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isolated elevated GGT

Discussion in 'Internal Medicine and IM Subspecialties' started by I Surgeon, Jan 5, 2009.

  1. I Surgeon

    7+ Year Member

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    I have a patient sent for pre-op and he had a isolated GGT, but all other liver enzymes and tests were normal (albumin, triglycerides normal). 32 yo non-alcoholic, slightly obese (for BMI) healthy male on no medications. would you request a workup? what could this be?

    Thanks:)
     
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  3. dragonfly99

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    The alk phos was normal too?
    I have seen this occasionally.
    How high was the GGT?
    I think in the vast majority of cases it should not be necessary to hold up a surgery for this.
    To me, the isolated high GGT shows some stress on the liver that isn't being picked up on the regular liver tests (AST, ALT, alk phos). I am not sure, but I believe the GGT is more sensitive than alk phos so sometimes it's positive even when the alk phos is normal.
    Does the patient take any herbal medicines or supplements? I have seen this in a patient on some type of herbal supplement that contained multiple different herbs...

    There's an UptoDate article on elevated liver function tests that has a section on high GGT, that you might want to read. Or you can just send him to an internist :)
     
  4. I Surgeon

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    I believe the value was 120's and he did drink a lot of green tea daily 2-3 cups (w/ splenda) and took multi-vitamins which may have had some herbal products in it. No other supplements. Alk phos. was normal. could mild obesity cause this?
     
  5. dragonfly99

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    120. What is the upper limit of normal for GGT @your institution?

    GGT is very sensitive for detecting hepatobiliary disease, but not very specific. Elevated levels of serum GGT has been reported in a wide variety of conditions - pancreatic disease, myocardial infarction, renal failure, chronic obstructive pulmonary disease, diabetes, alcoholism, medications such as phenytoin and barbiturates.

    Why was the GGT even checked? Generally there is not reason to check one unless someone has an abnormal alk phos (to confirm the alk phos is from live and not GI or bone source).

    I don't know what the GGT is from, but if there are herbals in the vitamins he takes, maybe it is that. I don't think plain green tea would do this, but perhaps there is something else in the tea as well. I don't know that obesity could cause it...mainly that causes NASH, which should cause AST and ALT to be high, not necessarily the alk phos and GGT, at least as far as I know.

    I wouldn't further work this up unless there is some other evidence of something going on. It shouldn't have been checked in the first place unless there was a definite reason for doing so. You can just have the person f/u with an internist in a couple of months, perhaps have patient check the vitamins and tea he is taking to see what other herb(s) are in there, if any, and try cutting out the supplements for a couple of weeks before having the GGT rechecked. I'm not sure I'd even recheck the GGT though...
     
  6. carrigallen

    carrigallen 16th centry dutch painter
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    that's is the downside of checking a test that isn't indicated: trying to decide what to do with the information. :D
     
  7. DrWBD

    DrWBD Formerly 'wanna_be_do'
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    +1

    Hopefully the surgery isn't being held up due to this.
     

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