1. Int J Cur Biomed Phar Res. 2011; 1(3): 93 -97 Contents lists available at CurrentSciDirect Publications International Journal of Current Biomedical and Pharmaceutical Research CurrentSciDirect Journal homepage: www.currentscidirect.com PublicationOriginal articleComparative Study of Serum 5 Nucleotidase,Alkaline Phosphatase ,Aminotransferases and Bilirubin in Hepatpbilrary DiseasesDr.Anil BattaAssociate Professor, Baba Farid Univ. of Health Sciences, Faridkot, India.ARTICLE INFO ABSTRACTKeywords:Cholecystitis Differential diagnosis of liver and biliary tract depends a lot on study of various enzymes assay.Hepatitis The development of serum enzymology has improved a lot the ability to diagnose & to monitorMalignancy the clinical course of patients & treatment of patients with Symptomatic & asymptomaticAlcoholc cirrhosis hepatobiliary diseases.For this a huge repository of enzyme assays is now available. The application of serum enzymes to the diagnosis of alcoholic hepatitis was introduced a way back in 1960s with the demonstrated usefulness of Alkaline Phosphatase assay in differential diagnosis of jaundice. A few years after that Ladue, Wroblewski & karmen showed that higher level of AST & ALT were characterized of some forms of hepatic disease led to an explosive increase of interest in serum enzyme assay as a diagnostic tool. Serum enzymology has proved to be a particular welcome addition to clinical hepatology. Of the more than 100 tests of hepatic function that have been devised none by itself has been reliable in the distinction of hepatobiliary diseases. The addition of selected enzyme tests to the roster of other procedures has enhanced the precision diagnosis. Amino transferases value is often useful in monitoring the course of acute & chronic parenchymal liver disease, though they are misleading certain circumstances (Wrobewski & La Dua, 1985). ALT is relatively specific for hepatobiliary disease.ALP activity may be increased in many diseases not associated with hepatic disease like bone, pregnancy, intestine, kidney diseases. Enzyme 5 NT was selected to observe its impact as a key enzyme for diagnosis of Hepatobiliary diseases. c Copyright 2011. CurrentSciDirect Publications. IJCBPR - All rights reserved.1. Introduction found in patients with ALD. Heavy drinking for as little as a fewdays can lead to fatty liver, if drinking continues, in some patients thisThe liver is one of the largest and most complex organs in the body. inflammation eventually leads to alcoholic cirrhosis, in whichIt stores vital energy and nutrients, manufactures proteins and healthy liver cells are replaced by scar tissue (fibrosis), leaving theenzymes necessary for good health, protects the body from liver unable to perform its vital functions. This finding has lead thedisease, and breaks down (or metabolizes) and helps remove researchers to single out an enzyme & metabolite which is specificharmful toxins, like alcohol, from the body. Because the liver is the & undoubtedly an early index of hepatobiliary disease [1-5].chief organ responsible for metabolizing alcohol, it is especiallyvulnerable to hepatobiliary diseases related injury. Even as few as Secondary liver cancer is a cancer that did not originate in thethree drinks at one time may have toxic effects on the liver when liver, but originated in some other part of the body and eventuallycombined with certain overthecounter medications, such as spread to the liver. It is important to realize, however, that eventhose containing acetaminophen. This issue of Alcohol Alert though the tumor spread to the liver, secondary liver cancer willexamines the diagnosis and treatment of alcoholic liver disease behave according to its origin. Prostate cancer involving the liver(ALD), a serious and potentially fatal consequence of drinking will behave like prostate cancer. Secondary liver cancer is alwaysalcohol. Another disorder, hepatitis C, also featured here, often is the result of primary cancer elsewhere in the body. Primary cancer is caused by the bodys cells continuously dividing and growing * Corresponding Author : Dr.Anil Batta into a lump called a tumor. If the cancer cells that make up this Associate Professor Baba Farid Univ. of Health Sciences tumor escape via the bloodstream and settle in the liver, it becomes Faridkot India secondary liver cancer [6-9]. E mail: akbattafarid@yahoo.co.in c Copyright 2011. CurrentSciDirect Publications. IJCBPR - All rights reserved.

2. Anil Batta / Int J Cur Biomed Phar Res. 2011; 1(3): 93 -97 94 There are several primary cancer sites from which metastatic It may increase only up to 5 fold of the normal activities. Up to 10tumors in the liver may originate, including lung, kidney, breast, fold increase is seen in carcinoma of the liver. In both cirrhosis andstomach and colon. Even though there are many possible origins, carcinoma activity of AST is found to be higher than the ALT. Evensecondary liver cancer results from the spread of primary though the activities of both AST and ALT are elevated in the serumcolorectal cancer up to 50 percent of the time. In some cases, the of the patients with liver diseases, ALT is more liver specificorigin of secondary liver cancer cannot be found, even with enzyme as increased ALT activity in serum is hardly seen in tissuesmedical testing. The reason is that the primary tumor may be too other than liver cell damage [11-14].small to detect and is not causing any symptoms. This is Clinical Significanceoccasionally referred to as unknown primary cancer. Secondary Serum 5NT activity is generally elevated in hepatobiliaryliver cancer has many possible origins because of the important diseases, especially with intrahepatic obstruction, but, unlikefunctions the liver performs. All of the bodys blood passes serum alkaline phosphatase, serum 5NT activity is not increasedthrough the liver, leading to early metastasis Because the liver in infancy, childhood, pregnancy, or osteoblastic disorders. It canfilters the bodys blood, it is often the first site of metastatic spread. help confirm the hepatic origin of an elevated ALP. GeneticAs a result, prognosis for secondary liver cancer does not always deficiency of erythrocyte pyrimidine 5NT activity is a commonmean the cancer cells have spread to other organs of the body, cause of hereditary non-spherocytic hemolytic anemia. Acquiredmaking early discovery is even more important.. In malignancy the deficiency of erythrocyte pyrimidine 5NT activity occurs incancer cells detection in ascitic fluid becomes significant. So there patients with beta-thalassemia and lead poisoning. 5NT activity isis parenchymal damage raising the AST/ALT. Again both 5NT and low in circulating monocytes, increases markedly upon theirALP rise due to proximity of the lesion and cholestasis. Having a differentiation to tissue macrophages, and subsequentlyliver metastasis is the most important indicator of disease diminishes during macrophage activation. Lymphocyte ecto-5NTprogression. Monitoring the elevation of ALP levels at each activity, a plasma membrane marker of cell maturation, ispatients follow-up visit may be economically used as an indicator generally low in immunodeficiency states, and undergoesof subsequent liver metastasis. Furthermore, a change in ALP characteristic changes in patients with certain lymphomas andlevels of greater than 120 U/L over a period of 4 to 6 months may leukemias. In cancer patients, elevated serum 5NT activity doesbe indicative of advanced disease progression, which warrants a not always indicate hepatobiliary involvement; in some cases,more aggressive treatment or a change in regimen. ALP is a simple, 5NT may be released into serum from the primary tumor or locallow cost, relatively sensitive screening tool for detecting liver metastases [3-5].metastasis. Future studies aiming at better defining the role of ALPin colon cancer is significant. Here again 5NT has an edge due to Alkaline phosphatases are present in almost all tissues of theits relative specificity and sensitivity [10-15]. body. They are membrane bound and are zinc containing metalloenzymes. Alkaline phosphatases are a family of Transaminases are present in most of the tissues of the body. isoenzymes. They hydrolyze a variety of organic phosphate estersThey catalyze the inter conversions of the amino acids and 2- transferring phosphate groups from a donor substrate to anoxacids by transfer of amino groups.Transaminases are specific acceptor containing a hydroxyl group. The isoforms derived fromfor the amino acid from which the amino group has to be the tissue non-specific isoenzyme by post translationaltransferred to a keto acid. 2-oxoglutarate and glutamate couple modification include the variants of the enzyme found in the liver,serves as one amino group acceptor and donor pair in all amino bone, kidney and the placenta. Some malignant tumors cantransfer reactions. In both the reactions pyridoxal-5-phosphate produce a placental form of the enzyme called the Regansfunctions as a prosthetic group in the amino transfer reactions. isoenzymes.Normal serum values: AST (SGOT) - 0-41 IU/L and ALT (SGPT) - 0-45 IU/L. In newborns value up to 120 units for AST and 90 units for Physiological bone growth elevates ALP in serum and hence inALT is considered normal. the sera of growing children enzyme activity is 1.5-2.5 times that in normal adult serum. The level of ALP in the serum of women inClinical significance the third trimester of pregnancy is 2-3 times more than that of Liver diseases: Determinations of activities of AST and ALT in normal level. Biliary obstruction due to any cause may elevateserum in patients with liver diseases like viral hepatitis and other ALP level by increasing its synthesis from the hepatocytesforms of liver diseases with necrosis, give high valueseven before adjacent to the biliary canaliculi. This newly synthesized ALPthe appearance of clinical signs and symptoms like jaundice. enters the circulation and elevates the enzyme level in the serum.Activity levels of 20 to 50 fold higher than normal are frequently Elevation of ALP in the serum is more with extra hepaticseen in liver cells damage but it may reach as high as 100 times in obstruction by stones or by carcinoma head of pancreas than insevere damage to cells. Highest serum activities are seen between intrahepatic obstruction. The enzyme level may return to normal7th and 12th days and return to normal levels by the 3rd to 5th on removal of the obstruction. Liver diseases affectingweek. In sevre tissue damage ALTactivity is higher than AST and parenchymal cells like infectious hepatitis show only moderatethe ALT:AST ratio becomes 1 (normally