What are the Symptoms of Elevated Liver Enzymes?
Alterations of the liver profile are one of the most frequently observed anomalies, both in patients who are assisted in the hospital setting, as in primary care consultations. In the latter case, it is very frequent that alterations of the liver profile constitute a casual finding in an asymptomatic patient or that one consults for banal or nonspecific symptoms, being able to be detected up to approximately in 8 to 10% of the routine analyzes performed. In the hospital setting, the liver function abnormalities usually have different connotations and often appear in the context of well-defined clinical conditions. Discerning the origin of abnormalities of “liver function” force doctors to focus on three important keys:
- The magnitude of the alteration.
- The duration of the problem.
- The clinical context in which they appear.
According to most authors, the latter is of paramount importance given that the elevation of transaminases in the serum constitutes a nonspecific event typical of numerous clinical conditions. It is important, therefore, to record the circumstances that accompany its discovery.
An example that illustrates the importance of these three keys is that of a patient who stays in an intensive care unit and who has a state of cardiocirculatory collapse that leads to a state of hypoxia and acute hepatocellular necrosis. In a situation of this type there is a very marked elevation of aminotransferase activity (> 40-50 times the upper range of normality) that tends to return to normal in a short interval of time. The magnitude of the elevation of transaminases, their duration (2 to 3 days) and the circumstances in which the disorder appears (shock) make it possible to orient the etiology of the problem towards ischemic hepatitis.
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are enzymes found in hepatocytes. They are sensitive markers of liver injury, but only ALT is specific (AST is also in cardiac and skeletal muscle, kidney, brain, pancreas, lungs, leukocytes and red blood cells).
There is no correlation between the transaminase levels and the degree of liver injury. Their plasma levels under normal conditions are between 30 and 40 IU / L, and can be elevated in a large number of diseases of both the liver and other organs.
The simultaneous presence of fever, elevation of transaminases can occur basically in two situations. They may be signs of primary liver or biliary tract diseases or fever of other origin, of infectious or non-infectious origin, this elevation being a sign of involvement of the liver by the disease causing the fever. Now there may be elevated transaminases in the absence of liver injury, usually in muscle diseases.
Most frequent causes of fever and acute elevation of transaminases:
- Hepatitis A, B, D and E
- Ebstein-Barr virus
- Herpes type I and II, coxsackie B, varicella-zoster, adenovirus, measles and rubella
Bacterial and Systemic Diseases
Severe systemic infections: pneumonia, pyelonephritis, peritonitis, appendicitis and other extrahepatic infections
- Lyme’s disease
- Drugs: Halothane, sulfonamides, clozapine, anticonvulsants such as phenytoin or lamotrigine, quinolones.
- Other toxic:
- Alcoholic hepatitis
- Neoplastic diseases:
- Hodgkin’s disease
- Non-Hodgkin lymphomas
- Acute cholecystitis. Cholangitis
A doctor observes signs of a disease process. Signs that accompany elevated liver enzymes depend on the disease, but it may include jaundice (a yellow discoloration of the skin and whites of eyes), dark urine, clay-colored stools, and accumulation of fluid in the abdomen called ascites, intestinal hemorrhage, low-grade fever or weight loss. The liver and spleen may feel larger than normal.
In cases of acute liver disease with elevated liver enzymes, symptoms may include fatigue, nausea, vomiting, right upper quadrant abdominal pain and tenderness, mental changes or itching.
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