Digestion

Elevated Liver Enzymes

Elevated liver enzymes

are a clinical condition which demands immediate attention. It could indicate liver related problems. Deaths due to chronic liver diseases and cirrhosis rank 12th in the list of killer diseases. The following are the liver enzymes (natural substances which play an important role in deciding the rate of chemical reactions inside the body) which are generally tested to aid in the diagnosis of any liver disease.

  • AST/SGOT-Serum Glutamic-Oxalocetic Transaminase
  • ALT/SGPT-Serum Glutamic-Pyruvic Transaminase
  • AP-Alkaline Phosphatase
  • GGT-Gamma-Glutamyl Transpeptidase
  • LDH-Lactic Acid Dehydrogenase

Of the above enzymes the first two are known as

Transaminases a

nd the next two are together called the

cholestatic liver enzymes.

Normal Laboratory Reference Range

  • AST/SGOT- 0-40 IU/L (IU/L stands for international units per liter)
  • ALT/SGPT-0-45 IU/L
  • AP-35-115IU/L
  • GGT-3-60 IU/L
  • LDH-45-90 IU/L

Causes of Elevated Liver Enzymes

Presence of high Transaminases (ALT and AST) in the blood stream could indicate damage or injury in the cells of the liver. AST is also found in the heart, pancreas, kidney and muscles. So a high AST could also result from strenuous physical activity and not be due to liver damage definitively.

High levels of ALT does point to liver damage as it is primarily found in the liver but the extent of damage can never be gauged from high numbers. The ALT to AST ratio is also an important earmark. High ALT is more a precursor to liver damage than AST.
However, the exception to this rule occurs when we are dealing with alcoholic liver damages such as cirrhosis of liver. In that case, AST levels are always higher.

Other possible causes of higher transaminases could be:

  • Heart failure
  • Renal (kidney) failure
  • Jaundice
  • Fatty Liver
  • Higher triglycerides
  • Medications like statins, NSAIDs (Non Steroid Anti Inflammatory Drug) or acetaminophen.
  • Pancreatitis
  • Muscular dystrophy
  • Wilson’s disease
  • Gall Bladder Inflammation
  • Congenital ( Birth) Liver Defects
  • Reaction to herbal supplements

Higher levels of AP and GGT or the cholestatic liver enzymes could be caused by the following reasons:

  • Bile duct blockage or damage
  • Alcoholism
  • Liver cancers and cirrhosis
  • Possible reaction to certain drugs like painkillers and steroids
  • Gall bladder removal
  • Fatty liver disease

Higher levels of LDH primarily indicate tissue damage. It is found in the skeletal muscle of the heart, liver and kidneys. Any trauma to these organs or the muscles can bring forth an elevation of the LDH levels in the blood stream. The above condition could be caused by the following reasons:

  • Myocardial infraction (Heart Attack)
  • Presence of cancer cells in the body
  • Empyema- Presence of fluids in the cavity of the lungs due to infection.
  • Meningitis caused by viral infections.
  • Encephalitis

Many a time

Elevated liver enzymes

can be without any symptoms. However, in most cases detailed investigations are needed to confirm the diagnosis.

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