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Liver enzymes elevated, what do they mean? – Hepatitis

Hepatitis is the liver’s inflammation. It has many possible causes, including infections, alcohol, drugs, toxins, and metabolic diseases.

In this article, there will be an exhaustive review through some of the most commonly asked questions like “What does the term liver enzymes elevated means?” Answered by a Doctor. Nonetheless, there will be an introduction to the topic. So, you can be able to fully comprehend and take advantage of the information within this article.

By reading this, you will acquire critical insights about Hepatitis as liver disease. It includes the symptoms and further complications if not treated. Therefore, we kindly invite you to keep reading this full article.

What are the essential functions of the liver?

The liver is one of the most critical organs within the human body. Its location is in the right upper quadrant of the abdominal cavity and below the trunk; it has several primary functions, which includes:

  • Detoxification of various metabolites from the body.
  • The synthesis of essential proteins.
  • The production of digestive enzymes.
  • Regulation of red blood cells.
  • It has a unique role in metabolism, acting as a deposit for glucose (blood sugar) asides from the synthesis of the same.

Therefore, to put all these terms in simple words, the primary liver function is to act as the main filter of the body. Fundamentally, by taking a vast amount of the blood flow from the digestive tract before passing it to the rest of the body.

To understand all the functions that the liver has, we are going to dig a little deeper within it. The liver cell’s name is “Hepatocyte.” It has a unique configuration that makes possible the accomplishment of the liver functions.

The liver cells have little bile canaliculi that receive all the bile acids synthesized within the cell. All of these canaliculi disembogue into the bile ducts. Eventually, the final destination is the gallbladder, with the deposit of bile acid, and salts of the body.

The bile drains directly into the small bowel, and it will help in the emulsion of big fatty particles from the foods. This process is essential for fats absorption in the gastrointestinal tract, specifically in the final portion. Also, it works as a way of excreting from the body the excessive amount of cholesterol and something called “bilirubin,” a final product of red blood cell degradation.

Which liver enzymes do we see in a liver blood test?

Importantly, the evaluation of the liver enzyme levels will orient the physicians in further diagnosis. In order to make an initial screening of the liver function, it is essential to do a liver blood test in which it is possible to see some of the following substances.

  • Alkaline Phosphatase (ALP)
  • Alanine Aminotransferase (ALT)
  • Aspartate Aminotransferase (AST)
  • Conjugated Bilirubin

Each one of the following has a specific value for a diagnosis, for example, an alteration of the Alkaline Phosphatase and the Conjugated Bilirubin may suggest an obstruction of the bile ducts. A change of the Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) levels may be because of liver disease and direct affection of the liver tissue.

Furthermore, even though these are tests that may guide the physician and the patient about the actual disease. In order to make an assertive diagnosis, the physician will run a full examination and a complete interrogation about the patient’s symptoms.

What are the blood tests to detect liver function?

In order to detect the liver function, it is necessary to run specific blood tests in which the physician can screen for liver infections or liver dysfunction. It also monitors the progression of a disease, determines how successful the treatment is, measure the severity of a disease, and monitor its possible side effects of medications.

The physician will specifically ask for the following tests to perform a complete screening on the liver asides from the imaging studies:

  • Alkaline Phosphatase (ALP) – 40 to 129 units per liter (U/L)
  • Alanine Aminotransferase (ALT) – 7 to 55 U/L
  • Aspartate Aminotransferase (AST) – 8 to 48 U/L
  • Albumin 3.5 to 5.0 grams per deciliter (g/dL)
  • Total Protein – 6.3 to 7.9 g/dL
  • Bilirubin – 0.1 to 1.2 milligrams per deciliter (mg/dL)
  • Gamma-glutamyltransferase (GGT) – 8 to 61 U/L
  • L-lactate Dehydrogenase (LD) – 122 to 222 U/L
  • Prothrombin Time (PT) – 9.4 to 12.5 seconds

These are the typical results for adult males, though it might be slightly different for women and children. Furthermore, these will give the physician a broader vision of the disease and its possible cause.

Do AST and ALT tests results indicate liver function?

Yes, both of them are transaminases and are indicatives of the liver function. However, they can also exist in other places within the body. Each one will have different importance in liver disease mainly due to its location.

The Aspartate Aminotransferase (AST) is a transaminase that is in the liver. Still, it exists in the heart, muscle, kidneys, brain, and pancreas, lungs, white and red blood cells. This is an essential factor within the diagnosis due to the multiple tissues where it can come from, making it a non-specific test for liver function. Abnormal levels of liver enzyme elevation, predominantly AST over ALT, may be due to Alcohol-related disease, chronic liver diseases, or non-hepatic diseases like thyroid diseases, myopathy, or extreme exercise.

On the other hand, there is the Alanine Aminotransferase (ALT). This transaminase exists only in deficient concentrations in other tissues. Therefore, it is primarily in the liver, making it a specific transaminase test for liver diseases. If abnormal levels of ALT are above AST, there are various causes like acute or chronic viral hepatitis, ischemic hepatitis, and autoimmune hepatitis, amongst others.

What causes a spike in liver enzymes?

In the initial screening of the patient, the physician will run a series of tests, including the liver enzymes and protein evaluation. Hence, if it shows an abnormal liver blood test, which can be the cause? Numerous clinical entities may alter the liver enzymes and may lead the doctor towards a specific liver disease. Still, remember, not all of them are from the liver.

The most common and not so common causes for an abnormal liver blood test are the following conditions:

  • Viral Hepatitis (Which includes Hepatitis A, Hepatitis B, and Hepatitis C)
  • Alcoholic Liver Disease
  • Drug-Induced Hepatotoxicity
  • Hepatobiliary Disease
  • Fatty Liver
  • Non-Alcoholic Fatty Liver Disease
  • Liver Cancer
  • Autoimmune Hepatitis

Non-Alcoholic Fatty Liver Disease

Although there are limitations in understanding why some people store fats in the liver while others do not, there is a correlation between Metabolic Syndrome and non-alcoholic fatty liver disease. Metabolic syndrome includes risk factors like:

These factors promote the deposit of fats in the liver cells, and it can act as a toxin causing liver inflammation. Its incidence is rapidly growing as it has become the most common cause of liver disease in developed countries. In 2019, 9 of 10 people with risk factors for metabolic syndrome develop non-alcoholic fatty liver disease.

Alcoholic Liver Disease

Associated with an abusive rate of alcohol intake, the alcoholic liver disease has a high prevalence within the worldwide population. Alcohol abuse leads to damage in liver cells and later, liver fibrosis. The real trouble is that it may remain undiagnosed and completely asymptomatic during an extended period.

Viral Hepatitis

Most of the time, the liver inflammation or Hepatitis is the result of infection from Hepatitis Virus. Whether it can be the Hepatitis Virus A, B, C, D, E, or G we will study subtypes A, B, and C as they represent 90% of the acute viral hepatitis cases.

Viral hepatitis infects millions of people annually. These infections can turn from acute to chronic liver diseases leading to chronic liver disease and liver cancer, which are potentially fatal. 

Hepatitis A

It has an incubation period of four weeks, which means that it could take that time from the infection to show symptoms. The countries with access to clean water and a higher socioeconomic level have lower cases of Hepatitis A infections. Therefore, it is usual that people traveling from these countries to others with poor water hygiene can return with the virus.

Most of the time, the patient will not develop symptoms, or they could be mild. However, acute infections can be very severe in children, although they do not result in cases of chronic hepatitis. These are the unusual severe cases (1%) in which Hepatitis A infections can lead to a fulminant hepatic failure. It is, indeed, a life-threatening situation.

Hepatitis B

It is a viral infection with an incubation period of twelve weeks, about one-third of the world’s population has had this infection. After acute infection resolves, patients develop immunizers (antibodies) against the Hepatitis B Virus and end up recovering fully. However, around 5%, approximately 350-400 million people have lifelong chronic infection, leading to further complications.

Hepatitis C 

It is the most common cause of parenteral hepatitis worldwide, and it has an eight week incubation period. Most of the cases of acute hepatitis C are asymptomatic. Nonetheless, this is a condition that causes liver damage at a plodding pace. More than half of these patients develop a chronic infection, which can be deadly.

What are the less common causes of abnormal liver enzymes?

For the less common causes of abnormal liver enzymes within a liver blood test, there is a wide variety of conditions that may not include liver diseases, some of them are due to hormones, bones, or blood diseases. These enzymes are within the liver and in other parts of the body. When a condition afflicts these specific systems, it may carry an elevation of the enzymes.

This is a list of diseases in which we will briefly dwell. They are not common enough as the last, and they are not the first option in diagnosis. Still, all of them as well carry elevated transaminases in their initial screening.

Autoimmune Hepatitis 

Autoimmune Hepatitis is a condition whose cause remains unknown. Factors like environmental agents, drugs, or viral infections like hepatitis viruses may trigger the autoimmune response; many of these patients have a family history of other autoimmune disorders. This condition may present as acute or chronic hepatitis with liver cells inflammation and its further death, leading to liver fibrosis.

Hemochromatosis

Hemochromatosis is the most common cause of the severe iron overload. In this specific condition, the iron accumulates in the organ tissues leading to toxicity. The most common presentation includes enlargement of the liver due to inflammation, skin pigmentation because of the iron deposits, and joint pain (arthritis).

Wilson Disease

Wilson Disease is a rare inherited disorder of copper metabolism. The copper in the body comes from the gastrointestinal tract, and it is transported to the liver cells, it deposits itself within them because a damage in the excretion system, leading to toxicity of the cells. There are different presentations of the disease as chronic active hepatitis, cirrhosis, or fulminant liver failure.

Is 150 high for liver enzymes?

Yes, it is a high value, but it depends on the enzyme. However, for all of the enzymes, 150 is an abnormal test result, with the sole exception of the L-lactate dehydrogenase. L-lactate dehydrogenase is not a specific liver enzyme. It is an enzyme which values rise if there is cell damage in the body. Nonetheless, 150 for the others is a result that denotes that there is a pathologic process underlying it should be carefully treated.

Liver diseases manage variable levels of transaminases. For example, the Alcoholic Liver Disease liver enzyme levels can go from a normal liver test to an elevation of 10 times its average value, especially the Aspartate Transaminase (AST).

In acute hepatitis, due to a viral infection, there are variable elevations of the transaminases, they can go from less than five times its average value to 15 times. The higher the value, the more severe is the condition, and more liver tissue is damaged. It is its way to say, “Hey, something’s happening to me.”

Moreover, in chronic hepatitis, there is substantial liver damage, though the levels of the transaminases may be normal in some patients. The single case which is almost certain its diagnosis is the liver infarction whose transaminases levels are over 3000.

What are the symptoms of abnormal levels of liver enzymes?

It depends on the specific condition and its clinical presentation. There are diseases like Hepatitis A that may go through a benign course and be asymptomatic with an abnormal liver test. There are conditions as well, like autoimmune hepatitis or fatty liver disease, with continuous liver damage that reflects on the patient’s condition and leads to chronic liver disease.

Now here is a list that includes the most common symptoms if there are abnormal liver enzymes.

  • Jaundice: It is the yellowish or greenish coloration of the skin and the whites of the eyes. There is an elevation of conjugated bilirubin or unconjugated bilirubin because the elimination is slow, and it gets into the bloodstream. It is seen in many liver diseases as Hepatitis C or biliary obstruction.
  • Itchiness: Due to jaundice and the deposit of bilirubin in the skin.
  • Abdominal Pain: The liver inflammation due to an infection or another condition produces a painful enlargement of the liver.
  • Fever
  • Fatigue
  • Malaise
  • Nausea
  • Anorexia

Bear in mind that these symptoms are non-specific for a condition. The physician would need to practice more tests on the patient to know the cause. Therefore, if you experience any of these symptoms, you should visit your nearest medical center.

What medications are hard on the liver?

Approximately over 600 drugs and chemicals are associated with a significant liver injury, but why is this happening? The liver has a crucial part in the metabolism and the things that go into our blood flow. Therefore, the metabolization of the drugs takes place in the liver. Still, there are drugs whose chemical components are just too hard on the liver cells, or there is simply an overdose. Overdose causes an override of the liver cell enzymatic system, causing the drug to remain on the bloodstream longer than it should be leading to a liver injury.

Here is a list of some medications that are hard on the liver and can produce liver damage.

  • Carbamazepine
  • Methyldopa
  • Minocycline
  • Macrolide antibiotics (Azithromycin, clarithromycin, erythromycin)
  • Nitrofurantoin
  • Statins
  • Sulfonamides
  • Chlorpromazine
  • Methotrexate
  • Medicinal Herbs

There is a notable mention in this list, which is Acetaminophen. Even though it is a widespread medication with analgesic properties, it can be hepatotoxic if consumed in high doses, causing a serious liver injury that may lead to death if it doesn’t receive medical attention.

Drug-Induced Liver Injury

It is a condition related to medications, and it refers to a liver injury caused by the toxicity of the cells due to them. There are approximately 2000 cases annually in the United States of acute liver failure. Drugs account for more than 50% of the cases in which around 40% are due to acetaminophen.

Its mechanism is not widely known. The liver metabolizes these drugs generating products for its further excretion. These are the ones that initiate the liver damage as they can bind to some components within the liver cell leading to liver injury, and if not treated on time, acute liver failure, and death. It is essential that if any medication that you are taking causes you abnormal symptoms, suspend them immediately, and consult your doctor.

Can liver enzymes be temporarily elevated?

Yes, there is a chance that exercise elevates them temporarily. Remember that liver enzymes can not only be found in the liver but other tissues, especially the muscles. Therefore, exercise is a stressful activity for the muscle to damage the cells, and an inflammation process begins. 

There are studies in which subjects do exercise in moderate-intensity, specifically weightlifting. Therefore a liver function test was run on the subjects. They had elevated liver enzymes, specifically ALT and AST, but less than three times the average value. They were healthy subjects without any other conditions.

So, if you are an active person who regularly exercises, has a healthy diet, and doesn’t consume any medications, don’t stress over slightly abnormal liver test results. It may be due to this transitory elevation of enzymes. However, it will depend on your medical background and how much the enzyme elevation is. Undoubtedly, your physician will keep an eye on you, and you will have to repeat these tests just to be sure that you are not sick.

How long do liver enzymes stay elevated?

It depends, as multiple causes can elevate liver enzymes, nobody can tell you with exact certainty how many days they will last. Some conditions may be acute or chronic, and the exercise represents a transitory rise in the enzymes. Therefore, it will depend on the cause.

However, it is assumed that the duration of the elevation of the liver enzymes is a reflection of clinical significance. While this may be true for some acute liver diseases, it is not strictly the case of chronic illnesses like Hepatitis C and Non-Alcoholic Fatty Liver Disease. Bear in mind that normal liver blood tests do not imply that you are not sick anymore if you have a chronic disease. 

If the patient is asymptomatic in a three weeks lapse, these tests may return to normality, but it should be treated carefully. However, if the patient is symptomatic, some studies demonstrate that after one month, the tests are still abnormal. So it depends on the treatment, the extension of the damage, and its further care. Moreover, if we are talking about exercise, these tests should be normal again in a lapse of 10 days.

What foods can cause elevated liver enzymes?

The food intake and the food that we choose to eat will play a significant role in our health, especially for the liver. Metabolic Syndrome is a rising concern for public health in every country of the world. Furthermore, a sedentary lifestyle and eating junk or processed foods are major risk factors.

Nevertheless, how does this condition correlate to elevated liver enzymes? The high levels of cholesterol in the blood cannot be excreted, and when this happens, the cholesterol may act as a toxin causing liver injury. If there are no lifestyle changes, it may lead to a Non-Alcoholic Fatty Liver Disease.

So which foods should you really avoid to have a healthy liver? The following list may help you:

  • Junk Food or Fast Food high in fat (Hamburgers, French fries, Pizza, Pasta, etc.)
  • Soda.
  • Alcohol.
  • Sugar.
  • Pastries (Cookies, cakes, ice cream, etc.)
  • Processed Foods.

Can the liver repair itself?

Yes, the liver is a unique organ with a special way to regenerate itself from an injury and keeping the liver function. With an astonishing amount of blood running through it every day and a particular set of cells, the liver, to maintain its functions will activate unique mechanisms to keep the balance within the body.

The liver has the ability to repair itself after the removal of a part of the liver or an infection. After the liver injury, the organism activates a mechanism that is “asleep” under normal circumstances called mitosis, which is basically the replication of the cell.

After this happens, the liver can regenerate itself to its full size, but only the mass, as it does not recover the original shape.

However, if the damage is continuous and incisive, the regeneration mechanism will be “exhausted” and damaged. It won’t have all that it needs to make replicas of the primary cells; instead, it will create a scar (liver fibrosis), which produces more liver damage by inducing rearrangement of the blood circulation within the liver leading to chronic liver injury.

Does everyone with elevated liver enzymes need a liver biopsy?

No, although the liver biopsy is an excellent tool that enables the physician to see what is happening directly in the cells, it is not the first choice. Due to its invasive nature, the physician should perform all of the other non-invasive tests first, like the evaluation of transaminases. However, if the cause of the condition remains unknown, the physician will perform a biopsy.

The biopsy should be considered in patients whom the diagnosis is in question, and when the exact diagnosis is very likely to alter the management of the disease. However, before this test, patients receive education about their condition and the procedure itself, including alternatives, risks, benefits, and limitations.

The physician usually performs this test when the patient is hospitalized due to its possible complications like internal bleeding or perforation. It is useful in patients with atypical clinical features, allowing the physician to distinguish between diseases and staging chronic hepatitis due to Hepatitis B or C.

What tests and procedures diagnose the cause of abnormal levels of liver enzymes?

There is a wide variety of tests and procedures that may help diagnose the cause of abnormal levels of liver enzymes. It goes from blood tests to take a portion of the liver and study the tissue and the extension of hepatocellular injury. Of course, a physician may not need all of these tests to diagnose; the first and most important procedure is a good clinical history, family history of diseases, and a complete physical examination. However, here is a list of the most common tests.

  • Liver Function Test (Includes transaminases, bilirubin level, alkaline phosphatase, L-lactate dehydrogenase)
  • Blood test (Hemoglobin, red blood cells count, white blood cells count, platelets, blood sugar, amongst others)
  • Abdominal Ultrasonography (Emphasis in the liver)
  • Liver biopsy
  • Computerized tomography
  • Surface antibodies and antigens (Specific for Hepatitis B that indicates if the patient has protection through vaccination or if the patient is currently infected)

All of these tests, with the correct use, will give the physician a complete insight into the disease. This enables the doctor to perform an assertive diagnosis, choose the specific treatment for the condition, and avoid any complications.

How can you reduce liver inflammation?

It is possible to reduce liver inflammation, and there are a couple of things you can do. The most effective way aside from pharmacological treatment is the change of lifestyle to have a healthy liver.

Dietary changes are the first to be taken into consideration; the diet should be based on the food pyramid; here are some products you should include:

  • Low sugar or sugar-free foods
  • Complex carbohydrates in the form of low-processed cereal products, like oatmeal, brown rice, beans, quinoa, and whole-grain bread.
  • Vegetables
  • Food that is rich in antioxidants like broccoli, pecans, spinach, berries, and artichoke.
  • Protein-rich products

Also, avoiding alcohol, drugs, and processed products with a high content of fat or sugar will reduce the inflammation. Therefore, in order to help the liver, the exercise provides the fat loss and helps the liver in its recovery process.

Are you having symptoms of hepatitis?

This tool is a hepatitis symptoms checker. It will help you to assess how likely it is for you to have either of these conditions. To use the tool is free, and it would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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