SGPT (Serum Glutamic-Pyruvic Transaminase)/
ALT (Alanine aminotransferase), Interpretations:

The increased SGPT (ALT) level :

1. Viral hepatitis. There is a markedly increased level.
2. Drug-induced hepatitis.
3. Chronic hepatitis.
4. Infectious mononucleosis.
5. Intrahepatic cholestasis.
6. Cholecystitis.
7. Active cirrhosis.
8. Metastatic tumors of the liver.
9. Obstructive jaundice.
10. Alcoholic cirrhosis.
11. The mild increase is seen in :
    1. Myosotis.
    2. Pancreatitis.
    3. Myocardial infarction.
    4. Shock.
    5. Infectious mononucleosis.
12. Alcohol-acetaminophen syndrome.
13. A significant increase in level has been in acute liver diseases.
    1. A moderately increased level is seen in chronic liver diseases and muscle trauma.
    2. A mildly increased level is seen in myositis, Myocardial infarction, and infectious mononucleosis.

AST/ALT ratio:

1. The ALT is the cytoplasmic enzyme in the liver, while AST is both a cytoplasmic and mitochondrial enzyme with a wide distribution in various other tissues.
   1. AST/ALT ratio is typically <1, but infectious hepatitis becomes greater in the liver.
2. AST/ALT ratio is usually greater than 1 is seen in:
   1. The patient with alcoholic liver disease (cirrhosis). AST is more sensitive to alcoholic liver disease.
   2. Liver congestion.
   3. Metastatic tumor of the liver.
3. AST/ALT ratio of less than 1 is seen in:
   1. Acute hepatitis.
   2. Viral hepatitis.
   3. Infectious mononucleosis.
   4. The ratio will be less accurate if the AST level is more than 10 times the normal.

Comparison of AST/ALT

1. AST (SGOT) is always raised in acute myocardial infarction, where ALT (SGPT) will be normal unless there is damage to the liver.
2. ALT  (SGPT) is more raised in acute hepatobiliary obstruction than AST (SGOT).
3. ALT (SGPT) is more specific than AST (SGOT) for liver cell injury.
4. The AST/ALT ratio is higher in alcoholic liver diseases.
5. AST (SGOT) is more sensitive to alcoholic liver cell injury.

 level may be mildly raised in:

1. metastatic diseases of the liver.
2. Hepatocellular carcinoma.
3. Biliary Cirrhosis.
4. Intrahepatic and extrahepatic cholestasis.
5. Gilbert’s syndrome.
6. Chronic alcohol ingestion.
7. Diabetes mellitus and diabetic hepatic lipidosis.

Other causes for raised alkaline phosphatase levels:

1. It is also raised in old age and pregnancy.
2. Hodgkin’s disease.
3. Sarcoidosis.
4. Amyloidosis.
5. Pulmonary and myocardial infarction.
6. Hyperthyroidism (with a raised level of calcium).
7. Chronic renal failure.
8. Ulcerative colitis.
9. ALP is increased during the last trimester of pregnancy and falls to normal within 3 to 6 days (postpartum).
10. Hyperparathyroidism.

ALP Decreased level is seen in:

1. Malnutrition.
2. Hypothyroidism (Cretinism).
3. Milk-alkali syndrome.
4. Celiac sprue.
5. Scurvy (vit. C deficiency).
6. Gross anemia.
7. Deposition of radioactive material in the bone.
8. In hypophosphatemia.
9. Pernicious anemia.
10. Nutritional deficiency of zinc or magnesium.
11. Theophylline therapy.
12. Estrogen therapy in postmenopausal females.
13. Wilson’s disease

Causes:

1. Increased RBC hemolysis ( Erythroblastosis fetalis).
2. Sickle cell anemia.
3. Hepatitis.
4. Cirrhosis.
5. Crigler-Najjar syndrome.
6. Gilbert syndrome.
7. Congenital enzyme deficiency.
8. Drugs
9. Transfusion reactions.
10. There is no role in surgery.

1.  Direct Hyperbilirubinemia:

   • When more than 50% is direct bilirubin.
     1. Gallstones.
     2. Gallbladder tumors.
     3. Inflammatory scarring or obstruction of extrahepatic ducts.
     4. It can be resolved by surgery.
     5. Dubin-Johnson syndrome.
     6. Rotor syndrome.
     7. Drugs may cause cholestasis.

Increased SGOT (AST) Level Seen In:

Decreased SGOT (AST) Level Seen In:

1. Chronic renal dialysis.
2. Acute renal diseases leading to Azotemia.
3. Vit.B6 deficiency.
4. Beriberi.
5. Pregnancy.

Increased Level Of Ceruloplasmin :

1. The latter half of the pregnancy.
2. Acute and chronic infections.
3. In myocardial infarction.
4. Thyrotoxicosis.
5. Leukemia and cancers.
6. In liver cirrhosis.

Interpretation of ascitic fluid:

Differentiation of exudate and transudate:

International Normalized Ratio(INR):

This is the patient’s prothrombin time (PT) ratio and the normal mean PT time raised to the power of the international sensitivity index.

Normal value =0.8 to 1.1

Indications For INR

1. PT and PTT are advised to find the cause of unexplained bleeding or blood clot formation.
2. INR is advised to monitor the blood thinning drug’s medication like warfarin therapy.
3. This is done for routine health screenings.
4. To evaluate whether the medical condition is improving or worsening.
5. To assess to measure the success or failure of a medication or treatment plan.
6. This measures the extrinsic pathway.

Use Of INR:

1. The prophylaxis  range of 2.0 to 3.0 is used to prevent:
   1. Embolism.
   2. Venous thrombosis.
   3. Pulmonary embolism.
   4. Myocardial infarction.
2. In patients with anticoagulant therapy, the INR is maintained between 2 and 3.
3. Raised range from 2.5 to 3.5 is used in the patient with mechanical heart valves.