Alanine Transaminase (SGPT)

Liver

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Alanine transaminase enzyme; elevated in liver cell damage from hepatitis, alcohol, or fatty liver.

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Alanine Transaminase (SGPT) - Comprehensive Medical Test Information Guide

Why is it done?
- Test measures the level of alanine transaminase (ALT), an enzyme primarily found in liver cells and, to a lesser extent, in muscle tissue, heart, and kidney cells
- Detects liver damage and disease by measuring enzyme elevation released when liver cells are damaged or inflamed
- Ordered to diagnose or monitor liver conditions such as hepatitis, cirrhosis, and fatty liver disease
- Evaluates effectiveness of treatments for liver disease and alcohol-related liver damage
- Monitors side effects of medications known to affect liver function
- Assesses liver health as part of routine physical examinations or health screenings
- Typically performed during annual check-ups, when patients present with symptoms of liver disease, or when monitoring chronic conditions
Normal Range
- Normal reference range typically: 7-56 IU/L (International Units per Liter)
- Range may vary slightly between laboratories, with some reporting 4-36 IU/L or 10-40 IU/L
- Values may be slightly higher in men than women; reference ranges may differ based on age
- Normal (Negative): ALT levels within the normal range indicate no significant liver damage or disease
- Elevated (Positive): ALT levels above the normal range suggest liver damage, inflammation, or disease requiring further investigation
- Moderately elevated (2-5 times normal): Suggests mild to moderate liver injury from viral hepatitis, alcohol, or medications
- Markedly elevated (>5 times normal): Indicates significant liver damage from acute hepatitis, cirrhosis, or acute liver failure
Interpretation
- Mild elevation (50-100 IU/L): May indicate fatty liver disease, muscle injury, recent heavy exercise, or early-stage liver inflammation
- Moderate elevation (100-400 IU/L): Suggests acute hepatitis, medication-induced liver injury, or active cirrhosis
- Marked elevation (>1000 IU/L): Indicates acute viral hepatitis, autoimmune hepatitis, or acute acetaminophen toxicity
- ALT/AST ratio significance: ALT-predominant elevation (ALT > AST) suggests viral hepatitis or non-alcoholic fatty liver disease; AST-predominant elevation suggests alcoholic liver disease or cirrhosis
- Factors affecting results:
- Medications (statins, antibiotics, anti-tuberculosis drugs, acetaminophen)
- Intense physical exercise or muscle injury
- Hemolysis or lipemia in blood sample
- Obesity and insulin resistance
- Pregnancy may cause slight elevation
- Clinical significance: ALT is more liver-specific than AST; it is considered a sensitive marker for detecting hepatocellular injury even in early stages
Associated Organs
- Primary organ: Liver (primary source of ALT enzyme)
- Secondary organs affected: Skeletal muscle, heart, kidneys, pancreas (ALT found in smaller amounts)
- Conditions commonly associated with elevated ALT:
- Viral hepatitis (A, B, C, E)
- Autoimmune hepatitis
- Non-alcoholic fatty liver disease (NAFLD)
- Alcoholic liver disease
- Cirrhosis
- Drug-induced liver injury (acetaminophen, statins, antituberculosis agents)
- Liver cancer (hepatocellular carcinoma)
- Hemochromatosis (iron overload)
- Wilson's disease (copper accumulation)
- Rhabdomyolysis (muscle breakdown)
- Myocardial infarction (heart attack)
- Pancreatitis (pancreatic inflammation)
- Potential complications of abnormal results:
- Progressive liver fibrosis and cirrhosis if underlying cause is not treated
- Liver failure and need for transplantation
- Portal hypertension with bleeding esophageal varices
- Hepatic encephalopathy (brain dysfunction from toxin accumulation)
- Development of liver cancer in cirrhotic livers
Follow-up Tests
- Recommended additional tests if ALT is elevated:
- Aspartate Aminotransferase (AST) - to compare liver enzyme patterns
- Alkaline Phosphatase (ALP) - to assess biliary function
- Total and direct bilirubin - to assess liver synthetic function
- Gamma-glutamyl transferase (GGT) - to differentiate liver vs. bone source of elevated ALP
- Albumin and prothrombin time (PT/INR) - to assess synthetic function
- Hepatitis A, B, C serology - to screen for viral hepatitis
- Autoimmune antibodies (ANA, anti-smooth muscle) - to screen for autoimmune hepatitis
- Lipid panel - to evaluate for metabolic syndrome and fatty liver
- Abdominal ultrasound - to visualize liver structure and exclude focal lesions
- CT or MRI of abdomen - for detailed liver imaging if cirrhosis or cancer suspected
- FibroTest or FIB-4 score - to assess degree of liver fibrosis non-invasively
- Liver biopsy - definitive test if other investigations inconclusive
- Transient elastography (FibroScan) - to measure liver stiffness indicating fibrosis
- Monitoring frequency:
- For chronic hepatitis: Every 3-6 months to monitor disease progression and treatment response
- For patients on hepatotoxic medications: Every 3-6 months or as recommended by prescribing physician
- For cirrhosis: Every 3 months for surveillance of complications and HCC screening
- Healthy individuals: Annually as part of routine screening
Fasting Required?
- Fasting requirement: No - Fasting is NOT required for ALT testing
- However, fasting may be recommended if additional tests like lipid panel or glucose are being performed simultaneously
- Medications: No need to discontinue medications unless specifically instructed by physician
- Inform healthcare provider of all medications, supplements, and herbal products being taken, as some may affect liver function
- Patient preparation requirements:
- Normal diet and fluid intake can be maintained
- Avoid intense physical exercise 24 hours before the test, as this can elevate ALT levels
- Avoid heavy alcohol consumption for 24-48 hours before testing
- Bring valid identification and insurance information to the testing facility
- Blood draw can be performed in any venipuncture setting (laboratory, hospital, clinic)
- No special collection containers needed - standard venipuncture tube for serum

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