“ALT” stands for alanine transaminase, an enzyme present in the cells of mammalian livers. While the enzyme may also be found in a few other organs, the quantities are low enough to make ALT reasonably liver-specific. The same enzyme is also known by an older name, SGPT, which stands for serum glutamic pyruvic transaminase. Normal serum level of ALT in dogs should be between 12 and 118.
ALT is known as a “leakage enzyme,” meaning the cells that contain it must die in order for it to be released. Therefore, if serum ALT levels are up, some death of liver cells has occurred. However, it is important to recognize that there is not a direct correlation among the elevation of the enzyme, the amount of liver damage and the prognosis for the patient. However, trends may be followed that give an indication of improvement or worsening of liver disease.
Many diseases may affect ALT, as well as non-liver conditions. For example, congestive heart failure (CHF) may result in poor blood circulation, causing stagnation of liver blood flow and poor liver function. Some medications, most notably phenobarbital used for seizure control.
“AST” stands for aspartate transaminase, which is also an enzyme. The older name is “SGOT,” which stands for serum glutamic oxaloacetic transaminase. AST is also present in the liver and several other organs including skeletal muscle, heart muscle and red blood cells. Interpretation of the enzyme is similar to ALT, while recognizing that it is much less liver-specific. Normal level in dogs is 15-66.
Alkaline phosphatase is also present in the liver, as well as bone, placenta and other locations. From the liver, it normally moves into the intestinal tract along with bile through the bile ducts. However, if bile flow is obstructed, levels within the liver may rise sufficiently to ‘back up” into the bloodstream. Patients with rapidly growing bones, puppies and kittens, as well as pregnant animals, may have elevated alkaline phosphatase levels.
Bile ducts may become obstructed at the microscopic level, inside the liver, or the macroscopic level, in the large ducts that leave the gall bladder, pass through the pancreas and enter the intestinal tract, where bile aids in the digestion of fats.
GGTP or gamma glutamyl transpeptidase, also becomes elevated in biliary obstruction, and is much more specific than alkaline phosphatase. It is also a much newer test.
It is important to realize that these are not measurements of liver function, rather they are measurements of liver damage. Now, that won’t keep physicians or veterinarians from calling them liver function tests. It’s not that we don’t know better, it’s just the term used as an inappropriate shortcut. To assess the function of the liver, we will discuss bile acids in this series.
See you tomorrow, Dr. Randolph.