Liver is the second largest organ in the human body and has over 500 functions. When the liver is not functioning optimally due to various reasons, the signs can be seen with elevated liver enzymes. The most common liver enzymes are alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphate (ALP), lactate dehydrogenase (LDH) and gamma glutamyl transferase (GGT). The normal levels of ALT are 7 to 55 IU per liter, AST in blood are 8 to 48 IU per liter, and ALP in the blood is in the range of 45 to 115 IU per liter, LDH range from 122 to 222 IU per liter, and GGT in blood ranges from 9 to 48 IU per liter.
How Long Do Liver Enzymes Stay Elevated?
Many conditions and diseases can cause liver enzyme elevation. These include alcohol consumption, hepatitis A, hepatitis B, hepatitis C, obesity, non-alcoholic fatty liver disease, liver cirrhosis, heart failure, certain medications (Tylenol, statins), autoimmune hepatitis, alcoholic hepatitis, cytomegalovirus infection, celiac disease, Epstein-Barr virus, hemochromatosis, liver cancer, mononucleosis, thyroid disorder, pancreatitis, polymyositis, sepsis, toxic hepatitis, Wilson’s disease, adrenal insufficiency, alpha 1 antitrypsin deficiency, diabetes, muscle disorders, liver or bile duct tumors. It can also be caused due to excessive herbal supplements such as kava, pennyroyal, comfrey, and skullcap.
Alcohol abuse is the most common cause of liver enzyme elevation leading to liver damage as metabolism of alcohol takes a toll on liver over time. Chronic alcoholism can lead to fatty liver, fibrosis, cirrhosis, liver failure, and even death.
Non-alcoholic fatty liver disease is one of the most common causes of liver enzyme elevation. Fatty liver, not only occurs due to excessive alcohol consumption, but also due to unhealthy lifestyle leading to excess fat deposition in the liver. It is mostly seen in obese people and requires lifestyle modification to reverse the condition.
Viral hepatitis, such as hepatitis A, hepatitis B or hepatitis C can all lead to liver enzyme elevation. All these viral infections can cause liver inflammation causing symptoms of weakness, abdominal pain, nausea and vomiting, and jaundice. Hepatitis can often go undetected for years.
Autoimmune hepatitis is a condition in which body’s own immune system attacks the liver cells. This could lead to liver inflammation, thus causing liver enzyme elevation. Patients often have symptoms of weakness, abdominal pain, muscle pain, swelling, and loss of appetite.
Wilson disease is a rare genetic disorder that causes excessive accumulation of copper in liver and brain. Excess copper leads to damage of these organs and liver enzyme elevation. It presents with symptoms of weakness, vomiting, itchiness, jaundice and swelling of legs and abdomen.
Liver cirrhosis is the damage to liver due to excessive fibrosis/scarring of the liver, which leads to its malfunctioning. It can ultimately lead to liver failure and death. Liver enzymes are also elevated in liver cirrhosis.
Liver cancer can also cause elevated liver enzymes. The most common primary liver cancer is hepatocellular carcinoma, but most of the cancers of liver are secondary due to metastasis as all the blood passes through liver.
Medications, such as Tylenol, ibuprofen, aspirin, naproxen, statins, tetracyclines, certain antibiotics and anti-seizure medications can lead to elevation in liver enzymes. Therefore, the increases in liver enzymes are secondary to liver injury/damage. The period for which liver enzyme remains elevated depends on the cause, persistence of cause, and extent of liver damage. Mild liver enzyme elevation does not signify permanent damage to liver or any serious liver disease. It is imperative to limit the exposure of the irritant and to make lifestyle modification for liver enzymes to get back to normal. Even with lifestyle modification and zero exposure of the irritant, it might take up to 6 months to one year for liver enzymes to be completely normal. The liver enzymes during recovery phase may also be temporarily more elevated due to repair process before getting back to normal. If the irritant is not removed and liver damage continues with no management and lifestyle changes, then liver damage will be permanent causing liver cirrhosis that will lead to liver failure and finally death.
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