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August 30, 2021 | Farah Jassawalla

Elevated Liver Enzymes: Causes, Symptoms and Tests

Liver enzymes are protein structures that carry out various chemical reactions within the liver. The liver itself is responsible for several functions, including primarily detoxifying various metabolites, synthesizing proteins, and producing digestive enzymes.

The liver enzymes also have a significant role in metabolism, regulating red blood cells (RBCs), and glucose synthesis and storage. They also control the levels of chemicals in the blood and help excretes waste products. Another function of liver enzymes is producing bile and substances that help your blood clot, breaking down food and toxins, and fighting infection. Thus, a high liver enzyme level can be harmful to one's health.

These liver enzymes are alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate transaminase (AST), and gamma-glutamyl transferase (GGT). If your liver is inflamed or damaged, it releases the liver enzymes into your bloodstream (usually ALT or AST). This causes an increase in liver enzymes in the blood.

Causes of Elevated Liver Enzymes

An increase in liver enzymes can be attributed to liver inflammation and damage, which have many causes.

The most commonly diagnosed cause of elevated liver enzymes and liver inflammation is fatty liver disease (FLD). FLD is a common condition caused by the storage of extra fat in the liver. According to research, almost half of patients with high liver enzyme levels have fatty liver disease.

Other causes for a high level of liver enzymes can include:

  • metabolic disorders such as heart disease, stroke, and diabetes
  • hepatitis A, B, or C
  • alcohol or substance abuse
  • cirrhosis (permanent scarring of liver tissue)
  • autoimmune diseases such as type-1 diabetes and hepatitis
  • celiac disease
  • liver cancer
  • mononucleosis
  • blood poisoning is also known as sepsis
  • Wilson's disease
  • inflammation of the muscles or polymyositis
  • some types of medications, including certain kinds of pain relievers and statins

Can Stress Cause Elevated Liver Enzymes?

Stress and anxiety are proven to contribute to high liver enzyme levels since they can reduce blood flow to the liver. Stress is also connected to high cortisol levels, which, in turn, is connected to liver damage. Additionally, NKT (Natural Killer Cells) expand in the liver during periods of stress and kill liver cells, making liver conditions worse.

Other connections of liver disease and stress are:

  • People with hepatitis C often comment that a period of stress usually leads to a 'flare-up' of symptoms, especially fatigue.
  • In patients with the persistent condition of Hepatitis B, there is a relationship between depression and ALT (alanine aminotransferase) levels that indicate whether you have liver disease or injury.
  • Liver transplant patients suffering from depression, anxiety, and stress-triggered mood swings are more likely to reject the transplanted liver.

How To Know If You Have Elevated Liver Enzymes

Most people with elevated liver enzymes are usually asymptomatic, but the underlying conditions responsible for the high levels of liver enzymes may show themselves in the form of symptoms. Liver damage and other diseases that may be a probable cause show symptoms such as:

  • Abdominal pain or cramps
  • Dark urine
  • Fatigue
  • Itching
  • Jaundice (yellowing of your skin or eyes)
  • Light-colored stools
  • Loss of appetite
  • Nausea
  • Vomiting

Tests For Elevated Liver Enzymes

If you have symptoms of conditions that typically cause liver damage, your doctor will usually order a test for elevated liver enzymes.

Routine blood tests can usually detect a high level of liver enzymes in the blood. This test detects increased levels of AST and ALT, which are enzymes that an inflamed liver releases. Different ratios of AST to ALT may indicate the various underlying causes. If you have increased levels of  AST or ALT, your doctor will conduct further diagnostic testing to determine the underlying condition.

Your healthcare provider may perform a liver function test (LFT) or liver panel to screen for this specific concern to check your liver enzyme levels. A liver function test is a series of tests that evaluate the levels of certain enzymes and other proteins in your blood. Your provider may prescribe regular liver function tests for you if you are at risk or have symptoms of liver damage.

Treatment Options

For most patients with a high level of liver enzymes, the level usually returns to normal after 2 to 4 weeks following the doctor's recommended treatment plan. However, if this is not the case, your doctor may order more blood tests or imaging tests and refer you to a hepatologist specializing in liver diseases.

The treatment for elevated liver enzymes will focus on managing the underlying condition causing the increased levels. Since the underlying cause of liver damage is usually responsive to treatment.

Treatments for the common causes may include:

  • Weight loss
  • Reduction in alcohol consumption
  • Eating a healthful, balanced diet
  • Managing blood sugar and stress levels
  • Increasing intake of fluids
  • Antiviral medication in cases of hepatitis

Cirrhosis, however, is not a curable condition, although treatments such as a modified diet, weight loss, and reduced alcohol consumption can reduce the risk of further liver damage. The prompt diagnosis and treatment of conditions that affect the liver can help prevent cirrhosis.

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Farah Jassawalla

Farah Jassawalla is a graduate of the Lahore School of Economics. She is also a writer, and a healthcare enthusiast, having closely observed case studies while working with Lahore's thriving general physicians at their clinics.