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PubMedDate not supplied

Sensitivity and specificity of liver function tests in the detection of parenteral nutrition-associated cholestasis.

We carried out a study to determine which of the liver function tests was the most sensitive and/or specific in detecting parenteral nutrition associated cholestasis. The tests utilized were alkaline phosphatase, gamma-glutamyl transpeptidase, cholylglycine, sulfolithocholylglycine, and bilirubin. Fifty-nine patients with no prior evidence of liver dysfunction were studied. We found gamma-glutamyl transpeptidase to be the most sensitive (89.5%) and also the least specific (61.9% specificity). Specificity of gamma-glutamyl transpeptidase was improved when it was combined with alkaline phosphatase. We recommend the combination of these two enzymes as the most cost effective way of detecting parenteral nutrition-associated cholestasis.

Adult↗
PubMed2005

Postoperative changes in liver function tests: randomized comparison of low- and high-pressure laparoscopic cholecystectomy.

BACKGROUND: Pneumporeitoneum at 14 mmHg causes dangerous hemodynamic disturbances in some patients, leading to splanchnic ischemia. Laparoscopic cholecystectomy (LC) using low-pressure pneumoperitoneum (7 mmHg) minimizes adverse hemodynamic effects on hepatic portal blood flow and hepatic function. This study evaluated the changes in liver function tests after high-pressure LC (HPLC; 14 mmHg) and low-pressure LC (LPLC; 7 mmHg). METHODS: For this study, 50 patients were randomly assigned to undergo either HPLC (n = 25) or LPLC (n = 25) Liver function tests including total bilirubin, gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were obtained preoperatively, then 24 and 48 h postoperatively. All patients had normal values on the preoperative liver function tests. The anesthesiologic protocol was uniform. RESULTS: The findings showed that ALT after 24 h (LPLC: 1473.72 +/- 654.85; HPLC: 2233.74 +/- 1247.33; p = 0.0096) and 48 h (LPLC: 1322.99 +/- 601.51; HPLC 2007.80 +/- 747.55; p = 0.0008) and AST after 24 h (LPLC: 1189.96 +/- 404.79 i.j.; HPLC: 1679.40 +/- 766.13; p = 0.0069) were increased in the patients who underwent HPLC. The AST levels after 48 h were statistically unchanged from baseline in both groups. Total bilirubin, ALP, and GGT levels remained unchanged from baseline in both groups, without a significant difference between the two groups. CONCLUSIONS: Because LPLC minimizes adverse hemodynamic effects on hepatic function, a low-pressure pneumoperitoneum should be considered for patients with compromised liver function, particularly those undergoing prolonged laparoscopic surgery.

Adult↗
PubMed2000

Short-term effects of branched-chain amino acids on liver function tests in cirrhotic patients.

A randomized study was conducted in 29 ambulatory cirrhotic patients to determine the short-term effects of branched-chain amino acids (BCAA) on nutritional status, biochemical liver function tests and caffeine clearance. Each patient received a 4-week period of isonitrogenous and isocaloric regimens, either a standardized diet contained 40 g protein with supplementation of BCAA 150 g daily (group I) or only a standardized diet contained 80 g protein daily (group II). At the end of treatment, only group I showed significant improvements in transaminase levels as well as the caffeine clearance test compared with those of the pre-treatment levels. Nonetheless, significant improvements in nutritional parameters and additional liver function tests were not yet detected. We conclude that the short-term nutritional supplementation of BCAA is well tolerated and leads to improvement in hepatic metabolic capacity assessed by the caffeine clearance test.

Adult↗
PubMedDate not supplied

Etiologic diagnosis of hepatic lesions in cancer patients. Value of ultrasound and liver function tests.

The purpose of this study was to evaluate the value of a combination of ultrasound (US) and liver function tests (LFT) for determination of the benign or malignant nature of one or more hepatic lesions in cancer patients. A total of 1235 patients with hepatic metastases and 832 patients with benign liver lesions investigated by US-LFT over a 12-year period were analyzed retrospectively. Ultrasound patterns considered indicative of a benign process (cyst, calcification without mass, irregular hyperechoic area without mass effect, small hyperechoic focal lesion as less than 3 cm) or malignancy (peritumoral halo, hypoechoic focal lesion, multiple solid nodules) were associated with LFT results. A US pattern of a benign process associated with normal LFT led to a diagnosis of benign disease with a false negative rate for malignancy of 11.6%. The highest figure corresponded to small hyperechoic nodules, for which the positive predictive value of malignancy (PPVM) depended on the type of primary cancer: 2.1% for breast cancer versus 62.5% for colorectal cancer. A US criterion of malignancy associated with abnormal LFT led to a diagnosis of malignancy (PPV 96.2% to 100%). Overall, the combination of US and LFT had a sensitivity of 80.6% and a specificity of 99.4%. The US-LFT combination correctly determined the benign or malignant nature of 74.5% of all hepatic lesions; the PPV was never less than 96.2% (small and solitary hyperechoic focal lesions were excluded because their PPV for malignancy is too high).

Calcinosis↗
PubMed2003

Aqueous kava extracts do not affect liver function tests in rats.

Kava ( Piper methysticum Forst. f., Piperaceae), prepared as the traditional aqueous infusion, was tested in the rat for possible effects on liver function tests. Extracts were administered in daily dosages of 200 or 500 mg of the active kavalactones/kg for two or four weeks. Sera were assayed for four enzymes that are markers of liver toxicity and liver homogenates for malondialdehyde formation that indicates changes in lipid peroxidation. The data showed that none of the enzymes, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and lactate dehydrogenase, nor malondialdehyde were elevated, in fact in some cases they were significantly reduced, suggesting the lack of a toxic effect by kava on the liver.

Alanine Transaminase↗