What Happens when your Liver Enzymes are High?
The most common causes of hypertransaminasemia have been mentioned here. Once these possibilities were explored, the detection of other infrequent hepatocellular diseases or other unsuspected sources of transaminase elevation must be considered. The consequences of having altered liver enzymes depend on the disease that causes a lot of damage if not treated.
Alcoholic Liver Disease
Alcohol abuse is one of the most frequent causes of asymptomatic elevation of transaminases. The doctor must be aware of this etiological possibility and consider that patients often deny this extreme.
Although, the isolated elevation of GGT is a fact that has little specificity, its elevation twice over the upper range of normality in a patient with an AST/ALT ratio> 2 strongly suggest the diagnosis of alcoholic liver disease.
Finally, the patients with hepatic lesions induced by alcohol often have a concomitant infection with HCV or HBV.
The list of drugs capable of causing hepatocellular injury is very broad. Some of them are very common in the field of primary health care, including NSAIDs, tuberculostats, some antibiotics, and antiepileptic drugs.
Establishing a cause-effect relationship between taking a drug and the onset of hepatocellular injury may not be easy, particularly when the sick person takes multiple drugs, ingests alcohol continuously or presents other systemic pathologies that can alter liver tests.
In general, the relationship is most likely established when three conditions are met:
- There is evidence that the patient did not have biochemical abnormalities prior to taking the drug.
- There is clear evidence that the liver tests have been altered immediately (or sometime after) of the ingestion of the medication.
- The abnormalities disappear or improve in a significant way after the withdrawal of the drug.
Frequently, the clinician faces the dilemma of whether or not to continue with a treatment that he considers essential for his patient. In a situation of this type, the risk/benefit of the treatment must be balanced, evaluating, as far as possible, the magnitude and possible progression of the hepatocellular damage.
Hepatitis B and C
Hepatitis B and C viruses are a frequent cause of elevated transaminases. Attributing the cause of a hypertransaminasemia to a chronic infection with HBV implies a broad knowledge of the meaning of viral markers. Special mention requires the following considerations:
- The presence of anti-HBs and/or anti-HBc with negative HBsAg implies a past infection and a state of permanent immunity. It should be searched another cause that explains the elevation of transaminases.
- The presence of HBsAg and antiHBc in the serum reflects the presence of a chronic infection with HBV. In this case it is necessary to determine HBeAg, antiHBe and DNA-HBV to guide the specific situation of a specific patient.
Hepatitis C represents a problem of the first magnitude worldwide. It is estimated that around 3% of the population is chronically infected with HCV. Hence this etiology can be considered in any patient with a sustained or fluctuating elevation of transaminases.
Although, the probability of infection increases in patients with a history of hemotransfusion, dialysis or drug addiction, the risk of infection should not be underestimated through inapparent or unsuspected percutaneous punctures. Nosocomial transmission through contact with non-disposable medical-surgical material is a clear fact at the present time.
Early diagnosis of this disease is important, given that currently it can be used effectively to eradicate the infection in many patients.
Steatosis and non-alcoholic steatohepatitis (NASH)
They have become the third cause of chronic and moderate elevation of transaminases in the Western world. Both entities can elevate the aminotransferase activity, generally in a range lower than four times the upper limit of normality and they affect more frequently in populations that exhibit some risk factors, among them the female sex, diabetes mellitus and obesity.
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