The liver is the second largest organ in the body. It has more than 500 different jobs. The liver regulates your body’s chemical levels and flushes toxins out of the blood. It also produces cholesterol and certain proteins for blood plasma. The liver supports many of the other organs in the body as well. So what happens when the cells of the liver are damaged or inflamed? Certain chemicals, including liver enzymes alanine transaminase (ALT) and aspartate transaminase (AST), may leak into the bloodstream. When this occurs, it raises red flags on a routine blood test. There are many different reasons elevated liver enzymes may show up on your blood test.
Nonalcoholic Fatty Liver Disease (NAFLD).
Nonalcoholic Fatty Liver Disease is the most common cause of elevated levels of ALT and AST in the blood. NAFLD affects people who do not consume a lot of alcohol. It is marked by too much fat stored in liver cells. Only 5 to 10 percent of a healthy liver consists of fat. A liver with higher fat content is considered a fatty liver (steatosis). Currently, NAFLD affects 25 to 30 percent of the population in the Americas. In severe cases, NAFLD can cause the liver to swell (steatohepatitis). This can lead to scarring (cirrhosis), raising the risk of liver cancer or liver failure. Increased risk factors for fatty liver include obesity, rapid weight loss, and Type 2 diabetes.
Prescription and Over-the-Counter Medications
Many prescription and over-the-counter medications can overload the liver, resulting in elevated liver enzymes. Acute liver failure due to medication-associated liver injury is common. If your doctor refuses to renew a prescription, this could be the reason.
Prolonged Alcohol Abuse
Over time, regular consumption of alcohol can result in liver damage. The chemicals contained in alcohol are difficult for the liver to break down. This can lead to fatty liver, alcoholic liver disease, or even alcoholic hepatitis. Fatty liver is usually reversible with abstinence from drinking alcohol. Alcoholic hepatitis is an inflammation of the liver due to heavy drinking. Those diagnosed with alcoholic hepatitis must stop drinking alcohol immediately, as the liver no longer functions properly. Those who continue to drink after this diagnosis risk liver failure and death.
Those affected with hepatitis A (HAV), hepatitis B (HBV), or hepatitis C (HCV) usually have elevated liver enzymes. A person with a case of acute hepatitis has very high liver enzymes over a short period. Those with chronic hepatitis have mildly raised liver enzymes over many years. Viral hepatitis, which causes liver inflammation, can be acute or chronic. Acute hepatitis is easier to diagnose. It usually has symptoms such as fatigue, abdominal pain, darkening of the urine, and jaundice. Chronic hepatitis due to HBV or HCV can go undiagnosed for years. Its only symptoms may be non-specific ones such as chronic fatigue.
Autoimmune hepatitis is a disease in which the body’s immune system attacks the liver cells. This causes the liver to become inflamed and elevates liver enzymes in the blood. Causes of this disease are unknown, but appear to be genetic and environmental. Autoimmune hepatitis can be acute or chronic. Sometimes it leads to cirrhosis and even liver failure and death. Symptoms include fatigue, abdominal discomfort, anorexia, myalgia, and edema.
Mononucleosis, also called mono, the “kissing disease,” and glandular fever, is most often caused by the Epstein-Barr Virus (EBV). In a minority of the cases, the cytomegalovirus (CMV) is the cause. In childhood, the disease may cause few to no symptoms. When the disease infects adults, it can result in fever, sore throat, enlarged lymph nodes, and fatigue. Diagnosis can be confirmed with a blood test. In many cases of mono, the liver and spleen become swollen as well. Any time the liver is enlarged or inflamed, liver enzyme levels increase. Mononucleosis usually resolves in three to six weeks, with fatigue sometimes lasting longer.
In celiac disease, the consumption of gluten triggers the immune system to attack the small intestine. When not managed properly, this can lead to long-term damage to the small intestine. The damage affects nutrient absorption and can cause a whole host of symptoms. These symptoms can include diarrhea, fatigue, weight loss, bloating, and anemia. Celiac disease patients often experience elevated liver enzyme levels. However, they typically resolve when a patient steers clear of gluten for an extended period.
Wilson’s disease is a genetic disease caused by a mutation. This rare disorder causes too much copper to accumulate in the liver and brain. Excess copper in the liver causes damage, resulting in elevated liver enzymes. Diagnosis for this rare condition is often difficult. Symptoms typically first occur in adolescence. They include vomiting, fatigue, fluid buildup in the abdomen and legs, jaundice, itchiness, and swelling in the legs. When the body cannot properly rid itself of excess copper, it can accumulate to dangerous levels and become life-threatening. Once the condition is diagnosed, it can be treated and managed through lifestyle changes. These include simple practices such as refraining from eating foods high in copper.
Pancreatitis, which is inflammation of the pancreas, can be acute or chronic. The most common cause of acute pancreatitis is gallstones, which also cause an increase in liver enzymes. Symptoms of acute pancreatitis may include nausea, vomiting, and pain in the upper abdomen. Causes of pancreatitis include heavy alcohol use, direct trauma, and certain medications. In addition infections such as the mumps, and tumors can bring it on.
Liver cancer, also known as hepatic cancer, begins in the cells of the liver. The most common type of liver cancer is hepatocellular carcinoma, which begins in the hepatocytes. Usually, liver cancer begins in another part of the body and becomes metastatic, spreading to the liver. The leading cause of liver cancer is cirrhosis from previous liver damage. Preventative measures include immunizations against HBV and treatment for those affected with HBV and HCV. Diagnostic tests for liver cancer include liver function tests that measure liver enzyme levels. Abnormally elevated liver enzymes raise a red flag and indicate the need for further testing.