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Thursday, September 19, 2013


Liver disorder itself it is diversified, with the number of patients was small. Number of people with hepatitis C only about 3% of the population. Not to mention the hepatitis A and B, which are more numerous. Especially when coupled with fatty liver, cirrhosis, drug intoxication, liver fibrosis, and other diseases that her name not so familiar.

Diseases was generally characterized by an increase in SGOT-SGPT numbers. However, the two enzymes was not 100% produced by the liver. A small portion is also produced by muscle cells, heart, pancreas, and kidneys. That is why, when muscle cells are damaged, the two levels of this enzyme increases.

Damage to the muscle cells can be caused by many things, such as strenuous physical activity, injury, trauma, or even scrapings. When we got the intramuscular injection (injection via the muscle tissue), muscle cells can have a bit of damage and increase the levels of transaminase enzymes. In short, there are many factors that can cause an increase in SGOT-SGPT.

Compared with SGOT, SGPT is more specific liver cells showed irregularities, because only a small SGPT produced by cells nonliver. Typically, factors not nonliver SGOT-SGPT increase drastically. Generally, less than 100% exceeded the upper limit of normal (BAN). For example, if BAN alanine aminotransferase levels were 65 units / liter (U / l), the increase was due to play football usually doubled.

If levels exceed twice, the sign began red light to watch. Do not be "hurt" if doctors suspect we suffer heartache. BAN itself can vary between laboratories. If ever a blood test in two different labs, and beyond the upper limit of normal (BAN) are different, you do not have to wonder.

"The upper limit of normal depending on the reagents and equipment used. In certain hospitals, BAN can SGPT levels 40 u / l, but in other clinics may 65 u / l. It's just a matter of technical inspection. That's why, we can not express the level of SGOT-SGPT of absolute numbers, but of the relative value (compared to surpass the upper limit of normal "BAN").

SGOT-SGPT are two transaminase enzymes are produced mainly by the liver cells. When liver cells are damaged, for example in the case of hepatitis or cirrhosis, usually two levels of this enzyme increases. Hence, by the results of laboratory tests, both considered to illustrate a disturbance in the heart.
SGOT-SGPT were slightly above normal does not necessarily indicate someone is sick. It could have happened is not due to an increase in liver disorders. "If we play ball after a blood test or scrapings, SGOT-SGPT very likely we will go up," said dr. Rino A. Gani, Sp.PD-KGEH, hepatolog Faculty of Medicine, University of Indonesia, Jakarta.
SGOT-SGPT levels are also easy up and down. Maybe when examined, the levels are high. But after that, he was back to normal. In others, may now be examined, the levels were normal, but usually it high. Therefore, a single examination alone can not be used as actual argument to make conclusions.

Planned suicide
As with other organs, the liver has a defense mechanism. When attacked by a virus, he tried to resist. If defeated, he had two choices: fight to the death or suicide. On hepatitis A and B, the liver took the first option, to fight to the death.

Once the liver cells die, the walls collapsed and eventually liver becomes inflamed. This condition causes increased SGOT-SGPT levels in the blood. Because the levels are elevated, doctors diagnose more easily.
But in hepatitis C, more complex affairs. Not all liver cells still responded to defeat by fighting to the death. Others in a planned suicide. In medical terms it is called apotosis (programmed cell death). Suicide event is not without purpose. With suicide, liver cells try to "kill" the virus indirectly.

One of the weaknesses of the virus, which does not have its own mechanism in the breed. They are bred by utilizing the mechanism of living cells of other living creatures. In the case of hepatitis, carrying cells are liver cells. With suicide, trying to make viral liver cells can not proliferate.
From suicide, liver cells do not rupture, but shrinking. What followed instead of the inflammatory process, but shrinking. Because the liver is not inflamed, ALT levels were not affected. That's what causes people with hepatitis C may have normal ALT levels, even though he has suffered a chronic illness. It's also what makes the doctor must repeatedly adjusted his glasses, because the diagnosis is difficult.

Need another test
SGOT-SGPT only describes the level of damage to the liver cells. Both of the other enzymes can not describe the level of ability of liver cells to regenerate themselves. Under normal conditions, the body's cells have the ability to regenerate. If defective, they will replace it with new cells. Regeneration ability is what will offset cell damage. Things that are not reflected in the results of tests SGOT-SGPT. It could be someone SGOT-SGPT increased to above normal, but the liver was not actually in a state hospital, because the cells that have died immediately replaced by new cells.

Although SGOT-SGPT increase could be due to many factors, increasing both should remain wary. Throughout still have two eyes, we can not look at him with one eye. Although only slightly above normal too, the cause must be traced, to be sure there is no disease that attacks. Levels above the normal so we should suspect the sign of a disturbance in the heart.
On hepatitis C, if the SGPT to exceed twice the upper limit of normal (BAN), the hepatolog agreed to take therapeutic action. For the case of normal ALT levels or slightly above BAN, differences of sect. The first approach requires immediate treatment. The second school of thought, the patient should be closely monitored before treatment.
During the monitoring period, patients should be 4-5 times to go to the lab to undergo liver function tests every 1-2 months. Liver function tests here is not just a test SGOT and SGPT. There are many other components of blood chemistry that needs to be checked. To be sure, doctors need to do a biopsy. A small segment of the liver tissue samples taken for examination by microscope. If the results of the examination showed normal values, patients may be a little relieved. He just needs to control for another year. However, if the circuit examination showed the patient had been hurt, he should be encouraged to undergo therapy.

Hepatitis C virus (HCV) can cause liver damage. HCV infection is spread primarily by direct contact of blood-to-blood. Most people infected with hepatitis C through injecting drug use with shared needles interchangeably. Up to 90% of people who ever injected drugs, even once, was infected with HCV. Some people are also infected with HCV through unprotected sex. This risk is especially high for men who have sex with men, people with other sexually transmitted infections, people with multiple sex partners, and those who perform a sexual activity that causes bleeding, for example, put your hand on the anal (fisting). HCV can also be transmitted by tattooing equipment. Some people are also infected in health facilities, through inadvertently punctured with needles or other instruments that are not sterile. HCV can also be transmitted through blood transfusion, although blood donors in Indonesia screened for HCV.

Hepatitis C treatment as early as possible is very important. Although your body has to fight against infection, but only 15% were successful, the treatment is still needed to prevent chronic hepatitis C and helps reduce the possibility of a broken heart.
Sometimes, the treatment of hepatitis C requires a long time, and can not help. But because the disease can become severe over time, it is important to seek the right treatment from your doctor.

Early diagnosis and treatment is urgent and important. A significant percentage of people who do it can recover from Hepatitis C and showed his improvement. Goal of treatment is to eliminate the Hepatitis C virus from your body as early as possible to prevent the development of worsening and end stage liver disease.
Course of the disease is indeed impressive sinister disease. But according to doctors Superior Budihusodo, SpPD, of subsection Hepatology, University of Indonesia Faculty of Medicine, patients with hepatitis C can be cured if diagnosed and treated early. Moreover, the development of hepatitis to cirrhosis or liver cancer may take a dozen to tens of years.
"When patients infected with hepatitis C virus was detected at a young age and get immediate treatment, the chance of recovery is quite large, up to 80 percent," said Dr. Excellence in Hepatitis C Issues seminar in Indonesia, which was held in Jakarta some time ago.
Leading doctors say, there are several factors that influence the success of drug therapies, namely the type of virus, the amount of virus in the body, the patient's age, condition of liver disease, when therapy is initiated, as well as patient compliance in therapy. "Patients who are younger generally greater chances of recovery," he said. In addition, patients infected with hepatitis C virus type 2 and type 3 were successfully cured many. "Unfortunately, the type of virus that many in our country are type 1 is more stubborn," he said. To determine the genotype of the virus, patients are required to do blood tests.
This virus genotype will determine the course of treatment that should be done. Patients with hepatitis C virus type 2 and 3 only require treatment for 6 months. Whereas patients with type 1 virus must take medication for 12 months.

Liver disease experts today recommend combination therapy of interferon and an antiviral drug called ribavirin as the best choice of drugs for hepatitis C. This drug is injected once a week for several months depending on the genotype of the virus. Most forms of Interferon Alfa could only last one day but can be modified through Pegylation process to make it last longer. Although interferon alfa can be used as a single drug, including hepatitis C pegylated interferon, showed more effective when combined with anti-viral ribavirin.

3 (three) compounds used in the treatment of Hepatitis C are:
  1. Alfa interferon is a protein made ​​naturally by the human body to boost the immune system / immunity and regulate the function of other cells. Recommended drugs for chronic hepatitis C is of interferon Alfa can be in the form of natural or synthetic.
  2. Pegylated Interferon Alfa, made ​​by combining water-soluble molecules called "Polyethylene Glycol (PEG)" with interferon alpha molecule. This modification of interferon alpha longer exist in the body, and studies have shown more effective in making a response to the virus survive from chronic hepatitis C patients compared to interferon alfa usual.
  3. Ribavirin is an antiviral medicine that is used with interferon alfa for chronic hepatitis C treatment. Ribavirin alone is not effective when used against the Hepatitis C virus, but with a combination of interferon alfa, is more effective than interferon alfa alone.
This treatment has been accepted by the ability to generate a response against the virus in patients with chronic hepatitis C disease. Patient is said to have a response against the virus if the number of Hepatitis C virus is so low that it was undetectable in standard tests Hepatitis C virus RNA and if the level remains undetectable for more than 6 months after treatment is completed.



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