- Subacute :persistent rise of liver enzymes more than 3 months upto 6 months ( often due to unresolved and/or untreated acute liver disease ( causes of acute hepatitis )

Subacute ده 🔰🔰🔰🔰🔰🔰🔰🔰🔰
هو غالبا acute hepatitis ممتد ولم يتم علاجه ولا السيطره عليه

- Chronic hepatitis :
التهاب مزمن فى خلايا الكبد لمدة تزيد عن ٦ شهور

chronic rise of liver enzymes with chonic necroinflammatory activity with chronic hepatocellular injury for a period ≥ 6
months due to the following diseases 🔰

- Viral hepatitis : like Chronic HCV ( predominant in Egypt ) & chronic HBV

- Metabolic
° steatohepatitis :
#Alcoholic steatohepatitis
#Non-Alcoholic steatohepatitis( NASH)
° Wilson's disease
° hemochromatosis
° alpha 1 anti-trypsin deficiency

- Autoimmune
° Autoimmune hepatitis

ملحوظه هااامه : اى مرض بيعمل chronic hepatitis لو لم يتم علاجه هيؤدى الى حدوث ما يسمى بال LIVER CIRRHOSIS تليف الكبد ،، وطبعا اشهر سبب فى مصر هو ال chronic HCV hepatitis واشهر سبب بيختلف من بلد لاخرى ( خلى بالك من النقطه دى ) ... وقد يؤدى ال liver cirrhosis الى ما يسمى ال ⤵️⤵️⤵️⤵️⤵️
decompensation & liver cell failure
وهنذكر علامتها لاحقا

⏳ مرض فيروس سى طبعا قل كتير عن الاول بعد الحمله القوميه لعلاج المصريين فى 2019 ولكن ما زال موجود .

ولكن ماذا عن كل انزيم ؟
=================

★ ALT ( SGPT)
Alanine aminotransferase (ALT, serum glutamic pyruvic transaminase [SGPT])
■ Found in cytosol of hepatocyte
■ Highest concentration in liver (more sensitive and specific than AST for liver inflammation and hepatocyte necrosis)

[[ ALT ]]
هو الانزيم المعبر بشكل حقيقى عن تلف خلايا الكبد بالمقارنه ب ال AST اللى موجود فى خلايا الكبد وخلايا اخرى من اعضاء اخرى بالجسم

★ AST ( SGOT)

Aspartate aminotransferase (AST, serum glutamic oxaloacetic transaminase [SGOT])
■ Found in cytosol and mitochondria
■ Found in liver as well as skeletal muscle, heart, kidney, brain, and pancreas

■ Aminotransferase elevations are often the first biochemical abnormalities
detected in patients with viral,autoimmune, or drug-induced hepatitis; the degree of elevation may correlate with the extent of hepatic injury but is generally not of prognostic significance

وفى حالات ال acute hepatitis ايا كان السبب بيكون ال ALT قيمته اعلى من ال AST لكن فى حالة ال Alcoholic hepatitis بيحدث العكس 🔰

■ In alcoholic steatohepatitis, the serum AST is usually no more than 2 to 10 times the upper limit of normal, and the ALT is normal or nearly normal, with an AST:ALT ratio >2
يا ترى ايه السبب ؟
Relatively low ALT levels may result from a deficiency of pyridoxal 5-phosphate, a necessary cofactor for hepatic synthesis of ALT.

ولكن فى مرض الالتهاب الكبدى الدهنى المزمن وده السبب الاشهر لدهون الكبد اكثر من الكحول بردو ال ALT بيكون اكتر من ALT 👇👇👇👇👇

In contrast, in nonalcoholic fatty liver disease, ALT is typically higher than AST until cirrhosis develops.

📎 هل بتعلى الانزيمات بارقام عاليه جدااا ؟

الاجابه فى الحالات الاتيه ⤵️⤵️⤵️
■ Aminotransferase levels may be higher than 3000 U/L in acute viral hepatitis
or drug-induced liver injury; in acute liver failure or ischemic hepatitis (shock liver), even higher values (>5000 U/L) may be found.

ملحوظه هامه :
فى الامراض اللى بتعمل chronic hepatitis بتعلى الانزيمات بدرجه بسيطه الى متوسطه غالبا ( 5 - 10 folds ) ويمكن اقل من 5 folds كمان ،، انما غالبا ما بتعلاش اكثر من 10 folds بالذات فى ال chronic viral hepatitis C .

■ Mild-to-moderate elevations of aminotransferase levels are typical of chronic viral hepatitis, autoimmune hepatitis, hemochromatosis, alpha-1 antitrypsin deficiency, Wilson disease, and
celiac disease

سؤال مهم ؛
هل ال hepatocellular Injury هو النوع الوحيد لل pathology اللى بيحدث فى الكبد ؟

الاجابه ؛