dieting to stay thin. I live by the south beach diet and healthly eating in general. I am 5’5 125-130 lbs.

    • ANSWER:
      Here is the answer to your questions from a doctor:

      http://doctormelgar.com/liverenzymes.htm

      Alcohol, medications, and many other things can cause
      the enzymes to go up. It is well known that over the
      counter pain medications are known to cause problems
      in the liver. Also, some vitamins, if taken in excess can
      also cause problems. Most medications go into the
      body and to the liver to be broken down and in a form
      the body can handle, then they are released. Some
      vitamins are stored in the liver until the body needs them and
      others cannot be stored. Some vitamins are fluid soluble,
      meaning that they can be removed easily from the body
      and have to be replaced by taking in more. Other vitamins
      are fat soluble and stay in the body longer, or are stored
      by the liver. This means that they can build up in the
      body to the point it becomes toxic and can harm the liver.
      Here is a link that explains this more clearly:

      http://www.ext.colostate.edu/PUBS/foodnut/09312.html

      This is not to say that this is what is causing your enzymes
      to be up, just that it may be contributing to it. It is best
      to only take medications that the doctor tells you until
      they can determine the cause or to be sure that the
      doctor knows every medication you are taking
      whether it be over the counter, herbs, herbal teas, or
      medications presribed by other doctors.

      Hope this info is of some help to you.

  7. QUESTION:
    well he got test results. liver enzymes slightly elevated… is that bad?
    my boyfriend has been feeling run down for past few weeks and i had a couple off questions on regardin this as a nurse while testing him said there was a trace of ketone in his urine. he was very worried because she never elaborated and left him to worry for several days waiting for the results.

    He got test results and blood and everything is normal, the doc said his liver enzymes were only solightly elavated but nothing to worry about and he would retest in a couple of weeks.

    My boyfriend doesnt drink alcohol and never has. he isnt on medication although he was on antibiotics a few weeks ago.

    he has been depressed lately and has been trying to lose weight.

    What causes elevation in liver enzymes?
    his doctor said his urine sample was also fine and that ketones were normal (the nurse had mentioned them when he’d given the sample in!)

    • ANSWER:

  8. QUESTION:
    what are the causes of slightly elevated liver enzymes?

    • ANSWER:
      Usually it’s because you either had an infection which tested your liver (e.g. hepatitis, glandular fever) or took a drug which compromised your liver (e.g. gout or cholesterol medication). As long as the levels keep improving with time, all should be well.

  9. QUESTION:
    why would a 12 year old have an enlarged liver? and what does slightly elevated liver enzymes mean?

    • ANSWER:
      whoever told you this (doctor?) should be able to tell you the answer not us yahoo doctors

  10. QUESTION:
    what are some of the natural methods to lower slightly elevated liver enzymes?
    During my last physical exam I was told by the doctor that my liver enzymes were a little elevated, the doctor advised me not to take any alcohol or medicines like tylenol. I never drink alcohol at all, except maybe a glass of wine during christmas or smoke or anything like that, I am currently in school so I stay up quite late in the night and I eat junk food occasionally. I cannot understand how my liver enzymes can be elevated. How dangerous can elevated liver enzymes be and what are the harmful effects that can result. I have tried to change my diet and exercise more often. I would greatly appreciate any suggestions that I can follow to reduce these elevated liver enzymes. Kindly help..

    • ANSWER:
      A little elevated means be careful, but if they go up over time, then there is an issue. Hepatitis can cause this, as can a case of hep that has resolved. You get over it, but your liver gets damaged. But there can be other things that cause this from cancer to fiddling with too many environmental chemicals, to taking too much tylenol, to taking fungal infection pills according to the prescription for your toenails. Pay attention to what your doctor told you. You gonna schedule a retest in a few months?

      Exercise can help, and probably taking it easy on fats and cholesterol can help because it rests the gall bladder a little, but you are really in the mode of keeping it from getting worse. Eat more turkey and less hamburger, and keep your nose out of fried food.

  11. QUESTION:
    elevated liver enzymes but it hasn’t been explained to him?
    my boyfriend had some blood tests and urine samples done a few months back when he was ill and they found his liver enzymes slightly elevated. he got retested last week and again they are slightly elevated. however the didn’t explain further. He is on antibiotics (as he was at the time of the last testing) for chest infection and the doc seemed unconcerned, He just asked if his antibiotics were helping his chest and said they would retest him in 2 weeks. My boyfriend is a total worrier and is now googling liver enzymes and coming up with all types of scary things like liver disease and hepatitis. He doesn’t drink at all. he isn’t on herbal medication and doesn’t have hepatitis. he’s worrying and the doc hasn’t explained any further. I am trying to get him to go into the doc and to ask for more details or get some other tests done because its really leaving him in a great deal of stress.

    is it likely he has some sort of liver damage?
    he was on antibiotics at the time of his last test also come to think about it but thats the only medication he’s on. thanks Dr J

    • ANSWER:
      I had a similar thing last year. The Dr kept telling me the liver enzymes were slightly elevated. I was on a prescription at the time so
      we passed it off as that but this went on for almost 8 months, just to be sure the dr had me get an ultrasound on my liver, a hep test but everything was normal. Blood work done in October and all was in order. By the way the difference in “slightly elevated” liver enzymes and the number that comes back when you have Hepatitis is quite staggering. Tell your guy to relax but have his Dr. monitor it.

      Best of luck

  12. QUESTION:
    i have slightly elevated liver enzymes ALT 54. All other bilirubin,blood count, etc.came back fine.?
    Should I be as worried about Hepatitis since all others are okay. Don’t smoke,drink or do drugs.Was taking a multivitamin and 1700mg fish oil.Retook test waiting for results

    • ANSWER:
      These results do not suggest hepatitis, or any liver problem. The ALT is just barely higher than normal range. Assuming that other liver enzymes are normal, there is nothing to worry about. If you had a reading twice this amount, that might indicate a problem.

  13. QUESTION:
    . My liver enzymes were slightly elevated. what is the main cause of this and should I be concerned.?
    on that was supposed to be 0-40 was 46
    and the other was suppost to be 0-50 was 56.
    ultrasound scheduled tomorrow
    One other thing I do not nor have I ever drank alcohol!!!
    One other thing I do not nor have I ever drank alcohol!!!

    • ANSWER:
      Alcohol use/abuse is one cause. So is use/overuse of Tylenol and some other medications, including those that lower cholesterol. Then there are liver diseases — hepatitis A, B and C are the best publicized.

      The ultrasound will help your doctor determine if there is liver damage. It is the least uncomfortable, least invasive test imaginable — you lie on your side, the technician spreads goo on your abdomen, then rolls a device the size of a cordless telephone over you.

      You may not get results for a couple of days. At that point, your doctor can tell you if you should be concerned.

  14. QUESTION:
    Liver Enzymes AST and ALT slightly elevated?
    They checked my liver enzymes because I’ve developed a really bad itching problem. Then they sent me a note saying they were very minimally elevated but it probably isn’t the reason I’ve been itching. I did take advil maybe 7 days before the test. Maybe 4-6 pills. In the past I’ve taken 20-22 in one day(just during my period), every month for about 14 years. I wonder if that might cause the slightly elevated test.

    • ANSWER:

  15. QUESTION:
    slightly elevated liver enzyme?
    Hi,
    I’ve received my blood test results a few days ago. I have some slightly elevated liver enzymes, AST and ALT. My AST is 35 and my ALT is 63. Should I be concerned about those results? My Total Cholesterol is 265, HDL is 61, Triglycerides is 202, and LDL is 164.

    9 months ago, my AST was 17 and my ALT was 24.

    Thank you for your answer.

    • ANSWER:
      continue to reduce your intake of animal products -meet with a nutritionist to ensure your diet is healthy, exercise daily, drink plenty of water, and follow up with your doctor.

  16. QUESTION:
    My doctor said I have elevated liver enzymes and need to get another blood test.?
    I’m away at school, 1,000 miles away from my doctor. I will be home in March but is it necessary for me to get another blood test before then? She told me not to worry because they were only slightly elevated, I looked up causes of elevated liver enzymes and I’m almost positive I cannot be a candidate for any of the reasons. Are these tests ever wrong or inconclusive?

    • ANSWER:

  17. QUESTION:
    Elevated liver enzymes & abdominal pain?
    I’m going in for blood work because my doctor said my liver enzymes are slightly elevated. I’ve had mild pain that comes and goes, at times very unpleasant, and it alternates from left to right sides in my upper abdomen… approx where liver & spleen are. I don’t really drink much. I don’t take acetaminophen on a regular basis. I’ve had HepB shots. I’ve already had mono. The doctor said sometimes it can come from using the pill. Anyone else been through this?

    • ANSWER:
      It’s hard to say without knowing which specific liver enzymes are elevated.

      The doctor probably thinks you have one of the following: a slight case of medication induced hepatitis, non-alcoholic fatty liver disease, Budd-Chiari syndrome or veno-occlusive disease of the liver.

  18. QUESTION:
    Elevated Liver Enzymes……….?
    Hi all! I gave birth to my daughter on Nov. 15th via c-section. I have a 15 month old son who was born c-section as well. Throughout this pregnancy I had some complications where around my 26th week I could not keep any food down, I had upper, right abdominal pain and I was super sick. When we went in they initially thought that it was my gallbladder and sent me in to do an ultra sound and did blood tests. Everything came back okay but they hospitalized me for ten days and did 2 endoscopys where they found ulcers lining my esophagus and then a biopsy which came up with nothing. They thought about removing my gallbladder but since there were no signs pointing towards it they decided to wait it out due to the risk to myself and my daughter. They decided to manage pain and nausea with Dilauded and promethazine. I was only taking 12 mg. of Dilauded a day and 25 mg. of promethazine once to twice a day. My daughter was born healthy and I was fine so they sent us home five days after she was born. Before I left they gave me my hepatitis and tetanus vaccines. I was fine up until a couple days ago when I started to feel super nauseated and dizzy. I got a migraine and was feeling horrible. I went to my doctor who checked me and said that I looked fine and it did not look like I had an infection or anything that was going on but he wanted to do a blood test to check to make sure everything was okay. Later that night the on-call oncologist called to tell me that my liver enzymes were high and she wanted me to come in to do some more tests first thing in the morning. I went in this morning and they did another blood test to see if my numbers went up, down, or stayed the same. I have not heard back from them yet and I am having major anxiety over the whole situation. I have an appointment with the G.I specialist in two weeks because he did not want to run any gallbladder tests so close to delivery of my baby girl. This morning when I went in for more blood tests my blood pressure was slightly elevated, my heart rate was up, and my doctor told me that my liver enzymes were only slightly elevated. Along with these symptoms I have had a headache that will not go away, My legs swelled up once I got home from the hospital and now they do not swell up as often but if I am on them to much they start to hurt and at night when I am asleep they hurt if I keep them in the same position to long. My left arm where I got the vaccinations is still sore but not as painful as it was the three days after I got the vaccinations. More of an uncomfortable feeling then a pain. I am nauseated but no throwing up. I have pain in my right side of my abdomen and my doctor said that is due to the muscles that are located on that side trying to heal because that was where the majority of my incision was. I have major anxiety when it comes to stuff like this so I am super shaky and I do not know if that is due to the stress of not knowing what is going on with my body or if it has to do with all the other stuff that is going on. I am dizzy, lightheaded and sometimes have muscle spasms. I am super tired but that could be due to the fact that I wake up with my newborn all night to feed her. Over-all I feel like crap and want to try to figure out what could be causing all of this so that I can get some rest and not worry that I am going to die in my sleep/ Has anybody eperienced anything like this? Could all of this be related to the vaccinations that I got? Does anybody know what could be causing all of this? What is the cure to elevated enzymes? What is the relation to the headache and elevated liver enzymes because everyone seems concerned that I have a headache but I have had migraines snce I was seven years old. Please help me calm my nerves! I wrote all of this yesterday and now to add to the fun I have lower left back pain. My doctor called to say that he is not to concerned about the whole thing but to keep my eye on it……..whatever that means. I am not sure I could get any more symptoms at this point and would like to know if anybody knows what this could be, what it could mean, and if I should ignore my doctor and go to the ER and make them run every test under the sun until they figure out what is wrong with me so I can feel better. :(

    • ANSWER:
      Sassy’s information is good. I would like to add to that – since you have nausea, you probably have not been taking in a proper amount of fluids daily which can dause your dizziness and feeling lightheaded. You have promethazine – use it regularly. Dramatically increasing your water intake daily will probably make this go away. As for the back pain – some tylenol or motrin would be appropriate for this. If your enzymes are coming back down, this may be only a temporary condition either related to your pregnancy, medications you have taken, etc. and might resolve itself without further treatment. That is probably why the doctor is taking the “watch and wait” – to see if it resolves on it’s own or if it gets worse and further testing then might be needed. Sometimes, there are not exact answers or diagnoses – you treat the symptoms, see if the treatment works and if not, try another plan of attack which is what your doctor is currently doing. And, since you have been seen recently by your doctor and lots of testing has been done, going to the ER (unless you get dramatically worse during the night) would not be fianancially prudent because your insurance has already paid for testing on your condition and may deny your claim. And, ER’s do not “order every test in the book” because insurance companies will not pay for this. They order tests specific to your complaint and what they believe is going on and you have already probably had a recent CBC and a chemistry with liver enzymes. You are worrying way too much about something that could possibly resolve over the next week or so. And, elevated liver enzymes will not kill you in your sleep. If you get worse, call your doctor back and report your symptoms. Follow your doctor’s advice exactly. Rest as much as possible. Increase your fluid intake and take some pain medication. You need to keep working with one doctor on this, otherwise, fractured care is the end result.

  19. QUESTION:
    Elevated liver enzymes..Can it be nothing major?
    Anyone have slightly elevated liver enzymes, and it end up being nothing major? I know its not related to medicine…Just waiting to get ultrasound done next week, but nervous..thanks…

    • ANSWER:
      There are several reasons that your liver enzymes can be elevated that are not serious. If you have taken any pain relievers in the NSAID category, there is a slight chance of elevation, and Tylenol has a much greater effect. Alcohol consumption will heighten these as well. Also, elevated liver enzymes can be caused by a condition known as ‘fatty liver’, where the liver literally has some fat attached to it. If not corrected it can eventually lead to scarring (cirrhosis) and liver disease. It is usually corrected by weight loss and/or eating healthier. Your doctor will instruct you what to do, no matter what your situation. Certainly don’t assume yet that something major is wrong.

  20. QUESTION:
    Liver enzymes are elevated?
    So I’ve recently got some blood work done for a range of different symptoms. Everything came back normal, but my doctor said my liver enzymes were slightly elevated, she called them mild. I’m calling tomorrow to find out what the exact reading was. She wanted me to stop all alcohol intake for two weeks and repeat the liver panel.

    Is this to make sure the raised levels was because of alcohol?

    I’m 23 and have been drinking lightly since I was about 18. I have also had tests done before and never had this. In the last 2 weeks, I have had very busy, overly fun drinking nights (both weekends Thurs-Sun, NOT my usual habits), could this be why they were raised?

    This is also stupid, but my best friend is getting married this Saturday, do you think I can have a few drinks and stop on Sunday and push my two weeks until two weeks from Monday? Its really not that important that I drink, I am just curious.
    Haha, thank you angiolia, I have asked my doctor and am waiting on her to get back to me. I am impatient and want to know what someone else thinks :)

    • ANSWER:
      Yes,they could be raised because of alcohol intake.
      My levels go up and down randomly and I have a very rare glass of wine. There are many medical reasons for liver enzyme elevations which if you have should be attended to.
      My suggestion is have your wedding drinks in moderation and then go for your blood work in two weeks. A week one way or the other will not matter too much. Be sure not to drink after the wedding and until after the blood work.

  21. QUESTION:
    My moms LFT came back saying her liver enzymes were elevated?
    She’s had hepatitis C for a while now, she took treatment years ago but it didn’t do much to help her. She got called from her doctor saying that her liver enzymes were slightly elevated. Is this bad? I’m 30 weeks pregnant so im already stressed out, then I hear this, now im a mess. I’m so worried about my mom.

    Is there anythign she can do to lower these levels?
    Is this something to be VERY concerned about since they’re “slightly elevated”.

    :( Please help.

    • ANSWER:
      If she has had Hepatitis C for a while, her liver enzymes are probably always slightly elevated. If they are more elevated than usual, her physician should talk with her about possible treatment. If he has not mentioned any treatment, then they are still just in the monitoring her liver enzyme stage, not treatment stage. She cannot lower these numbers but avoiding anything that is metabolized by the liver such as alcohol and some medications can avoid a rise in these numbers. Only her doctor can truly answer this questions appropriately because he is the only one that knows the condition of her liver.

  22. QUESTION:
    Absolute lymphocyte elevated / liver enzymes elevated?
    Anyone one here know anything that would cause these type of results? The lymph has been slightly elevated about three months just found out about the liver enzymes. Hope for a response sincerely okedocke

    • ANSWER:
      A liver problem usually starts out as
      inflammation inside the liver cells. This can
      be caused by any number of reasons:
      alcohol consumption, medication toxification,
      chemical exposure, biliary problems,
      fatty liver (NASH), viral infections like Hep A,B,or
      C…and there are still other causes.

      When the liver cells are damaged or are
      having a problem, the lymphocyte (immune system)respond and causes this inflammation in the liver. If caught early on and if the cause can be removed…you may be started on medication
      and the liver will heal. However, if it is
      not treated and it continues on…it can cause
      death of the liver cells, scarring inside the liver
      and then this is known as cirrhosis of the liver
      and then the only thing the doctors can do
      is try to slow the progression of the cells
      dying down. It doesn’t sound like you are
      this far and with treatment you can be cured.
      The best doctor to be with, if this does
      involve your liver, is either a gastroenterologist
      or a hepatologist. Sometimes, these level
      can be elevated and it isn’t a liver problem…but
      a blood problem.

  23. QUESTION:
    Liver enzyme test came back slightly elevated?
    So I have had an elevation of liver enzymes for about three months now and I am getting worried that it may be fatty liver (non alcoholic). I recently had an ectopic pregnancy and then a tubal ligation to remove it. Due to the excessive imbalance of hormones I put on a lot of water weight and sometimes take spironolactone/aldactezide to shed the water, which may be elevating the liver enzyme level. I still experience getting puffy in my feet, legs and arms. What can I do to balance out my hormones, and how can I make sure not to continue having elevated liver enzymes? I fear diabetes mellitus. Yes, I am overweight too. Please advise.

    • ANSWER:
      i think the first answer you got was spam.

      there are different reasons for an elevated liver enz. yeah it could be fatty liver. but also consider all the medications you take. do you take any Tylenol or asprin. your liver enz can be acutely elevated following a procedure. also how elevated are the liver enz, if its slightly elevated then its not too bad. most hospitals have different standards regarding enz levels. however if your AST ALT are in the thousands then you have a problem. remember any injury, like surgery, can increase these enz.

      about your weight. get checked up for your blood sugar levels as soon as you can. its really important to control your blood sugar levels. most people have elevated sugar levels for years before getting diagnosed with diabetes. for these people the next step is to get their eyes, heart, and whole body examined for complication of diabetes. i know its scary. but the sooner you know, the sooner you can control it. good luck. take care.

  24. QUESTION:
    Can we get life insurance if we’ve been previously denied for elevated liver enzymes?
    My husband and I applied for life insurance and had blood/urine tests done. His bloodwork showed that his liver enzymes (ALT to be specific) were slightly elevated and they denied him. He was tested by our doctor a week later and they had dropped down to almost normal (10-40 is normal and his were 69). He’s testing next week and our doc thinks they’ll be normal again. He thinks the levels were temporarily elevated due to taking too much Tylenol. My husband had bad sinus headaches for about a week before our initial exam and was taking a lot of Tylenol to try to relieve the pain. Hepatitis tests have come back negative and other liver diseases have been ruled out. Anyway, will there be a way for us to get life insurance if we’ve previously been denied, even though there is nothing health-wise wrong with him?

    • ANSWER:
      Sure. Even if you’ve got one foot in the grave, you can buy life insurance – if you’re willing to pay enough.

      Especially if the doctor will write a note that the one test result was a fluke, you should be fine.

  25. QUESTION:
    How long does it take for liver enzymes to normalize after obstaining from alcohol?
    I have hemachromatosis and periodically donate blood to reduce iron levels. I have decided to stay away from alcohol to prevent liver damage as enzymes have been slightly elevated. If all else is normal, how long should it take for enzymes to normalize? Does drinking large quantities of water help?

    • ANSWER:
      Hi Duane, I can only speak from personal experience.I also believe that the M.D.s can only generalize as we are all different.Good choice to stop drinking.I hope you will consider making this a permanent decision as alcohol and liver disease do not mix.You already have liver disease,why make it worse?When I sobered up 4 years ago,my LFTs were also slightly elevated.I can say that sometime,6 months to 1 year,my LFTs normalized.As I also have Hep.C,after a while they crept back up a bit.However,medicine etc. could be responsible.Remember,just about everything goes through the liver.Stay away from the booze,Duane!

  26. QUESTION:
    Any ideas about why a 26 year old male would have low testosterone level and elevated liver enzymes?
    Physically active in a construction job, but not the best of diets. Slightly overweight but not obese. Regular health care, non smoker. Primary symptom is fatigue.

    • ANSWER:
      Try testosterone boosters like T Bomb to give you all the stamina that your lacking. This body building supplement somehow retards the lactic acid build up in your muscles. It also makes me feel super human physically.

  27. QUESTION:
    Liver Damage or Typical Pain Med Side Effect?
    I am taking Lortab 10/500′s for a tooth I broke. I’ve been on them since Sunday and I am so itchy I want to peel my skin off. I also literally cannot keep my eyes open. I read that these issues can be signs of liver damage. I’m concerned because I already have slightly elevated liver enzymes. Does this sound like normal Lortab side effects, or should I be concerned about my liver?

    • ANSWER:
      Itching and sedation are both possible side effects of opioids, and Lortab contains hydrocodone.

      Itching can also be a sign of an allergic reaction, or liver trouble (as you suggest). Acetaminophen in very high doses can be toxic to the liver. Normal doses shouldn’t be a problem (up to 2-3 grams, i.e., 4-6 Lortab 10/500s at once), but if you already have some liver troubles, you might be more vulnerable to liver toxicity. If you know you have liver problems, make sure the doctor who prescribed the Lortabs knows about them, as you may have to go with a lower dose.

      You can also simply stop taking them, if the broken tooth doesn’t hurt too much.

  28. QUESTION:
    Is it possible to go from a slightly fatter liver to Cirrhosis in 5 months?
    Had a CT scan in January for Diverticulitis which also revealed a slightly fatter liver. My GGT count was 117. Had a blood test the end of May and my other Enzymes were slightly elevated. Would it be possible go from from a slightly fatter liver to cirrhosis in 5 months? I am a moderate drinker but now only have a few glasses of wine on weekends.

    Male 43 years

    • ANSWER:
      No, it would not progress so quickly from alcohol unless something else was going on that caused it to happen. I had cirrhosis and never had a fatty liver ever plus I never drank alcohol. My liver enzymes were only slightly elevated to the point where the doctors paid no attention to them and told me my liver was fine. I had some fluid retention which sent me to the doctor.

      In reality, I actually had only 10% liver function left and my liver was pretty much destroyed with cirrhosis from an autoimmune problem. What a shocker! My only choice was to get a transplant if I wanted to stay alive.

      I would cut out all alcohol use, stick to a low fat diet and see what happens after about 3 months. Get the blood work done again and see if there is any improvement. If there is no improvement, then something else could be going on that needs checked out.

  29. QUESTION:
    Question about elevated liver enzymes?
    I have recently been having some lower GI problems – most likely IBS, but I have one more test before that will be confirmed. Anyway, my doctor has ordered blood work twice now and both times my both my ALS and my ALT have been slightly elevated. ALS was in the 50-55 range, ALT was in the 88-90 range. Anybody out there know what might be causing this? Just curious.
    BTW – gallstones and gallbladder disease have been ruled out with HIDA scan and I don’t consume alcohol.

    • ANSWER:

  30. QUESTION:
    Can a pinched nerve be related to enlarged liver?
    I have been experiencing pain for about 3 weeks on my right side and left side. A little in my back and pelvic area. I did a cat scan without contrast and the radiologist said that the liver was enlarged. My doctor did a bloodtest and one of the liver enzymes were slightly elevated. He checked the liver and it was a normal size. He sent me for another cat scan with contrast because the other one got lost. That one came out normal. I went to the ER because no pain medicine was helping. They did a chest x-ray as well as an abdominal x-ray. Normal. Sonogram was taken and it showed the liver enlarged. Doctor in hospital called my GP. GP said that I should go for an MRI of the spine as it can be a pinched nerve. Can the 2 of them be related? If the cat scan came out normal then why did the sonogram show the liver enlarged? What does it mean liver enlarged? Can it be that that is my normal size liver? If it is a pinched nerve then do I worry about the liver? The liver tests showed normal

    • ANSWER:
      The pain in the area of the liver can be related to the pinched nerve. If the nerve to your liver is pinched, it’s like a garden hose that’s kinked–all the information that your nerves are trying to carry to and from your liver aren’t getting through. It bothers me that first the liver was enlarged then it wasnt and that doctors are losing your CT films. I’m in chiropractic college right now and I’ve been to one as a patient and worked for one for a while and have seen amazing things happen. My mom had a pinched nerve in her shoulder and the chiropractor that she goes to helped her with it. Check in your area for one. Different chiropractors use different adjusting technique, so just find one your are comfortable with (Activator is the most gentle method-it uses a small device to apply a low force to move the bones that might be the root of the pinched nerve and if your a ina lot of pain it will be the easiest for you). When you go take all your films (MRI, CT’s, xrays, etc). I’m truley sorry for your pain and hope that something/someone will be able to help you with this problem. Best of luck to you.

  31. QUESTION:
    Elevated liver enzymes?
    Alright, a long story short: Over the past 6-7 months, I have lost nearly 50 pounds because I cannot financially afford to feed myself. I have had a poor sleeping pattern and I have been excessively self-medicating with Imodium and Nyquil (Mostly Imodium however). Recently I went to the doctor and took a blood test. The test results came back and I discovered that I elevated levels of three different types of liver enzymes: ALP, AST, and I believe the other was ALT.

    Besides the fact that I was slightly anemic, my other tests came back fine (WBC count appeared normal, normal albumin levels, stool sample appeared okay, etc..).

    On a positive note I believe, these enzyme levels were only in the 100′s and not in the 1000′s.

    My question is is there likely a correlation beteween poor diet/sleep, excessive Imodium and Nyquil use, and elevated liver enzymes?

    By the way, there is no history of any type of liver disease or disorder in my family’s history and I rarely ever drink. Is this condition likely the result of a poor lifestyle or something that is potentially serious?

    • ANSWER:

  32. QUESTION:
    Anyone else have enexplained liver pain?
    I have chronic liver pain that i have had for 2+years. I have had tons of ultrasounds that show nothing to be concerned with, and have slightly elevated liver enzymes. they have done MRI and cat scans, and still no answers to why i would be having PAIN. the only diagnoses they can give me is that i have “fatty liver disease” which is normally something someone would get if they were morbidly obese, or an alcoholic. Neither of which i am, not even close. I had my gallbladder removed 3 years ago, but i still feel like i am having gallbladder attacks, thats what the pain feels like: sharp, crampy, like someone is squeezing my organs and stabbing them. Its horrible and the pain can last anywhere from 20 min.-2 hours. Anyone know of anything that could cause this?

    • ANSWER:
      The liver itself doesn’t have nerves so most doctors don’t believe patients that complain of “liver pain.” However, my wife got Hep C from a blood transfusion at birth. Before she was diagnosed, she would complain of “liver pain”, not a severe as your description, but similar.
      You can only get Hep C from blood to blood contact. Maybe bring it up to a doctor next time. I don’t know if this is an answer to your question, but it’s good information at least.

  33. QUESTION:
    Fatty Liver on and off for years – ALT Slightly Elevated?
    I was diagnosed with a fatty liver (ultrasound) about 5 or 6 years ago. I had elevated ALT and AST enzymes. I was a bit overweight but not obese (6′ 215) – drank on weekends mostly. I lost the weight and went down to 186. All levels returned to normal but I never had another ultrasound. I have never gotten back up to that weight but on occasion I would get to 200 or 205 (maybe twice to be exact) and enzymes would come back slightly elevated (lose weight and they would go back down). This last time, only the ALT came back high .. (80 on a scale of 10-60). I am in the process of losing weight, I am around 205. I have no symptoms. Should I be concerned that this can evenutally lead to NASH and then Cirrohsis? Or can you have slight elevations and fat in the liver from time to time and have it be harmless?

    • ANSWER:
      In general, fatty liver is a completely reversible process. If you abstain from alcohol and lose weight, your liver should regress to its previous state of health (presuming that there is no damage besides the fatty change). The problem, as you seem to be aware, is that the fatty change can lead to non-alcoholic steatohepatitis (NASH) which can in turn lead to cirrhosis. Most healthy people do not have significant fat accumulations in their livers, nor do they have recurrent elevations of liver enzymes. You should probably go see your physician and ask for a personal evaluation related to your own situation.

  34. QUESTION:
    Elevated Liver Enzymes, When should I be concerned?
    After blood tests, One of my liver enzymes was at around 240 something, which is apparently 4-5 times the normal amount. I was on a bunch of antibiotics for treating a surgery related infection, Invanz and Vancomyocin. I was on relatively high doses, along with Norco for helping me with pain. I got to the point where i could go one dose of Norco a day and still be OK with dealing with the pain, and the pain is gone so I’m not taking the norco anymore. After the doctor first noticed this increase, she took me off of these two medications and then prescribed me something called Ciprofloaxcin which i take twice daily. We are hoping that taking me off this medication will bring down the liver enzyme production. After a week off the invanz, she said my levels were slightly higher. She took me off the Vancomyocin and the Norco then at this point and now it has been about a week since i have taken those two medications. I am a young guy and pretty healthy all around, i play college football so im in pretty good shape. Alcohol is only consumed on the weekends. so my question is

    At about what level of enzyme production should i be concerned that there is a problem with my liver?

    • ANSWER:
      If you have high liver enzymes levels, it is best not to drink any alcohol at all. Alcohol should never be mixed with any medications. Combining them could cause instant liver cell damage.

      Vancomycin is an antibiotic. Antibiotics are not easy on the liver, but are necessary to use if someone develops an infection. It is one of the most potent antibiotics. Many pain medications also are hard
      on the liver.

      The liver processes all medications that enter the body…it goes to the liver first, to be broken down, before going to the rest of the body. It is the same with any toxic substance that enters the body. The liver will take the toxin, and with its enzymes, break them down into non toxic substance that the body can dispose of. Your doctor is right in removing any medications that he thinks may cause this elevation. Both alcohol and medications can cause a rise in the enzymes results.
      Both are known causes of damage to the liver cells if taken in excess or they become toxic to the liver.

      However, the liver enzymes (known as the ALT, AST, GGT, and Alkaline Phosphatase) are not the only tests done to check the liver. There are also the liver functions tests (known as the Bilirubin, INR, Albumin, PT, PTT).
      An elevation of the liver enzymes may show if there is liver cells damage, because the liver cells make these enzymes and when they become damaged, they leak out and go higher in the blood. The liver functions tests will show how well the cells of the liver are able to do the 500 plus functions the liver does as a whole to keep the body well. There is also viral testing to see if a virus has entered the body and is using the liver cells to replicate itself.

      If your liver enzymes stay high, they may have to speak with the infectious team to see what medications they could use as an antibiotic that will lessen the effect on your liver.
      Be sure not to take any over the counter meds, herbs, vitamins, minerals, or supplements…without “asking your doctor” first. Interactions between drugs can occur.

      Any damage to the liver cells can cause the immune system of the body to respond to this damage and cause inflammation to develop in the liver which will cause the liver to enlarge in size. Since you have to take medications to help your body rid yourself of the infection inside of you…it would be best to be very careful now. Stop any alcohol and keep checking with your doctor to see how your liver is doing. If there is damage to the liver cells, your medications has to be adjusted according to that.

      I hope this information is of some help to you.

  35. QUESTION:
    liver problem – depression & weight gain?
    Let’s see you have slightly (and I mean only slightly!) elevated liver enzymes – could this cause either weight gain or depression (maybe cos it makes you feel tired?)? Thanks in advance!

    • ANSWER:
      I found some good information on depression as well as treatment to cure it etc here http://xrl.us/u3ww. Seems to have some good advice and should help you.

  36. QUESTION:
    Liver test / Peripheral Neuropathy?
    hi everyone

    so, im a 28 year old male. Last year I noticed that my legs and feet (and sometimes hands) became tingly and sore. I didnt think much of it until I realised that it was not going away and was becoming worse. At first when I mentioned it to the doctor he said it was anxiety related and not to worry about it. I didnt think that it was anxiety related so I asked “what about some kind of neuropathy?” and he responded saying that’s unlikely but we will give you some bloodtests for the liver, as I have been a heavy drinker for maybe 6 years now, binge drinking maybe 3 times per week, anywhere between 12 & 20 units per average session. Im guessing probably 45 units per week minimum

    The bloodtest came back with a count of 60 liver enzymes in my blood. The doctor said the normal range is between 0 and 40 and that it was probably sitting at 60 due to my heavy drinking. He then said its possible that it is the alcohol that is causing these sensations in your legs, but didnt give me any definite answer. I asked if that means I couldnt drink any more alcohol and he said “well, in moderation”.

    so since that doctors appointment I have severely cut down on alcohol, and infact made my new years resolution to give up drink. It is now the 27th and I have only had one beer session (6 beers) around the 14th. The sensations have severely decreased since I have not been drinking regularly, but are still there to a certain extent. No pain really exists anymore, just more of a dull cold sensation in my feet that I can pretty much forget about.

    so basically my questions are,

    1) Should I be worried about this slightly elevated liver enzyme count?
    2) Is it likely that this really is alcohol neuropathy?
    3) do you consider it to be okay to drink in moderation from now on, maybe 6 beers once a month or so?

    some answers from people that have alcohol neuropathy or have had some kind of contact with it would be helpful. Thanks!

    • ANSWER:
      This is a great resource for panic and anxiety related issues, and I hope it helps

  37. QUESTION:
    Weird liver? Any ideas?
    I am working with a team of doctors and none of us have any clue what’s going on with me! The symptoms I have had are extreme abdominal pain(in the area around my belly button and up which goes all under my ribs in the front) darkened urine, and today my eyes have turned yellowish. I have never touched alcohol, I’ve never touched any medication not prescribed to me and I only have ever had one sexual partner(my husband). I gave birth in November of 2007 to a healthy baby boy. The only abnormality in ANY of my tests has been slightly elevated liver enzymes. I want to re-emphasize that I have NEVER drunk alcohol… not even a drop! They did a hepatitis panel and I was negative for all of that. When I had the abdominal pain it was incredibly severe(worse than labor could have thought of being!). It doesn’t seem food related. The doctors are at a loss. Nothing else in my history seems related. I am otherwise fairly healthy.

    • ANSWER:
      Levir is one of the vital organs of the body, your levir needs to be puified. a little problem in lever can cause great problems on overall health. have you been tested for jaundice. I felt the same situation in jaundice as well drink more fluids and see a doctor who can check your bile which is assciated with liver. I hope i can help to locate your problem.

  38. QUESTION:
    What causes elevated muscle enzymes?
    Does anyone know what might cause muscle enzymes to be elevated?

    For sometime (a couple of months), I have been feeling a discomfort on the left side of my upper abdomen. Sometimes, it also seems like my left ribs just by the diaphrahm protrude a little bit more than the right, just the section of ribs at the top of my left abdomen, and just with two ribs.

    I have done tests on my spleen, abdomen, kidney, liver and heart and they are all normal. However, my muscle enzymes were slightly elevated. My doctor advised that I stop working out for a while (as this increases muscle enzymes) and test again, but they are still elevated. Does anyone know any other causes for elevated muscle enzymes?

    • ANSWER:
      actual damage to the muscle tissues increases enzymes, and it can take many months for such damage to heal and for the enzymes to go back to normal. Do as your doctor tells you and limit your workouts when you go back to exercising.

  39. QUESTION:
    What is the difference between an MRI and a Cat Scan?
    I know that one uses Computer and the other uses Radio waves. I did a cat scan without contrast and it showed liver enlarged. (Radiologist said) Doctor never seen it since it got lost. He sent me for another cat scan with contrast and it was normal. Liver enzymes were slightly elevated. I was still in pain so I went to the hospital and they did a songram which showed the liver enlarged. I want to know how come it didn’t show up enlarged on the cat scan but on the sonogram it did? Liver tests showed normal. Would anything different show up if I took an abdominal MRI? I took an MRI of the spine because the doctor thinks it might be a pinched nerve and he is not worried about the liver because the cat scan came out normal. Who do I trust? The Cat Scan or Sonogram?

    • ANSWER:
      I’m not comfortable trying to evaluate your tests but I’ll tell you the difference.

      MRI is using radio waves where the protons are excited and give off energy which is detected external to the body where their signal is interpreted

      Cat or CT(you’ll hear both terms) are x-rays. The x ray source spins around you and based on the attenuation in the body. An image is reconstructed.

      Sonograms are rather iffy since you need to remember, a lot of that stuff in the abdomen won’t have any difference in their properties under US(sonogram) unless you’re looking for something specific.

      The major difference between CT and MR is in the soft tissue contrast. With CT, it’s wonderful for its speed and for distinguishing problems due to emergent situations since the attenuation difference is great between tissue and bone. However, it sucks for differentiating soft tissues. It’s not easy to see a noticeable difference between liver and stomach for example since they attenuate about the same in terms of x-rays.

      MRI is slow so its not good in ER situations however it provides a wealth more information since there is a difference based on healthy versus patholoigal tissue. There WILL BE A DIFFERENCE IN WHAT CAN BE SEEN IN AN MRI DUE TO THE BETTER CONTRAST.

      It’s possible the liver enlarged in the interim between your tests. Additionally, there is some physiologcal variation based on diet, time of day, lots of factors….

      Shoud you have the MRI?

      Based on the fact that the doctors don’t seem to have a clear picture on what’s going on, the MRI will provide them with more information so it might be useful. Will it be definitive? Probably not, the best information for liver and kidney stuff still seems to be chemical rather than imaging.

  40. QUESTION:
    Liver symptoms: help?
    I have a nasty reoccurring bile taste in my mouth—I have swollen area in my side. I have had gallbladder removed. Liver enzymes only slightly elevated so dr does not want to persue that direction. Has anyone had these symptoms before? Thanks.
    Gall bladder was removed a couple years ago because of pain and nausea. It did not help—-and it has gotten progessively worse.

    • ANSWER:
      Unfortunately a foul taste and abdominal pain could be a large list of conditions/disease/syndromes, or what-have-you. The fact that you gall bladder was removed (knowing why would help) makes me lean towards a possible infection; but you didn’t mention the typical immune response to infection, fever etc. I would advise to get another blood test, hepatic health can change surprisingly rapidly despite what people have told me.

  41. QUESTION:
    Can a pinched nerve from the spine go down the waist and leg?
    For about 2 months now I have been having pain on the right side by the waist area and back. It started off on the right side by the waist and the back and then now it is on my right leg. I did 2 abdominal cat scans. One showed liver enlgarged and the other (done with contrast) showed normal. At first one of the liver enzymes were slightly elevated but then a couple of weeks later they were not. However the sonogram showed liver enlarged. A few doctors said that the pain can be from a pinched nerve from the back but the MRI showed normal. Can it still be a pinched nerve from th spine even the the MRI was normal? I went to a neurologist and they said I should do an EMG to find out if it is a nerve pain or not. They also said that it can be from the epidural I took when I was in labor for my 4 months old son. The GI said that the enlarged liver can be from the pregnancy. Is this true? I am confused about all this. IF anyone has any suggestions let me know. Thanks.

    • ANSWER:
      The pain you are having sounds like referred pain. The pain may originate one place, like the pinched nerve in your spine, and then be felt down your leg. This is not uncommon but does need to be pursued to determine the cause. I think you should stick with the neurologist or consider going to a pain management specialist. They are really great with back pain and try to avoid surgery whenever possible.

  42. QUESTION:
    Does my dog need this special liver diet and supplements?
    My 10 months old chihuahua got his bloodwork done again today (since the vet said there were a little bit of elevation last time.. liver enzymes are slightly elevated).

    Blood test results:
    ALT levels
    June 2007 53
    Jan 2008 378
    Feb 2008 230

    She told me that the results today improved, but it’s still a bit out of range. She suggested that we put Bagel on a special diet for a month to see if it will help. It has to do with the blood not going through the livers adequately……

    Ok this is what she is trying to give him:
    Hill’s Prescription Liver Diet

    http://www.hillspet.com/zSkin_2/products/product_details.jsp?PRODUCT%3C%3Eprd_id=845524441760644&FOLDER%3C%3Efolder_i d=1408474395183868&bmUID=1203987390850

    BUT IT HAS NO MEAT!!!!! brewers rice and pork fat seems disgusting!!!! He normally eats Merrick’s & Canidae.

    She also gave us these supplements called Zentinol.

    http://www.vetoquinolusa.com

    http://www.hillspet.com/hillspet/products/productDetails.hjsp?PRODUCT%3C%3Eprd_id=845524441760644

    Here are the ingredients….

    Brewers Rice, Pork Fat (preserved with mixed tocopherols and citric acid), Dried Egg Product, Soybean Meal, Pasta Product, Soy Fiber, Flaxseed, Pork Protein Isolate, Dicalcium Phosphate, Chicken Liver Flavor, Soybean Oil, Powdered Cellulose, Potassium Chloride, Glycerol Monostearate, Calcium Carbonate, vitamins (Vitamin E Supplement, L-Ascorbyl-2-Polyphosphate (source of vitamin C), Vitamin A Supplement, Niacin, Thiamine Mononitrate, Calcium Pantothenate, Biotin, Vitamin B12 Supplement, Pyridoxine Hydrochloride, Riboflavin, Folic Acid, Vitamin D3 Supplement, Menadione Dimethylpyrimidinol Bisulfite (source of vitamin K)), Choline Chloride, Iodized Salt, L-Arginine, Taurine, minerals (Zinc Oxide, Manganous Oxide, Calcium Iodate, Sodium Selenite), DL-Methionine, L-Tryptophan, L-Carnitine, Ethoxyquin (a preservative).
    Thanks Frozen98! The vet did mention to try the diet for a month. But what happens after a month when I put him back onto the normal diet? Wouldn’t the enzyme levels be elevated again?

    • ANSWER:
      Follow the vet’s instructions. It may not be what you would normally feed your dog, but with elevated liver enzymes your dog CAN’T be on a normal diet. Sometimes the levels will come down, your vet will let you know if and when you can return him to regular food. If he has a liver condition, he may always need a special diet. My 8 month old dachshund mix was just diagnosed with portosystemic shunts (after checking and rechecking serum bile acids and serum bilirubin levels). Our next step is an appt. tomorrow morning with a specialist for a vascular ultra-sound of his liver to see if it is operable. Either way, he may always need to be on a special diet and medications because his liver doesn’t work correctly. That doesn’t mean he can’t live a long happy life if it is treated correctly. A liver showing elevated enzymes cannot handle much protein, that is probably why there is not meat in the food and she /he needs the supplements. Did you have an xray done on the liver? My puppy’s liver was of normal size (an excellent sign that the condition is treatible). Sometimes a malfunctioning liver can retard the growth of the liver. I am not telling you to go out and get expensive tests because I am not a vet and just because my puppy also has elevated liver level does not mean that they are the same thing. But it may be worth asking your vet about his liver size. Good luck with your puppy, I pray he is okay. I will find out more tomorrow about my puppy’s condition. It just seems odd because he is growing at a normal rate and he is otherwise healthy and happy! But without the proper treatment he would not remain that way, so we do what we have to do to ensure the health and well being of out four legged family members. I will pray that your puppy lives a healthy happy LONG life!

  43. QUESTION:
    Do I Have Celiac Disease of Liver Problems?
    My doctor did blood tests and it came out negative for celiac. He referred me to a gasterentrologist. I have all the symptoms of celiac, including a pesky rash. My bowel movements are light colored and fatty. Sometimes constipated and sometimes diareah. I am losing weight, but I do eat right and exercise. My liver enzymes were slightly elevated, however. I have some abdominal pain and bloating after I eat. Anyone have any ideas? What are some other tests for liver disease?

    • ANSWER:
      Hello your story sounds very similar to what i went through just a few months ago, i was experiencing abdominal pain and had many of the symptoms for celiacs, yet my tests came back negative. i was losing weight and my liver enzymes were also slightly elevated. All my tests came back negative for any type of liver problems however. About three weeks into all this testing i had a very bad day where my pain became very bad and i went to the hospital, long story short after many tests i was diagnosed with crohn’s disease. Crohn’s Disease is an auto immune disease that affects the digestive tract. You may want to ask your doctor for a CT scan which would be a good option to rule out crohn’s and it will give a good look at your whole digestive tract to see if anything else is up. To answer your question blood tests, and ultrasounds would be the best tests to check for liver disease, although i don’t think that is your problem… Hope i helped and feel free to email me if you have any questions

      Feel better & Good luck

  44. QUESTION:
    What can cause a high pulse rate and slightly low blood pressure? And what might they do for it?
    My pulse always ranges between 110 and 150 at rest and my blood pressure is staying around 100/60. I have been having some dizzy spells and some pressure in my chest and I am so tired of waiting.

    As far as test results so far, my liver enzymes were slightly elevated along with my blood sugar. The ECG was normal except that while they were performing my test my heart rate was about 130. They said it isn’t white coat syndrome because it would have slowed down after a few minutes.

    They put me on a 24 hour halter monitor and I am awaiting the results of that.

    I have had issues with my heart about 7 years ago, the doctor let tests results sit on his desk for 2 weeks and there were high troponen levels. They did a stress test and it came back okay, but they never did anything about it.

    I am 34 years old. Most doctors don’t look twice because women at this age are protected by hormone levels until they reach menopause, but I only menstruate about 2-3 times a year, so I think this could be a key factor too.

    Anyway, any information that I can find will help. I can’t stand waiting.
    Thanks. I am only on medicine to help me sleep and this should slow it down, but doesn’t. I don’t do caffeine, because my body reacts to an extreme when I do.

    • ANSWER:
      One cause of an increased heart rate and decreased blood pressure is dehydration and dramatically increasing your daily water intake may change these numbers a little. But, I do not believe this is the primary cause of your problems. You have some sort of electrical conduction problem with your heart which allows the fast heart rate. There are medications which can slow this heart rate down but they need to know what this rhythm is (sinus tachycardia vs supraventricular tachycardia) in order to prescribe the correct medications. Your holter monitor should give then an idea of what is going on and then, hopefully, they will prescribe the correct medications for you. And, as your heart rate decreases, you should see a slight increase in your blood pressure. In the meantime, avoid smoking, caffeine and any prescription drugs (cough medications, etc) or street drugs which can contribute to this high heart rate.

  45. QUESTION:
    What is causing my 37 yr. old husband abdomen pain for the last 2 months?
    Started out w/chest pain & then found slightly elevated liver enzymes (normal now though) & slightly higher blood pressure at times. His pain could be on either side of his abdomen-either upper left side under ribs to lower right abdomen. Sometimes blood in stool and urine along w/ diareah at times. By sternum there always feel like a fullness there(trapped gas-I think).Stomach always bloated, heartburn at times & burping. Recently his big toe went numb for quite awhile (poor circulation). They notice in his urine that he was dehydrated a couple of times.His ct scan says gallbladder wall is thickend without gallstones.Therefore soon they are doing a stess test on his gallbladder to see if it needs to be removed or not. If that all it is I would be happy with that but when I try to diagnose this online it seems the symptoms I find seems to be more serious than the gallbladder. Anyways, I would like opinions on what this could be-the sooner the better!! Thank you!!

    • ANSWER:
      He may have irritable bowel, or diverticulitis. Sometimes those disease processes can cause blood in the stool. If he smokes, has a high cholesterol, high blood pressure, or a family history of heart disease, he should see the doctor about this, too. Colon disease dosen’t cause poor circulation in the feet.

  46. QUESTION:
    Can a hepatitis test have a false positive or negative?
    I was tested a year ago when I was pregnant and it was negative for all types, but now a recent test showed to be positive for C. I haven’t done anything to get it. I haven’t hardly left my house because I have a baby, and my husband is negative. My liver enzymes are slightly elevated. Which test could have been wrong?

    • ANSWER:
      Yes there can be false positives and negatives. If you want to know for sure, get a viral load test (HCV PCR RNA). If you have chronic active hep c (HCV) it will show a detectable number. 85% or so of the people who have become exposed to HCV go on to have chronic active infection. HCV does not lie dormant (that’s a myth). What it does is slowly and usually without symptoms begin to damage the liver (called fibrosis or scarring). That’s why HCV is called the Silent Killer. Also, if your husband has not tested positive for it by now, he hasn’t acquired it from when his mom gave birth. Perinatal transmission is less than 5% (see the link below). Sexual transmission is 1-3% among stable, monogamous couples. Get the viral load test to be sure. Best wishes.

  47. QUESTION:
    Spleen, Liver, & Pain?
    Ok – I’m an ex drug addict and I’ve had my fair share of beers from Age 15 – 18. I have been sober now for 5 years. I have adominal pain. My abdominal area (lower abdomin, left & down from belly button & upper abdomin, right hand side below ribs) are sore to touch. Liver Enzyme are slightly elevated. I had an ultrasound done; showed an Enlarged Spleen & Enlarged Liver w/ Fat. I also suffer from fatigue & tiredness, but yet I have insomnia most nights but when I fall asleep, I don’t want to wake up. I’ve been tested for Hep & HIV for 5 years with all results being negative. I also get a bad twisting, ripping my guts out sharp pain in my abdomin. This pain comes & goes randomly and is unpredictable. It is usually followed by a bowel movement. My doctor thinks it could be Alcoholic Hepatitis with my liver, I’m going for an biopsy in 2 weeks. Could the three things be linked (bladder, liver, & abdominal pain). What does this sound like? Should I be worried? Is this life threatening? THANKS
    Sorry, when I asked about if they are related above, I accidently put down bladder, I meant to say spleen there.

    I have been tested for Hep B & C. I think the doctor also tested me for A because I was living in Mexico for a few years.

    • ANSWER:
      I too am a recovering alcoholic but Thank God my liver is ok.
      The fatty liver is probably causing you the pain you speak of and the pain you have usually followed by a bowel movement could be some intestinal problem.
      Generally speaking,the liver starts to repair it’self of damage due to drinking /drugs but in some cases some of us used past the point of the liver repairing itself and will have problems with the liver for the rest of our lives.
      Go ahead and have the liver biopsy and see what it will tell you and your Dr. and go from there.
      There is treatment for fatty liver and there is diagnosis and treatment for intestinal problems,all of which you can live with and that are not life threatening.
      The fatigue is probably due to the problems with you are having with possibly a fatty liver and the junk that is storing up in your body that might have been filtered out by a healthier liver.
      The insomnia is probably due to the worry you have over your symptoms,thinking about finances,job situation etc.
      If you are sober and if you are a member of AA,you know that you can’t control these things and you need to let your higher power take care of those things and shut down the committee meetings in your head.
      I like to sit down and do some writing about what is on my mind and in my heart. After doing so I set it aside then take my hot as I can make it bubble bath.
      In a day or two I pick up and read what I wrote previously and see how things have changed since I did the writing. . . you’d be amazed.
      Even if you do have serious problems with your liver etc,all you can do is what the Dr tells you to do so worrying isn’t going to change anything.
      It’s OK to be concerned as the unknown does bother us but to fret like you are doing is only going to do to you the things you are going through right now.

      Let Go and Let God

      Good Luck

  48. QUESTION:
    I have a question about liver?
    I just had a full blood panel done and then some. I had my entire overall health evaluated. My only problem is, is that I have “Slightly” elevated liver enzymes. I had an ultra sound, and was told that I have mild fatty liver. I do not drink alcohol, and my doctor said it is nothing to worry about, just lose some weight, eat right, and work out. Well I have had a dull achy pain on my right side. I dont know if thats the cause or not. It only happens when I sit down. The only way for me to describe the pain is you know when you drink too much water before u run, or workout, and then you get the dull achy cramp in your side. Thats what it feels like. I know there is nothing else wrong from my blood work, and I just had my entire torso looked at in the ultra sound. What do you think? Its really annyoing.

    • ANSWER:
      Just do as the doc suggests and the liver will lose it’s fat.
      Being a bit overweight is a major cause of fatty liver.
      Your pain may be something as simple as a pulled muscle. If it persists take yourself back to the doc.

  49. QUESTION:
    I dont have pcos and dont know what else it could be.?
    I am a 28 year old female and weigh 294 pounds. I have always had an irregular period since day 1. I finally found a doc that would look to find out what it could be. My blood test results came back slightly elevated liver enzymes and elevated testosterone. So he thought maybe polycystic ovarian syndrom. Nope pelvic CT scan said negative.
    Now what could it be.

    • ANSWER:
      First, women with PCOS do not always have cysts, and the other symptoms vary from woman to woman… I’d say do a bit more research on PCOS, and if it keeps fitting your story, get a second opinion (see an endocrinologist) .. Secondly, if PCOS is really out of the question, have the other adrenals checked out.. also thyroid.

      I’ve done quite a bit of study on PCOS, and one of the things I’ve read is that testosterone levels and regularity are often linked with body fat… more body fat = more testosterone in the system .. don’t ask me why! They say that a loss of just 5-7% body weight through diet and exercise can help alleviate physical symptoms (irregular periods). It might be worth a try :)

      Best of luck! Christiana

  50. QUESTION:
    Liver/Gallbladder?
    I’ve had pain in my mid/upper right abdomen for 3 years now. Last year my blood tests were great, this year liver enzymes were ‘very slightly elevated, nothing to worry about’ (doctor) . the pain is very minimal but still bothersome, I was wondering if anyone had similar knawing kind of pain that starts in upper abdomen then radiates to your back. When I eat a high fiber diet the discomfort subsides. I am overweight by about 30 pounds and that’s what my doctor said made my liver enzyme count slightly high. Otherwise I’m healthy. Moderate drinker. Has anyone had this experience with gallbladder disease that isn’t excruiating but very nagging? Thank you for your help.

    • ANSWER:
      You could have a partial biliary obstruction. Your upper right abdomen pain & slightly elevated liver enzymes are symptoms of this condition. Here’s the link for a complete description & more information on symptoms & treatment:

      http://www.pennhealth.com/ency/article/000263.htm

      If the pain gets worse, your doctor can order a CT scan to confirm diagnosis. In the meantime, try & restrict your alcohol intake & eat a low fat, high fiber diet….this should help cut down on your symptoms. Here is a link to a low fat diet recommended for those who suffer from Gall Bladder & Biliary problems:

      http://www.wakesurgical.com/DIET%20PDF/FAT%20RESTRICTED%20DIET%20FOR.pdf

      In addition, studies recommend taking 1200 mgs of a high grade Fish Oil supplement daily for best results. Of course, any weight loss will help greatly too. Hope you’re feeling better soon! Good luck!