What are the types of liver problems and their causes? How can infections, immune system issues, cancer, inherited conditions, and other factors lead to liver disease? Find answers to these questions.

Introduction to Liver Problems and Their Causes

The liver is a vital organ that performs numerous crucial functions for maintaining good health. It plays a key role in converting nutrients into essential chemicals, filtering out toxins, and supporting energy production. When the liver doesn’t function properly, it can have far-reaching consequences for the entire body.

There are various types of liver problems with diverse underlying causes. Understanding these different liver conditions and their root causes is essential for effective prevention, diagnosis, and treatment. In this comprehensive article, we’ll explore the top causes of liver problems, including infections, immune system disorders, cancer, inherited conditions, and other factors.

Liver Infections and Viral Hepatitis

One of the most common causes of liver problems is infection, particularly viral hepatitis. Hepatitis A, B, and C are the primary types of viral hepatitis that can lead to liver inflammation and dysfunction.

Hepatitis A is typically contracted through consuming contaminated food or water and often resolves on its own within 6 months without long-term consequences. Hepatitis B, on the other hand, is transmitted through contact with infected bodily fluids, such as during unprotected sex or drug use with shared needles. If hepatitis B becomes chronic, it can increase the risk of liver cancer and other liver diseases.

Hepatitis C is acquired through exposure to infected blood, often via intravenous drug use or needle stick injuries for healthcare workers. The symptoms of hepatitis C may not appear for many years, making it particularly insidious. Interestingly, baby boomers are at a higher risk of contracting hepatitis C for reasons that are not entirely clear.

Autoimmune Liver Disorders

The immune system is designed to protect the body from foreign invaders, such as bacteria and viruses. However, in some cases, the immune system can mistakenly attack the body’s own tissues, including the liver. This can lead to autoimmune liver disorders.

Autoimmune hepatitis is an inflammation of the liver caused by the immune system’s attack on liver cells. It is more common in women and can potentially lead to other disorders or even liver failure if left untreated.

Primary biliary cholangitis is another autoimmune liver disorder that targets the bile ducts, the small tubes responsible for carrying bile, a vital digestive fluid, from the liver to the small intestine. Damage to the bile ducts can lead to a buildup of bile within the liver, causing scarring and impaired liver function.

Primary sclerosing cholangitis is a similar condition that also affects the bile ducts, leading to scarring and blockages. This can eventually result in liver cancer or the need for a liver transplant.

Liver Cancer and Tumors

While cancer that originates in the liver is relatively uncommon, the liver can be a common site for metastatic cancer, where the cancer has spread from another part of the body, such as the lungs, colon, or breasts.

Hepatocellular carcinoma is the most prevalent form of primary liver cancer, and it is more likely to occur in individuals with pre-existing liver conditions, such as viral hepatitis or excessive alcohol consumption.

Bile duct cancer, also known as cholangiocarcinoma, targets the tubes that transport bile from the liver to the small intestine. This type of cancer is relatively rare and typically affects older adults.

Liver cell adenomas are non-cancerous liver tumors that are more common in women, particularly those who have taken birth control pills for an extended period. While these tumors are usually benign, there is a small risk that they could eventually transform into cancer.

Inherited Liver Disorders

Certain liver problems can be inherited, meaning they are passed down through families due to genetic factors.

Hemochromatosis is a condition where the body accumulates too much iron, which can lead to liver damage, as well as heart disease and diabetes. This disorder is typically inherited and can be life-threatening if left untreated.

Hyperoxaluria is another genetic liver disorder that causes an excess production of oxalate, a chemical that can form kidney stones and contribute to kidney failure. In severe cases, the oxalate can also accumulate in other organs, leading to further complications.

Wilson’s disease is a rare inherited condition that causes copper to build up in the liver and other organs, leading to liver problems as well as neurological and psychiatric issues. It usually manifests during the teenage years or early adulthood.

Alpha-1 antitrypsin deficiency is an inherited disorder that affects the production of a protein that helps protect the lungs. However, the faulty protein can also accumulate in the liver, causing liver disease.

Other Causes of Liver Disease

In addition to infections, autoimmune disorders, and inherited conditions, there are several other factors that can contribute to liver problems.

Excessive alcohol consumption is a well-known cause of liver cirrhosis, a severe and irreversible scarring of the liver. Nonalcoholic fatty liver disease, where too much fat accumulates in the liver, can also lead to inflammation and cell damage, potentially progressing to a more serious condition called nonalcoholic steatohepatitis (NASH).

Overdoses of certain medications, particularly acetaminophen, can also cause acute liver injury. It’s essential to follow dosage instructions carefully and be aware of the potential for acetaminophen to be present in multiple medications.

Conclusion

The liver is a remarkably versatile organ that plays a crucial role in maintaining overall health. However, a variety of factors, including infections, autoimmune disorders, cancer, inherited conditions, and lifestyle factors, can lead to various types of liver problems.

Understanding the different causes of liver disease is essential for healthcare providers to accurately diagnose and effectively treat these conditions. By addressing the underlying causes, patients can receive the appropriate care and potentially prevent or manage liver-related complications.

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

Medically Reviewed by Jennifer Robinson, MD on May 20, 2021

• 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 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

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 together 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.

Preparation for 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, it is permissible to 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, antitumor 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 values ​​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. – 2020.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

ALT blood test in Moscow

Alanine aminotransferase is produced by cells of the human body to catalyze metabolic processes. The largest amount of the enzyme is formed in the liver and is normally almost completely involved in reactions. With various pathologies, the level of ALT in the blood increases. As a result, the study of alanine aminotransferase is used to diagnose acute and chronic diseases: hepatitis, diseases of the cardiovascular system, gastrointestinal tract, skeletal muscles – and evaluate the effectiveness of their therapy stages.

Analysis of the transaminase index and identification of the size of the deviation from normal values ​​is carried out in combination with ultrasound data, studies of viral hepatitis markers, other biochemistry indicators: total bilirubin, G-GTP, AST, alkaline phosphatase. Indications for testing are symptoms of damage or situations of increased risk of liver damage, chronic alcoholism, previous contact with patients with viral hepatitis, hereditary diseases, diabetes.

Alanine aminotransferase 9 determination0019

Transferases, which include alanine aminotransferase, or glutamate-pyruvate transaminase, are involved in protein-carbohydrate metabolism – in cyclic reactions of converting amino acids into keto acids, transamination. The ALT enzyme exhibits high activity in the tissues of the kidneys and liver, and relatively less activity in the tissues of the spleen, myocardium, lungs, skeletal muscles, and pancreas. An increase in the amount of enzyme in the bloodstream occurs when the cells of these organs are damaged: nephorons, hepatocytes, cardiomyocytes, myocytes.

Indications for analysis of ALT

The study of the ALT indicator is prescribed in the presence of symptoms of liver dysfunction: loss of appetite, nausea, vomiting, fatigue and weakness, pain in the right hypochondrium, yellowness of the whites of the eyes or skin, staining of feces in a light color, darkening urine.

Analysis of blood biochemistry for ALT is carried out to confirm the diagnosis of the following liver diseases:

• viral, autoimmune, toxic hepatitis;
• cirrhosis;
• steatosis;
• malignant neoplasms.

Patients who are overweight, take drugs that are toxic to the liver, abuse alcohol, have diabetes, or have a history of a hereditary predisposition to liver pathologies, are also prescribed blood chemistry with the determination of ALT.

In addition, alanine aminotransferase testing is performed in the following situations:

• diagnostics of pathologies of skeletal muscles, pancreas, kidneys, gallbladder, spleen;
• screening of contacts for viral hepatitis;
• screening of blood donors;
• medication monitoring;
• inflammation, soft tissue injury: trauma, burns;
• in the presence of a state of shock.

ALT study is prescribed as part of a comprehensive examination to detect viral infections, malignant tumors, diseases: myocardial infarction, pericarditis, myocarditis, hypothyroidism, hemolytic anemia, myopathy

An alanine aminotransferase test is performed in patients with chronic diseases before starting drug therapy. Further, in the course of treatment, testing is carried out in order to control the dynamics, the tolerance of drugs, the state of the liver is checked.

Identification of pathologies and their features by the value of transaminase

To a large extent, the activity of the enzyme increases in drug-induced and viral hepatitis. There is a proportional relationship between its amount in the bloodstream and the severity of the disease. For the diagnosis of pathologies, it is important that the ALT level exceeds the norm even before the onset of the jaundice stage. Alanine aminotransferase also increases already at the early stages of infectious and toxic hepatitis and, with favorable development, gradually decreases over several weeks. In liver damage due to alcohol exposure, the excess from the reference intervals is not so significant.

The amount of transaminase in the blood is also affected by natural causes. The level of the enzyme increases due to factors affecting the state of the muscles, such as multiple intramuscular injections, intense exercise. The production of the enzyme is affected by drugs that depress the liver, dietary supplements, excessive consumption of alcoholic beverages, eating food containing a lot of nutritional supplements.

Causes of abnormal levels of alanine aminotransferase from the norm

A significant increase in the level of alanine aminotransferase can be observed in case of poisoning with potent drugs, lead, carbon tetrachloride, when taking narcotic analgesics, as well as in diseases:

• infectious mononucleosis;
• hepatitis, cirrhosis, cholestasis, liver cancer;
• fatty hepatosis;
• acute myocardial infarction;
• pericarditis;
• myocarditis;
• renal, heart failure;
• destructive pancreatitis;
• myodystrophy;
• myositis;
• acute cholecystitis;
• cholelithiasis;
• extensive soft tissue lesions.

An increase in the amount of ALT in most cases indicates damage to hepatocytes and disruption of their normal functioning. Metabolic pathologies cause liver infections, autoimmune processes, neoplasms, diseases that provoke ischemia, circulatory disorders, and the use of substances toxic to the liver.

Hepatotoxic drugs: alcohol, nutritional supplements, psychotropics, anabolic steroids, COCs, immunosuppressants, antibiotics, anesthetics.

Causes of a decrease in the level of alanine aminotransferase:

• liver necrosis;
• decompensated cirrhosis;
• deficiency in the body of vitamin B₆.

Extensive liver damage leads to a reduction in the number of hepatocytes and, as a result, to a decrease in the level of ALT in the tissues of body fluids. Vitamin B₆, along with AlAT, is involved in transamination, therefore, for the normal activity of the enzyme, its intake from food should be sufficient.

Treatment of pathologies causing deviations in the ALT level

The result of the biochemistry analysis for ALT is deciphered in conjunction with the results of complex biochemistry, data on aspartate aminotransferase. Therapy of diseases that cause an increase or decrease in the level of transaminase in the blood is carried out by the following specialists: hepatologists, cardiologists, gastroenterologists, endocrinologists, nephrologists, infectious disease specialists, therapists.

Treatment is aimed at eliminating the causes of pathological processes. Medications are combined with dietary nutrition. In liver diseases, drugs are prescribed that improve digestion, choleretic, hepatoprotectors. Prescribed, to a greater extent, plant foods rich in vitamins, especially vitamins B₆ and D. The amount of salt and animal fats is limited. It is also important to exclude nicotine, alcohol, hepatotoxic substances, the intake of which is not agreed with the doctor.

Symptoms of heart muscle damage associated with an increase in alanine aminotransferase require consultation with a cardiologist. In this case, the doctor additionally prescribes echocardiography, electrocardiography (ECG), blood tests for troponin I, MB-CPK.