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Sample

Purpose of the test (Indications)

  1. This test is done for liver dysfunction.
  2. This is also useful to detect alcohol-induced liver cell injury and in chronic alcoholics.
  3. This test can detect the slightest degree of cholestasis.
  4. GGT is very sensitive to the biliary obstruction, cholangitis, and cholecystitis.
  5. GGT is a good marker for pancreatic cancer, prostatic carcinoma, and liver cell carcinoma.
  6. GGT level indicate remission and recurrence.

Precautions

  1. Keep in mind that value may be low in late pregnancy.
  2. Drugs which decreased the value are Clofibrate and oral contraceptives.
  3. Drugs which increased the value are Alcohol, Dilantin, and Phenobarbital.
  4. GGT is raised in patients who are taking antiepileptic drugs.

Pathophysiology

  1. According to concentration, GGT is present in:
    1. proximal tubule of the kidney.
    2. Liver.
    3. Pancreas.
    4. Intestine.
  2. As GGT is found in the epithelial cells of the biliary tree and mostly in the interlobular bile ducts and bile ductules. This is the reason that it is very sensitive to the biliary injury.
    1. GGT is present in kidney, pancreas, spleen, heart, intestine, brain and prostate gland.
    2. GGT level is higher in the men because of the additional amount due to the prostate.
    3. The kidney has a maximum amount but the liver is considered the normal source of serum activity.
    4. It is found throughout the hepatobiliary system and other tissues.
  3. GGT is present in the microsomes of the cytoplasm and the cell membrane.

  1. GGT takes parts in the transfer of the amino acid and peptides across the cell membrane.

  1. The Very small amount detected in the endothelium of capillaries.
  2. This test has been useful in the detection of a male in nearly-risk drinkers (Not in female).
    1. This is most applicable as part of an alcoholic screening program.
  3. It is a more sensitive indicator of liver disease in children than is alkaline phosphatase.
  4. This is a very sensitive test to tell liver cell injury and its correlation with alkaline phosphatase level.
  5. GGT is raised in the acute myocardial infarction and mechanism is not clear.
    1. If it occurs in first 7 days then it may be due to liver insult.
    2. Otherwise, it is raised usually in 1 to 2 weeks.
  6. However, its raised level is nonspecific because it is raised in cardiac, pulmonary, pancreatic, renal disorders, Diabetes, and alcoholism.
  7. GGT correlates with alkaline phosphatase in obstructive jaundice and metastatic infiltrate in the liver.
    1. In such case, GGT is more sensitive and specific.
  8. The overall clinical significance is limited.

  1. GGT normal with raised alkaline phosphatase indicates skeletal muscle disease.
  2. GGT raised with alkaline phosphatase indicate hepatobiliary disease.

Normal

Source 2

Another Source

Raised levels are seen in:

  1. Obstructive liver disease and posthepatic obstruction.
    1. This may reach 5 to 30 times of the normal value.
  2. Infectious hepatitis where the rise is 2 to 5 times of the normal value.
  3. Liver diseases like cirrhosis, space-occupying lesion.
  4. Mild increase in the fatty liver.
  5. Infectious mononucleosis,
  6. Renal transplant.
  7. Hyperthyroidism.
  8. Diabetes mellitus.
  9. Pancreatitis.
    1. The increase may be 5 to 15 times of the normal value.
  10. Myocardial infarction.
    1. The increase is mild and may occur after the fourth day of infarction and peak reaches in the next 4 days (another reference).
  11. Alcohol ingestion
  12. EBV infection in Infectious mononucleosis, cytomegalic viral infection, and Reye syndrome.

The decreased level is seen in:

GGT values normal:

  1. Bone disorder and bone growth.
  2. Pregnancy.
  3. Skeletal muscle disease.
  4. Renal failure.

Possible References Used

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