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Multaq and Liver Damage : Cholestatic Liver Enzymes: GGTP and AP

When a liver function test indicates an elevated level of gamma- glutamyl transpeptidase (GGTP) and alkaline phosphatase (AP), a clinician is likely to suspect blocked, damaged, or inflamed bile ducts. When bile is not flowing adequately, a condition known as cholestatis develops. Any injury or illness involving bile ducts is known as a cholestatic liver injury or cholestatic liver disease.

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Bile ducts are positioned inside and outside the liver. Intra- hepatic cholestasis describes blockage or damage in a bile duct inside the liver, a condition that strikes patients with liver cancer or primary biliary cirrhosis. Extrahepatic cholestasis is an injury or blockage of a duct outside the liver. The bile backs up, the choles­tatic enzymes GGTP and AP seep into the bloodstream, and their levels may be very high. However, both GGTP and AP must be elevated to indicate a liver problem. This distinction is important because while GGTP is mostly found in the liver, AP is routinely found in the bones, kidneys, intestines, and placenta. An elevated level of AP is common during pregnancy and in adolescents who are going through growth spurts. In these circumstances, the level of GGTP would be normal.

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Liver-related conditions that cause GGTP and AP to elevate include liver tumors, autoimmune hepatitis, nonalcoholic fatty liver disease, primary biliary cirrhosis, primary sclerosing cholan­gitis, and alcoholic liver disease, as well as gallstones, particularly those that may have moved out of the gallbladder.

Bilirubin

Bilirubin is the yellowish-green pigment that produces the condi­tion known as jaundice. When the liver fails to excrete bilirubin, symptoms include a yellow cast to die skin and eyes; dark, tea-col­ored urine; and light-colored stools.

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