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).
What can Cause Liver Enzymes to be 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.
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.
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.
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. Autoimmune hepatitis is idiopathic in nature, but is supposed to have environmental and genetic predisposition. Patients often have symptoms of weakness, abdominal pain, muscle pain, swelling and loss of appetite.
Medications, such as Tylenol, ibuprofen, aspirin, naproxen, statins, tetracyclines, certain antibiotics and anti-seizure medications can lead to elevation in liver enzymes.
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.
Mononucleosis is a viral disease that is mostly caused by EBV (Epstein – Barr virus), in some cases by CMV (cytomegalovirus), and is usually transmitted by kissing, thus it is also known as “kissing disease”. It presents with symptoms of sore throat (pharyngitis), high fever and lymphadenopathy. Mononucleosis causes liver inflammation thus causing liver enzyme elevation.
Celiac disease is an inflammatory bowel disease and the individuals having it have gluten sensitivity, thus it is also known as gluten sensitive enteropathy or sprue. The cause of this disease is sensitivity of the immune system to gluten rich or gluten containing foods such as wheat, barley, rye and many other foods. Celiac disease could cause diarrhea or constipation, if gluten is consumed. It can lead to intestinal lining damage, which causes malabsorption of nutrients leading to anemia, weakness, weight loss and patients of celiac disease also tend to have elevated liver enzymes.
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 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.
The underlying cause of elevated liver enzymes are determined by additional liver blood tests, physical examination, ultrasound, computed axial tomography, and liver biopsies. Elevated liver enzymes can be normalized by treating the underlying cause and dietary modifications.
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