38 male
My Hepatologist told me bilirubin is the true indicator of how well the liver is functioning. Bilirubin results from the enzymatic breakdown of heme. Unconjugated bilirubin is conjugated with glucuronic acid in hepatocytes to increase its water solubility and is then rapidly transported into bile. The serum conjugated bilirubin level does not become elevated until the liver has lost at least one half of its excretory capacity. Thus, a patient could have obstruction of either the left or right hepatic duct without a rise in the bilirubin level.
Because the secretion of conjugated bilirubin into bile is very rapid in comparison with the conjugation step, healthy persons have almost no detectable conjugated bilirubin in their blood. Liver disease mainly impairs the secretion of conjugated bilirubin into bile. As a result, conjugated bilirubin is rapidly filtered into the urine, where it can be detected by a dipstick test. The finding of bilirubin in urine is a particularly sensitive indicator of the presence of an increased serum conjugated bilirubin level.
When a patient has prolonged, severe biliary obstruction followed by the restoration of bile flow, the serum bilirubin level often declines rapidly for several days and then slowly returns to normal over a period of weeks. The slow phase of bilirubin clearance results from the presence of delta-bilirubin, a form of bilirubin chemically attached to serum albumin. Because albumin has a half-life of three weeks, delta-bilirubin clears much more slowly than bilirubin-glucuronide. Clinical laboratories can measure delta-bilirubin concentrations, but such measurements are usually unnecessary if the physician is aware of the delta-bilirubin phenomenon.
With elevated bilirubin jaundice may occur. What essentially occurs is a buildup of bilirubin, which is formed when red blood cells break down. Since it cannot be excreted in the bile, it essentially backs up into the body and causes a yellowing of skin and eyes. This is not something you want to see!
The normal bilirubin range is 0.1 to 1.2 milligrams per deciliter (mg/dL). The normal range may vary slightly from lab to lab. Normal ranges are usually shown next to your results in the lab report.
Your level of bilirubin may be higher than normal because:
You are taking a medicine that raises the bilirubin level in your blood.
You have an infection.
You have a liver or biliary tract disease, such as hepatitis or gallstones.
You have a blood problem, such as anemia.
A bilirubin level lower than normal is, in general, never cause for concern
The normal range of values for AST (SGOT) is from 5 to 40 units per liter of serum (the liquid part of the blood).
The normal range of values for ALT (SGPT) is from 7 to 56 units per liter of serum
AST (SGOT) and ALT (SGPT) are sensitive indicators of liver damage or injury from different types of disease. But it must be emphasized that higher-than-normal levels of these liver enzymes should not be automatically equated with liver disease. They may mean liver problems or they may not. For example, elevations of these enzymes can occur with muscle damage. The interpretation of elevated AST and ALT levels depends upon the entire clinical evaluation of a patient, and so it is best done by doctors experienced in evaluating liver disease.
It is, therefore, worth mentioning that these liver enzymes do not give an indication of the function of the liver. Sometimes they are mistakenly referred to as “liver function tests” or LFTs, but it is a misnomer commonly used.
Mild to moderate elevations of the liver enzymes are commonplace. They are often unexpectedly encountered on routine blood screening tests in otherwise healthy individuals. The AST and ALT levels in such cases are usually between twice the upper limits of normal and several hundred units/liter
What is usually most helpful is serial testing of AST (SGOT) and ALT (SGPT) over time to determine whether the levels are increasing, remaining stable, or decreasing.
