Types of Liver Problems & Their Causes

Written by Steven Brown

• Infections
• Immune System Problems
• Cancer and Tumors
• Conditions You Inherit
• Other Causes of Liver Disease

Your liver does a lot of things that keep you healthy. It turns nutrients into chemicals your body needs. It filters out poisons. It helps turn food into energy. So when your liver doesn’t work well, that can affect your whole body.

Different things can cause serious liver conditions. You’ll want to know about the top causes.

Sometimes, the problem is that you have an infection that inflames your liver. Viral hepatitis is the most common cause, including:

• Hepatitis A. Most people get it by eating or drinking something that’s tainted by fecal matter. You might not have any symptoms. It usually goes away by itself within 6 months without any long-term harm.
• Hepatitis B. You get it from somebody else, such as through unprotected sex or taking drugs with shared needles. If it lasts longer than 6 months, it makes you more likely to get liver cancer or other diseases.
• Hepatitis C comes from infected blood that gets into your blood. You might get it if you take drugs with shared needles or in connection with HIV. If you’re a health-care worker, you might get it from an infected needle that accidentally sticks you. Symptoms may not show up for many years. For reasons that aren’t quite clear, baby boomers are at risk for hepatitis C and should be tested for it.

Your immune system fights off invaders including bacteria and viruses. But it might go wrong and attack one or more parts of your body, such as your liver.

• Autoimmune hepatitis inflames your liver. It can lead to other disorders and even liver failure. It strikes girls and women more often than boys or men.
• Primary biliary cholangitis attacks tiny tubes in your liver called bile ducts. They carry bile, a chemical that helps you digest food. When the ducts are injured, the bile backs up inside your liver and scars it. Women come down with this more often than men.
• Primary sclerosing cholangitis scars your bile ducts, and it can eventually block them. The bile builds up inside your liver, and that makes it harder for your liver to work. It may lead to liver cancer, and you might someday need a liver transplant. Men are more likely than women to get it.

If cancer shows up in your liver, that’s most likely because it has spread from another part of your body, like your lungs, colon, or breasts. But a few cancers can start in the liver.

• Liver cancer affects women more often than men, and African-Americans more often than whites. Your doctor might call it hepatocellular carcinoma. It’s more likely if you have hepatitis or drink too much.
• Bile duct cancer strikes the tubes that run from your liver to your small intestine to carry bile, a fluid that helps you digest food. This kind of cancer mainly affects people over age 50, but it’s uncommon.
• Liver cell adenoma is a tumor that doesn’t have cancer. It’s uncommon, but women who take birth control pills for a long time are more prone than other people to develop it. There’s a small chance the tumor could eventually turn into cancer.

Some inherited liver disorders only happen if they run in your family.

• Hemochromatosis makes your body store up too much of the iron from your food. The extra iron builds up in your liver, heart, or other organs. It can lead to life-threatening conditions such as liver diseases, heart disease, or diabetes.
• Hyperoxaluria hits when your urine has too much of a chemical called oxalate. In this condition, your liver makes too much oxalate due to a genetic mutation. This can cause kidney stones and kidney failure. If your kidneys do fail, that can give you oxalosis, where the oxalate collects in other organs and causes more trouble.
• Wilson’s disease makes copper build up in your liver and other organs. Its first symptoms usually show up when you’re between the ages of 6 and 35, most often in your teens. It not only affects your liver, but it can cause nerve and psychiatric problems.
• Alpha-1 antitrypsin deficiency involves a chemical that helps your lungs resist infections. Your liver makes it. But when your liver gets the recipe wrong, the faulty chemical can build up and cause liver disease.

• Alcohol abuse can lead to cirrhosis. So can nonalcoholic fatty liver disease and long-term cases of hepatitis B and C.
• Drug overdoses. Taking too much acetaminophen or other medications can harm your liver. Make sure you follow the dosing instructions on the label, and be aware that acetaminophen might be in more than one medicine you take.
• Nonalcoholic fatty liver disease (NAFLD) is when too much fat has built up inside your liver. The extra fat can inflame your liver. One type of NAFLD is nonalcoholic steatohepatitis (NASH). It means you have inflammation and cell damage in your liver, as well as fat. It can scar your liver and lead to other disorders, like cirrhosis.

Dire complications of liver disease include:

• Acute liver failure. This happens when you don’t have a long-term liver disease but your liver quits working within a very short time — days or weeks. That may happen because of an overdose of acetaminophen, infections, or because of prescription drugs.
• Cirrhosisis a buildup of scars in your liver. The more scars replace the healthy parts of your liver, the harder it is for your liver to do its job. Over time, it may not work like it should.

Top Picks

Alkaline Phosphatase Test (ALP): High vs.

Low Levels

Written by WebMD Editorial Contributors

• Why Would I Get This Test?
• How Is the Test Done?
• How Do I Prepare?
• What Do My Results Mean?

Alkaline phosphatase is one kind of enzyme found in your body. Enzymes are proteins that help chemical reactions happen. For instance, they can break big molecules down into smaller parts, or they can help smaller molecules join together to form bigger structures.

You have alkaline phosphatase throughout your body, including your liver, digestive system, kidneys, and bones.

If you show signs of liver disease or a bone disorder, your doctor may order an alkaline phosphatase (ALP) test to measure the amount of the enzyme in your blood and help in diagnosing the problem. Sometimes it’s part of a broader group of tests called a routine liver or hepatic panel, which checks how your liver is working.

If your liver isn’t working right, the amount of ALP in your blood may be high. Doctors often use the test to look for blocked bile ducts. Other conditions that can cause problems with your liver include:

• Liver cancer
• Cirrhosis
• Hepatitis
• Blockage in the bile ducts

The test can also spot problems with your bones, including:

• Cancers that have spread to your bones
• Paget’s disease, which affects how bones grow
• Issues caused by vitamin D deficiency

The lab will need a small amount of blood to perform the test.

The person in charge of taking your blood will start by placing a tight elastic band, called a tourniquet, around your upper arm. This makes your veins swell with blood.

The lab tech will clean an area of your skin with a germ-killing solution. (It might be a spot inside your elbow or the back of your hand). You’ll feel a small stick when the needle goes into your vein. The blood flows into a small vial attached to the needle.

When the test is done, the lab tech will take the tourniquet off, and you’ll get a bandage on the spot where the needle went in. It takes only a few minutes.

Taking blood samples is usually very safe. Some things that might happen after the test include a bruise at the spot where the needle went in, and a little dizziness. There’s also a slight chance of infection.

You may have to limit food and liquids for several hours before the test. Some medicines interfere with the results, so make sure your doctor knows about all drugs you take, including over-the-counter medicines, vitamins, and supplements.

Be sure to let your doctor know if you are pregnant, because that will increase the level of ALP in your blood.

It generally takes 1-2 days for results to come back from the lab.

Higher-than-normal ALP levels for your age and sex may not necessarily mean you have a problem. (Children and teens naturally have higher levels than adults because their bones are still developing).

If your ALP level is high, your doctor may have you take another test, called an ALP isoenzyme test, to determine whether the alkaline phosphatase in your blood is coming from your liver or your bones.

Low levels of ALP indicate a deficiency in zinc and magnesium but can also be an indicator of a rare genetic disease called hypophosphatasia (HPP), which affects bones and teeth.

Top Picks

Liver test up to 50% off

Description of analysis

A comprehensive analysis for the liver, which includes tests that allow you to evaluate both the general functional state of the liver: ALT, AST; the function of protein metabolism: total protein, albumin, urea; synthesis of bilirubin and bile production: bilirubin and its fractions; bile secretion: GGTP, alkaline phosphatase.

The complex is recommended at any age in case of suspected damage and inflammation of the liver, before and against the background of taking hepatotoxic drugs, to control the treatment of liver diseases, cholelithiasis. Also, the complex is suitable for the initial assessment of the state of the liver against the background of diseases of other organs, for example, kidneys, stomach, intestines, diabetes mellitus, rheumatological diseases, parasitic infections.

Research material
— Blood serum

includes 8 studies

• Enzyme of liver cells, increases when they are damaged

• Major substance carrier protein, decreases with malnutrition and liver dysfunction

• Enzyme of liver and muscle cells, increases when they are damaged

• Pigment formed during the breakdown of blood cells indicates increased breakdown of blood or impaired functioning of the liver and biliary tract

• Enzyme of cells of the liver, biliary tract and pancreas

• Metabolic product of liver proteins, excreted by kidneys

• Total amount of protein produced by the liver and supplied with food

• Enzyme of cells of the biliary tract and bones, increases when they are damaged

Order other complexes suitable for you

if the analyzes are repeated, the price of the complex will decrease by their cost

• Current complex

  Liver function, complex of analyzes (liver tests) – 8 studies

• Another

  Biochemical blood test (advanced) – 20 studies

How to prepare

In advance

Do not take a blood test immediately after x-ray, fluorography, ultrasound, physiotherapy.

The day before

24 hours before blood sampling:

• Limit fatty and fried foods, do not take alcohol.

• Avoid strenuous exercise.

From 8 to 14 hours before donating blood, do not eat, drink only clean still water.

Delivery day

Before blood sampling

• 60 minutes without smoking,
• 15-30 minutes to be in a calm state.

Result

• Electronic result

  At the post office and in your personal account when ready

  View example

• Expert interpretation of results

  Transcription created based on our expert algorithms, medical and statistical data. She will talk about each analysis separately and, most importantly, how they affect each other. All analyzes of the complex are grouped by organs, diseases or processes.

  We will decipher your tests if you are not pregnant, you are over 18 years old, you do not have chronic diseases and all the results of the analyzes of the complex have been completed. We may refuse to decrypt at our discretion with a refund.

  We will send the transcript within 1 day after the analysis is ready, excluding Saturday and Sunday.

• Doctor’s consultation

  Online consultation based on test results and a questionnaire that you fill out in advance. It will be available to order in 2024.

  See example

Liver function, complex of analyzes (liver tests)

A comprehensive analysis for the liver, which includes tests that allow you to evaluate both the general functional state of the liver: ALT, AST; the function of protein metabolism: total protein, albumin, urea; synthesis of bilirubin and bile production: bilirubin and its fractions; bile secretion: GGTP, alkaline phosphatase.

Many types of metabolism take place in the liver cells. Protein metabolism involves enzymes of liver cells (hepatocytes), called transaminases (ALT and AST). An increase in transaminases in the blood can be observed during cytolysis (destruction) of hepatocytes. An increase in ALT often indicates liver damage, while an increase in AST can also be observed with muscle damage, myocardial infarction, hemolysis of red blood cells. In acute viral hepatitis, the levels of enzymes exceed the upper limit of the norm by 5-10 times, and in chronic hepatitis by 1.5-2 times, increasing approximately the same. In alcoholic hepatitis, cirrhosis, liver metastases, there is a predominant increase in AST.

The biliary function of the liver and biliary tract is assessed by the enzymes alkaline phosphatase (AP) and gamma-glutamyl transpeptidase (GGTP). In the case of their simultaneous increase, first of all, obstruction (blockage) of the biliary tract is excluded, for example, with cholelithiasis. High levels of GGTP are characteristic of cirrhosis and liver metastases. A moderate increase in GGTP (2-5 times) is observed in viral hepatitis. Unlike GGTP, alkaline phosphatase also increases in diseases of the bones and intestines.

For hepatic jaundice and obstruction of the biliary tract, the increase in total bilirubin is also typical more due to the direct fraction. Violation of the synthesis of bilirubin occurs with hereditary Gilbert’s syndrome, when there is not enough enzyme that neutralizes indirect bilirubin.

Many drugs are hepatotoxic, causing temporary damage to liver cells. To exclude the development of toxic hepatitis during the treatment of certain diseases, it is necessary to regularly evaluate liver function.

The general assessment of the results of research, the establishment of a diagnosis and the appointment of therapy is carried out by the attending physician.

ALT (ALT, Alanine aminotransferase, alanine transaminase, SGPT, Alanine aminotransferase)

Alanine aminotransferase (AlAT, ALT) is an intracellular enzyme, the content of which in the blood of healthy people is low. It is mainly found in the cells of the liver, myocardium, skeletal muscles, pancreas. When cells containing ALT are damaged or destroyed, the enzyme is released into the bloodstream, and its concentration in the blood increases.

Determination of the level of alanine aminotransferase is carried out for the diagnosis of liver diseases and dynamic monitoring of their treatment. The analysis is performed for suspected acute or chronic hepatitis of viral or toxic etiology, cirrhosis of the liver, primary tumors, or metastatic liver disease.

The growth of alanine aminotransferase in the blood in hepatitis is noted much earlier than the onset of the icteric stage, which makes it possible to identify the pathology at the initial stage.

As part of a screening examination (preventive examination of persons who do not have complaints) to assess the state of the liver, before planned hospitalization and surgical treatment, an analysis for ALT is prescribed together with another enzyme – AsAT (aspartate aminotransferase).

The level of ALT along with other enzymes is evaluated in diseases of the pancreas and gallbladder – pancreatitis, cholecystitis, cholelithiasis; if there are complaints of unexplained general weakness, fatigue, yellowness of the skin and sclera, abdominal pain, including a feeling of heaviness in the right hypochondrium, nausea, vomiting.

In addition, the ALT level is taken into account in myocardial infarction and myocarditis, although in cases of heart damage it is only of secondary importance. The study is prescribed for suspected myositis, myodystrophy, when complaints of muscle pain cannot be explained by injuries or excessive physical activity.

Donation is a mandatory reason for testing for ALT.

ALT values ​​are assessed in any chronic disease, before prescribing drug therapy, for example, antitumor, anti-tuberculosis drugs, to assess the initial state of the liver and over time to assess drug tolerance.

Preparing for the procedure

It is better to take the test in the morning on an empty stomach (after an 8-14 hour break after the last meal).

Drinking water is allowed.

If necessary, donate blood 4-6 hours after a light meal.

On the eve it is desirable to avoid physical and emotional overload, overeating.

Avoid drinking alcohol 5-6 days before the test.

Avoid smoking 30 minutes before blood sampling.

Deadline

The survey is completed within one business day.

What can affect the results

Intense physical activity the day before and even a few days before the test can lead to damage to muscle tissue (the so-called tear of muscle fibers) and, accordingly, an increase in the level of ALT. For the same reason, the analysis given after the injury is not informative.

Alcohol, certain drugs (antibiotics, non-steroidal anti-inflammatory drugs, anticancer drugs, oral contraceptives, etc.) often distort the result of the study. The list of medications taken should be discussed with the doctor who ordered the analysis, cancel those that are possible – without risk to health.

ALT (ALT, Alanine aminotransferase, alanine transaminase)

For research, blood is taken from a vein. Usually, ASAT (AST, Aspartate aminotransferase) is determined simultaneously and the ratio of ASAT / AlAT (de Ritis coefficient) is estimated.

You can take a blood test for ALT (ALT, Alanine aminotransferase, alanine transaminase) at the nearest INVITRO medical office. The list of offices where biomaterial is accepted for laboratory testing is presented in the “Addresses” section.

Interpretation of test results contains information for the attending physician and is not a diagnosis. The information in this section should not be used for self-diagnosis or self-treatment. An accurate diagnosis is made by the doctor, using both the results of this examination and the necessary information from other sources: history, results of other examinations, etc.

Normal

Units of measure: U/l.

Reference values ​​

Explanation of indicators

The level of ALT depends on the age and sex of the patient. Minor deviations from the norm, as a rule, do not require drug therapy, and the recommendations associated with them, such as rational nutrition, avoidance of alcohol, etc. should be discussed with your doctor.

The AST/AlAT ratio (de Ritis ratio) is normally between 0.91 and 1.75.

What do low readings mean

A significant decrease in the level of ALT can be detected in severe liver damage, for example, in the terminal stage of liver cirrhosis, when the number of liver cells is significantly reduced.

What do increased indicators mean

First of all, with an increase in ALT, liver problems should be suspected: fatty hepatosis, hepatitis of viral or toxic etiology, cirrhosis of the liver, liver cancer – primary or metastatic.

The degree of increase in ALT is usually associated with the extent or severity of liver damage, but cannot be considered as a determining factor for the prognosis of the disease. The maximum levels of ALT (and AST) – more than a hundred times higher than the norm, are observed in patients with acute viral and drug-induced hepatitis.

A significant increase in alanine aminotransferase can be observed in acute cholecystitis, cholelithiasis, and acute destructive pancreatitis. Another reason may be the use of hepatotoxic drugs that damage liver cells.

An increase in the level of ALT is detected with extensive injuries of the skeletal muscles, severe myositis and myodystrophy, frequent intramuscular injections.

A less significant increase in ALT is recorded in acute myocardial infarction and myocarditis.

Additional examination in case of deviation of the indicator from the norm

If a change (often an increase) in the level of ALT is detected, patients are consulted

general practitioners

,

gastroenterologists

, hepatologists, infectious disease specialists.

To clarify the diagnosis, in addition to ALT, other liver enzymes (AST, gamma-HT, alkaline phosphatase, bilirubin), clinical blood counts, and markers of viral hepatitis, primarily hepatitis B and hepatitis C, are usually examined.

An ultrasound examination of the abdominal organs is performed, according to indications – computed tomography (CT) with contrast.

If damage to the skeletal muscles is suspected, the CPK enzyme is additionally examined and a rheumatologist is consulted.

If a heart muscle disorder is suspected, a cardiologist should be consulted. Usually, the doctor prescribes additional electrocardiography (ECG), echocardiography, blood test for CF-CF, troponin I.

O.P. The role of new reference values ​​of alanine aminotransferase in the diagnosis of various forms of non-alcoholic fatty liver disease in patients with metabolic syndrome. Journal of Biomedical Technologies № 1. 2015. P. 9-15.

Clinical guidelines “Liver cancer (hepatocellular)”. Developed by: Association of Oncologists of Russia, Russian Society of Clinical Oncology, Russian Society of Radiologists and Radiologists.