What are the common causes of elevated liver enzymes. How do doctors diagnose high liver enzyme levels. What are the treatment options for various conditions causing elevated liver enzymes.

Understanding Liver Enzymes and Their Significance

Liver enzymes are proteins that play crucial roles in various metabolic processes within the liver. When these enzymes are found in elevated levels in the bloodstream, it often indicates liver damage or inflammation. The two primary enzymes doctors look for are:

• Aspartate aminotransferase (AST)
• Alanine aminotransferase (ALT)

Elevated levels of these enzymes can be detected through a simple blood test. But what exactly causes these levels to rise? And what are the implications for our health?

Normal vs. Elevated Liver Enzyme Levels

Normal liver enzyme levels typically fall within the following ranges:

• AST: 10 to 40 units per liter
• ALT: 7 to 56 units per liter

Levels above these ranges are considered elevated and may warrant further investigation. It’s important to note that slight elevations may not always indicate a serious problem, but persistent or significant increases often require medical attention.

Common Causes of Elevated Liver Enzymes

Several conditions can lead to increased liver enzyme levels. Understanding these causes is crucial for proper diagnosis and treatment. Let’s explore some of the most common culprits:

Fatty Liver Disease

Fatty liver disease is the most prevalent cause of elevated liver enzymes, affecting 25-51% of individuals with high enzyme levels. This condition occurs when excess fat accumulates in liver cells. It can be categorized into two types:

1. Alcoholic fatty liver disease (caused by excessive alcohol consumption)
2. Nonalcoholic fatty liver disease (NAFLD, often associated with metabolic syndrome)

Symptoms of fatty liver disease may include fatigue and right-sided abdominal pain, although many people remain asymptomatic.

Metabolic Syndrome

Metabolic syndrome is a cluster of conditions that increase the risk of heart disease and other health problems. These conditions include:

• High blood sugar
• High blood pressure
• Excess body weight
• Abnormal cholesterol levels

Individuals with metabolic syndrome are at a higher risk of developing NAFLD, which can lead to elevated liver enzymes.

Hepatitis

Hepatitis is a viral infection that causes liver inflammation. There are several strains of hepatitis (A, B, C, D, and E), all of which can lead to elevated liver enzymes. Common symptoms include:

• Fatigue
• Muscle and joint pain
• Nausea
• Loss of appetite
• Fever
• Jaundice (yellowing of the skin and eyes)

Alcohol and Drug Use Disorders

Excessive alcohol consumption or illicit drug use can cause liver inflammation and damage. This can lead to conditions such as alcoholic hepatitis or toxic hepatitis, both of which can result in elevated liver enzymes.

Cirrhosis

Cirrhosis is a late-stage liver disease characterized by permanent scarring of liver tissue. It can be a consequence of untreated hepatitis or fatty liver disease. Symptoms may include fatigue and skin itching. Cirrhosis can significantly impact liver function and lead to elevated enzyme levels.

Less Common Causes of Elevated Liver Enzymes

While the conditions mentioned above are the most frequent culprits, several less common factors can also contribute to high liver enzyme levels:

• Autoimmune hepatitis
• Celiac disease
• Epstein-Barr virus infection
• Liver cancer
• Hemochromatosis (iron overload)
• Mononucleosis
• Sepsis
• Wilson’s disease
• Polymyositis

Additionally, certain medications, including some pain relievers and statins, can cause elevated liver enzymes as a side effect.

Diagnosing Elevated Liver Enzymes

How do healthcare providers determine if a patient has elevated liver enzymes? The process typically involves the following steps:

Blood Tests

The initial diagnosis is made through a blood test that measures AST and ALT levels. If these levels are found to be above the normal range, further investigation is usually required.

Medical History and Lifestyle Assessment

Doctors will inquire about a patient’s medical history, lifestyle habits, and any symptoms they may be experiencing. This information can provide valuable clues about potential underlying causes.

Additional Tests

Depending on the initial findings, healthcare providers may order additional tests to pinpoint the specific cause of elevated liver enzymes. These may include:

• Imaging studies (ultrasound, CT scan, or MRI)
• Liver biopsy
• Specialized blood tests for specific conditions

Treatment Options for Elevated Liver Enzymes

The treatment for elevated liver enzymes primarily focuses on addressing the underlying cause. Here are some common approaches for various conditions:

Fatty Liver Disease

Treatment for fatty liver disease often involves lifestyle modifications, such as:

• Weight loss through a balanced diet and regular exercise
• Limiting alcohol consumption
• Managing diabetes and high cholesterol

Metabolic Syndrome

Managing metabolic syndrome typically involves a combination of lifestyle changes and medication:

• Adopting a heart-healthy diet
• Increasing physical activity
• Medications to control blood pressure, cholesterol, and blood sugar

Hepatitis

Treatment for hepatitis depends on the specific viral strain:

• Hepatitis A and E often resolve on their own with supportive care
• Hepatitis B and C may require antiviral medications
• Hepatitis D treatment focuses on managing hepatitis B, as it only occurs in conjunction with HBV infection

Alcohol and Drug Use Disorders

Treatment for alcohol and drug-related liver issues involves:

• Cessation of alcohol or drug use
• Rehabilitation programs
• Supportive therapies to manage withdrawal symptoms
• Medications to reduce cravings and prevent relapse

Cirrhosis

While cirrhosis itself is irreversible, treatment aims to slow its progression and manage complications:

• Treating the underlying cause (e.g., hepatitis, alcohol use)
• Medications to control symptoms and complications
• Liver transplantation in severe cases

Preventing Elevated Liver Enzymes

While not all causes of elevated liver enzymes are preventable, there are several steps individuals can take to maintain liver health:

• Limit alcohol consumption
• Maintain a healthy weight
• Exercise regularly
• Eat a balanced diet rich in fruits, vegetables, and whole grains
• Avoid unnecessary medications and follow dosage instructions carefully
• Practice safe sex and avoid sharing needles to prevent hepatitis transmission
• Get vaccinated against hepatitis A and B

When to Seek Medical Attention

While elevated liver enzymes themselves may not cause symptoms, the underlying conditions can lead to various health issues. It’s important to consult a healthcare provider if you experience:

• Persistent fatigue
• Unexplained weight loss
• Abdominal pain or swelling
• Yellowing of the skin or eyes (jaundice)
• Dark urine or pale stools
• Frequent nausea or vomiting

Early detection and treatment of liver issues can significantly improve outcomes and prevent more serious complications.

The Role of Regular Health Check-ups

Regular health check-ups play a crucial role in detecting elevated liver enzymes early, even before symptoms appear. These routine examinations often include blood tests that can reveal changes in liver enzyme levels. Early detection allows for timely intervention and better management of underlying conditions.

Frequency of Liver Function Tests

How often should one undergo liver function tests? The frequency of these tests depends on various factors:

• Age
• Overall health status
• Presence of risk factors (e.g., obesity, diabetes, alcohol use)
• Previous liver enzyme test results

For most healthy adults, liver function tests are typically part of annual check-ups. However, individuals with known risk factors or pre-existing liver conditions may need more frequent monitoring.

Interpreting Test Results

Understanding liver enzyme test results can be complex. It’s essential to interpret these results in the context of an individual’s overall health profile. Factors to consider include:

• The specific levels of AST and ALT
• The ratio between AST and ALT
• Changes in enzyme levels over time
• Presence of other abnormal blood test results

Healthcare providers use this information, along with a patient’s medical history and symptoms, to determine the need for further investigation or treatment.

Living with Liver Disease: Lifestyle Adjustments

For individuals diagnosed with liver disease or conditions causing elevated liver enzymes, certain lifestyle adjustments can help manage symptoms and slow disease progression:

Dietary Modifications

A liver-friendly diet typically includes:

• Plenty of fruits and vegetables
• Whole grains
• Lean proteins
• Healthy fats (e.g., olive oil, avocados)

It’s also important to limit intake of:

• Processed foods
• Sugary beverages
• Saturated and trans fats
• Salt

Exercise and Physical Activity

Regular physical activity can help improve liver health by:

• Promoting weight loss
• Improving insulin sensitivity
• Reducing inflammation

Aim for at least 150 minutes of moderate-intensity exercise per week, or as recommended by your healthcare provider.

Stress Management

Chronic stress can negatively impact liver health. Incorporating stress-reduction techniques can be beneficial:

• Meditation
• Yoga
• Deep breathing exercises
• Regular sleep patterns

Avoiding Harmful Substances

Limiting or avoiding substances that can damage the liver is crucial:

• Alcohol
• Illicit drugs
• Certain medications (always consult with a healthcare provider before stopping or starting any medication)

Emerging Research and Future Directions

The field of hepatology is continuously evolving, with new research shedding light on liver function and disease processes. Some areas of ongoing investigation include:

Novel Biomarkers

Researchers are exploring new biomarkers that may provide more specific information about liver health and disease progression. These could potentially offer earlier and more accurate diagnoses in the future.

Targeted Therapies

Advances in understanding the molecular mechanisms of liver diseases are paving the way for more targeted therapies. These treatments aim to address specific aspects of liver dysfunction with greater precision and fewer side effects.

Regenerative Medicine

Studies into liver regeneration and the potential use of stem cells for liver repair are ongoing. These approaches could offer new hope for patients with severe liver damage in the future.

Artificial Liver Support Systems

Development of artificial liver support systems continues, with the goal of providing temporary assistance to patients awaiting liver transplantation or recovery from acute liver failure.

As research progresses, our understanding of liver health and the management of conditions causing elevated liver enzymes will continue to improve, potentially leading to more effective prevention strategies and treatment options.

Causes, symptoms, tests, and treatment

Elevated liver enzymes may mean a person’s liver is not working properly. Damaged or inflamed liver cells release enzymes into the bloodstream, which a blood test will detect.

Doctors test people for elevated liver enzymes if they have symptoms of conditions that typically cause liver damage.

In this article, learn about the causes of elevated liver enzymes, as well as the symptoms and treatment of each of these conditions.

Share on PinterestIf a person has elevated liver enzymes, a doctor may investigate possible underlying causes.

If a person’s blood test results show elevated liver enzymes, a doctor will investigate possible underlying causes. They may do further tests in addition to asking about a person’s lifestyle and dietary habits.

The most common cause of elevated liver enzymes is fatty liver disease. Research suggests that 25–51% of people with elevated liver enzymes have this condition.

Other health conditions that typically cause elevated liver enzymes include:

• metabolic syndrome
• hepatitis
• alcohol or drug use disorder
• cirrhosis, which is liver tissue scarring

Other conditions that less commonly cause elevated liver enzymes include:

• autoimmune hepatitis
• celiac disease
• infection with the Epstein-Barr virus, a type of herpes
• liver cancer
• hemochromatosis, when the body absorbs too much iron
• mononucleosis
• sepsis, or blood poisoning
• Wilson’s disease
• polymyositis, which involves inflammation of the muscles

Certain medications, including some pain relievers and statins, can also cause elevated liver enzymes.

Elevated liver enzymes are themselves asymptomatic, but the underlying conditions responsible for them may cause symptoms.

Below are the common causes of elevated liver enzymes, as well as their symptoms:

Fatty liver disease

Fatty liver disease occurs when fats build up in the liver. If this buildup is due to alcohol consumption, it is called alcoholic fatty liver disease.

When alcohol is not a causative factor, the buildup of fat in the liver is called nonalcoholic fatty liver disease (NAFLD). People with metabolic syndrome are at a higher risk of NAFLD.

Fatty liver disease may sometimes cause tiredness and pain on the right side of the abdomen, but it often causes no symptoms.

A doctor may test someone with alcohol use disorder or metabolic syndrome for elevated liver enzymes to check for fatty liver disease.

Learn about what to eat to help manage fatty liver disease here.

Metabolic syndrome

Metabolic syndrome is a group of symptoms that increase the risk of heart disease. These symptoms include:

• high blood sugar
• high blood pressure
• being overweight
• high cholesterol

The doctor may test people with one or more of these symptoms for elevated liver enzymes.

Hepatitis

Share on PinterestA person with hepatitis may experience fatigue, joint pain, and nausea.

Hepatitis is a virus that leads to liver inflammation. There are several different strains of hepatitis, which are called A, B, C, D, and E. The symptoms of all of the strains are similar.

Common hepatitis symptoms include:

• fatigue
• muscle soreness
• joint pain
• nausea
• loss of appetite
• stomach pain
• fever
• dark urine
• skin itching
• yellowing of the eyes and skin (jaundice)

The doctor may test a person with symptoms of hepatitis for elevated liver enzymes.

Alcohol or drug use disorder

Drinking too much alcohol or using illicit drugs may lead to liver inflammation or damage.

Liver inflammation due to alcohol consumption is called alcoholic hepatitis. When drugs are the underlying cause, doctors call it toxic hepatitis.

The symptoms of alcoholic and toxic hepatitis are similar to those of other strains of hepatitis.

If a person is experiencing symptoms of alcohol or drug use disorder, the doctor may check their liver enzyme levels and offer various forms of treatment and support.

Cirrhosis

Cirrhosis is a type of liver damage. A person with cirrhosis has permanent scarring of the liver, which can prevent it from working properly. Cirrhosis may eventually lead to liver failure.

Cirrhosis symptoms include fatigue and skin itching. People are at risk of cirrhosis if they do not receive treatment for hepatitis or fatty liver disease.

If a person has cirrhosis symptoms, the doctor may check their liver enzyme levels.

A blood test can show elevated liver enzymes. The blood test checks for raised levels of AST and ALT, which are enzymes that the liver releases when it becomes inflamed or damaged.

If a doctor finds that a person has raised AST or ALT levels, they are likely to carry out further tests to determine the underlying cause.

Different ratios of AST to ALT may indicate various underlying causes.

The treatment for elevated liver enzymes will focus on managing the underlying condition causing the increased levels.

The treatments for some common causes of raised AST or ALT levels include:

Fatty liver disease

People can work with their doctor to treat NAFLD with weight loss. The doctor may advise a person to make lifestyle changes to lose weight, such as:

• exercising more
• eating a healthful, balanced diet
• trying to burn more calories than they consume

Speaking with a nutritionist or even a personal trainer can help someone stay on track with their weight loss plan.

If a person has fatty liver disease due to alcohol consumption, the doctor will support them in reducing their alcohol intake.

Metabolic syndrome

Share on PinterestSomeone with metabolic syndrome may benefit from exercising more, losing weight, and reducing their stress levels.

Treatments for metabolic syndrome include:

• losing weight
• exercising more
• eating a healthful, balanced diet
• managing blood sugar levels
• reducing stress levels

Lifestyle changes that may help a person manage stress include:

• exercise
• meditation
• mindfulness
• yoga
• journaling
• reducing commitments

Hepatitis

Treatments for hepatitis depend on whether it is acute or long term. A doctor may recommend the following treatments for acute hepatitis:

• bed rest
• plenty of fluids
• avoiding alcohol

Treatment for long term hepatitis usually includes antiviral medication.

Alcohol or drug misuse disorder

Treatments for alcohol or drug use disorder include:

• behavioral therapies
• medications
• support groups

Anyone who feels as though their alcohol or drug use is causing health problems or interfering with their everyday life should speak to their doctor.

Cirrhosis

Cirrhosis is permanent liver damage, so it is not always treatable. However, the underlying cause of liver damage is usually responsive to treatment. The conditions that we discussed above may all lead to cirrhosis.

Treatments such as a modified diet, weight loss, and reduced alcohol consumption can all reduce the risk of further liver damage. The prompt diagnosis and treatment of conditions that affect the liver can help prevent cirrhosis.

Elevated liver enzymes are a sign that a person has an inflamed or damaged liver. Many conditions may cause liver inflammation or damage.

Doctors use a blood test to check for elevated liver enzymes. They may test anyone with symptoms of one of the conditions that they know to raise liver enzyme levels.

If a person’s blood test results reveal that they have elevated liver enzymes, the doctor will investigate the underlying cause. Once they make a diagnosis, the doctor will recommend suitable treatments.

Fatty liver disease is the most common cause of elevated liver damage. People with fatty liver disease can manage their condition by losing weight, if necessary, or reducing their alcohol consumption. Other causes of liver inflammation are also treatable.

Elevated liver enzymes are usually a temporary sign. Liver enzyme levels may return to normal quickly if a person follows the doctor’s recommended treatment plan for the underlying condition.

Elevated Liver Enzymes in Children: Symptoms, Diagnosis and Treatment

Nationwide Children’s Hospital

Overview

Causes

Symptoms

Diagnosis

Treatment

Next Steps

What Are Elevated Liver Enzymes in Children?

Enzymes are substances that help speed up chemical reactions. Thousands of enzymes are found in the human body. Every day, these enzymes carry out many jobs that are vital to life.

Two of these enzymes are alanine aminotransferase (ALT) and aspartate aminotransferase (AST). These are also called transaminases. It is normal for children to have small amounts of ALT and AST in the blood. ALT is mostly found in the liver. AST is found in many organs, including the liver, pancreas, muscles, heart and brain. This is important because it means that although we call ALT and AST “liver enzymes”, they usually, but not always come from the liver.

There are other liver enzymes that your doctor may test in the blood, such as alkaline phosphatase (AP) or gamma-glutamyltransferase (GGT), but as tests for liver disease in children, ALT and AST are used most commonly.

Elevated (too high) levels of liver enzymes are a warning sign that something might be harming the liver. This may happen for a variety of reasons. Further tests may be needed to find the exact cause.

What Causes Elevated Liver Enzymes in Children?

Most of the time, elevated liver enzymes are due to conditions that are not dangerous, are easily treatable, or go away on their own. Some common causes include:

• Non-alcoholic fatty liver disease (NAFLD). This is probably the main reason for elevated liver enzymes in children in the U.S. today. Mild forms of this disease are very common; the more serious form that over many years can lead to cirrhosis (scarring) and liver failure is called non-alcoholic steatohepatitis (NASH).
• Certain medicines. Drug-induced liver injury (DILI) is another possibility. Medications that can affect the liver include those for attention-deficit/hyperactivity disorder, such as atomoxetine; antibiotics, such as erythromycin or minocycline; anticonvulsants, such as valproic acid; or products containing acetaminophen. Drug-induced liver injury is often mild, but sometimes it can be severe.
• Viral infections. Many viruses can temporarily increase liver enzyme levels. These include rhinovirus (common cold) or Epstein-Barr virus (EBV), the virus that causes mononucleosis (“Mono”).

Rarely are elevated liver enzymes due to a serious or even life-threatening condition. Some of these less common causes include:

• Autoimmune hepatitis (AIH)
• Hepatitis B and C
• Diseases of the bile ducts, such as biliary atresia, choledochal cyst, or bile duct blockage from a gallstone or from pancreatitis 
• Diseases of other organs, such as celiac disease, a disorder of the intestine (gut) 
• Genetic (inherited) conditions, such as alpha-1 antitrypsin (AAT) deficiency (where a protein gets produced incorrectly and “gets stuck” in the liver), hemochromatosis (too much iron) or Wilson disease (too much copper)

What Are the Symptoms of Elevated Liver Enzymes in a Child?

Many times, childhood liver diseases do not cause obvious symptoms, especially in the early stages. Elevated liver enzymes are often the first sign of liver trouble in children. When symptoms do appear, they may include:

• Jaundice (yellowish skin and eyes)
• Swollen abdomen
• Swelling of arms or legs
• Vomiting or diarrhea
• Black or bloody stools
• Easy bleeding or bruising, or bleeding for longer than usual 
• Pain or swelling in joints
• Unexplained fever 
• Unusual or unexplained rash 

How Are Elevated Liver Enzymes Diagnosed in a Child?

High liver enzymes may show up on a routine blood test during a child’s yearly checkup. A health care provider may also test for elevated liver enzymes when a child is feeling unwell. This is especially true if a child has abdominal pain, vomiting, diarrhea, or jaundice (yellowish color of the eyes or skin).

What Does a Diagnosis of Elevated Liver Enzymes in a Child Mean?

Liver enzyme levels alone are not enough to tell exactly what is wrong with the liver. This is why it is very important to follow up with a child’s health care provider. If high levels of liver enzymes are found, more tests can help determine the cause.

The reason for elevated liver enzymes sometimes appears to be fairly clear. For example, your child’s health care provider may decide that the elevated liver enzymes are probably due to a virus. In these cases, your child’s health care provider may want to wait and see what happens. As the illness clears up, elevated liver enzymes should return to normal levels. 

Seeing a Specialist

It is rare for a primary health care provider to not be able to explain why liver enzymes are elevated. However, occasionally your child’s health care provider may suspect something more serious. If so, a doctor who specializes in liver diseases (hepatologist) can help.

Specialized care starts with taking a careful history, and then a physical exam to check for outward signs of liver disease. Such signs may include jaundice or an enlarged liver or spleen.  

If liver trouble seems likely, additional tests may include:

• Other liver tests to compare levels of ALT and AST with alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), bilirubin, albumin, prothrombin time etc.
• Specialized lab tests to look for specific diseases, such as celiac disease, autoimmune hepatitis, alpha-1 antitrypsin deficiency, Wilson disease, and viruses such as hepatitis B, hepatitis C, EBV or cytomegalovirus (CMV)
• Imaging tests, such as ultrasound, computerized tomography (CT) or magnetic resonance imaging (MRI), to examine the liver, blood vessels, and nearby organs – especially the spleen.
• Liver biopsy (under anesthesia) to remove a tiny piece of the liver that will be examined under a microscope

Once complete, all of these tests help paint a more complete picture of a child’s liver. This can point the way to the correct diagnosis.

How Are Elevated Liver Enzymes Treated in a Child?

Treatment for elevated liver enzymes depends on the cause. Often, elevated liver enzymes will get better without treatment. For example, if a child has a viral infection, liver enzyme levels may go up for a week or two. When the virus goes away, enzyme levels typically return to normal.

In other cases, simple treatments can help. For instance, NAFLD is a common cause of elevated liver enzymes. Weight loss is the main treatment. As the child loses weight, liver enzyme levels and other symptoms of NAFLD improve.

If elevated liver enzymes are due to something more serious, treatment may include medicines, surgery or other medical procedures. 

What Are the Complications of Elevated Liver Enzymes in a Child?

Possible complications of elevated liver enzymes depend on the cause. Most children with elevated liver enzymes do not develop complications. Rarely, children with a serious liver disease may have complications including:

• Cirrhosis (scar tissue in the liver)
• Fluid buildup and swelling in the belly (ascites)
• Severe jaundice 
• Liver failure

Should I Call My Child’s Health Care Provider?

Elevated liver enzymes in children must not be ignored. Liver disease in childhood can be very serious or even life-threatening if not properly treated. Call your child’s health care provider right away if your child’s symptoms get worse or new symptoms show up.

Key Points about Elevated Liver Enzymes in Children

• ALT and AST (liver enzymes or transaminases) are normally present in the body and in the blood.
• Elevated liver enzymes in children are often found during a routine blood test.
• Elevated liver enzymes are a warning sign of possible liver damage, irritation or inflammation.
• Elevated liver enzymes are usually due to common conditions that are easily treated or resolve on their own. 
• Rarely, they may be due to a serious or even life-threatening disease.
• Liver enzyme levels alone are not enough to tell exactly what is wrong with the liver.
• More tests may be needed to find the reason for elevated liver enzymes. 
• Sometimes, no cause for the elevated liver enzymes is found at all; in those cases, the liver enzymes may return to normal on their own.  
• Treatment options vary depending on the cause.

Next Steps

If you have been told your child has elevated liver enzymes, your best source of information is your child’s health care provider. He or she will work with you to give your child the best chance of recovery. Some things you can do to help include:

• Learn all you can about recommended treatments. Ask about the benefits and the downsides.
• Keep all follow-up appointments with your child’s health care provider. 
• Ask if your child should see a liver disease specialist. 
• Ask your child’s health care provider before trying any home remedies or over-the counter medications. 
• If there is any concern about liver disease, we do not recommend any supplements or herbal drugs to “help the liver.” No such thing exists, and some products sold for that purpose can be dangerous and may actually harm the liver.

You Might Also Be Interested In

Condition

Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in American children. NAFLD occurs when too much fat builds up in the liver. Excess fat in the liver and elsewhere in the body makes it harder for the liver to work well. Over time, NAFLD can cause other health issues.

Condition

Liver Failure in Children

Liver failure happens when the liver becomes so sick and damaged that it stops working, either partly or completely. Although this is rare, liver failure can happen even in children. Many of them recover well, but others become extremely ill, and some may need a liver transplant to survive.

Condition

Autoimmune Hepatitis

Autoimmune hepatitis in children is a rare and serious disease of the liver. It happens when something goes wrong with the body’s immune system. In autoimmune hepatitis, the immune system attacks normal liver cells. This causes damage that makes it hard for the liver to work properly.

Increased blood ALT – CMD

ALT (glutamate pyruvate transaminase; GPT, L-alanine:2 oxoglutarate aminotransaminase, EC 2.6.1.2.) belongs to the class of transaminase enzymes that play a key role in the synthesis and catabolism of amino acids (transamination or transamination reaction) and providing cells with energy. ALT catalyzes the transamination reaction between alanine and α-ketoglutarate, which leads to the formation of pyruvate and glutamate. The reaction coenzyme is pyridoxine, vitamin B6.

ALT is an intracellular enzyme, its content in the blood serum of healthy people is significantly lower than in many organs and tissues, its highest activity is detected in the liver, skeletal muscles, and myocardium. An increase in ALT activity in the blood indicates damage or destruction of cells enriched with the enzyme.

The most significant increase in ALT activity (exceeding the upper limit of the norm by more than 15 times) is noted with necrosis of liver cells (acute viral hepatitis, toxic hepatitis). In acute viral hepatitis, a multiple increase in ALT activity in the blood occurs much earlier than the development of jaundice. A somewhat smaller increase in ALT activity (exceeding the upper limit of the norm by 5–10 times) is found in various liver diseases (chronic hepatitis, cholangitis, liver tumors), acute pancreatitis, burns, taking hepatotoxic drugs, acute myocardial infarction, etc.

An important indicator is the ratio of the activity of AST / ALT enzymes (de Ritis coefficient), it is advisable to calculate its values ​​only with increased activity of one or both enzymes. An increase in the coefficient of more than 1.4 is noted in cirrhosis, severe alcoholic and toxic liver damage, which is evidence of deep necrosis of hepatocytes with damage to the mitochondrial apparatus of cells and the release of the mitochondial AST fraction. In uncomplicated viral hepatitis or non-alcoholic liver damage, the value of the coefficient is less than 1.0.

Indications for examination

• Liver diseases;
• donor survey;
• examination of persons in contact with patients with viral hepatitis in the focus of infection.

Research methods. Spectrophotometric (kinetic) methods based on the recommendations of the International and National Federations of Clinical Chemistry. The addition of pyridoxal-5-phosphate to the reaction mixture ensures the maximum catalytic activity of ALT. The activity of the enzyme depends on the temperature and the presence or absence of pyridoxal-5-phosphate in the reaction mixture.

Elevated ALT values ​​

• Acute and chronic liver diseases;
• taking hepatotoxic drugs;
• acute and chronic pancreatitis;
• acute myocardial infarction, acute myocarditis;
• trauma, skeletal muscle necrosis, myopathies, myositis;
• thermal shock;
• hemolysis of erythrocytes, hemolytic diseases;
• renal failure.

Decreased ALT values ​​

• Vitamin B6 deficiency;
• obstructive jaundice;
• end-stage liver failure.

Available studies in CMD:

• 0
  – Alanine aminotransferase (Alanine aminotransferase)

  By what blood test indicators can you understand that your liver is on the verge of failure? Some pathologies can develop over the years, and if they are not detected in time, the consequences can be very deplorable.

  April 18, 2022

  Source:

  Getty Images

  It is not for nothing that the liver is called the main filter organ: after all, everything that enters our body is absorbed into the bloodstream, and then passes through the filtration in the liver. Therefore, like no other body, it feels all the consequences of our wrong lifestyle: the habit of eating fatty and high-calorie foods, drinking alcohol, smoking cigarettes. Also, do not forget about the load that the body experiences while taking medications: the liver takes the entire blow from the breakdown of chemical compounds.

  Why the liver does not hurt

  – This is due to the fact that there are no pain receptors in the liver itself. They are located in the capsule of the liver, which surrounds the organ. When the capsule is stretched due to an increase in the size of the liver itself, this already leads to pain, the doctor explains.

  You may experience sudden sharp pain in the liver area due to an injury. For example, this can happen from a strong blow to the stomach. If in this case the capsule ruptures, there is a high probability that internal bleeding will begin.

  Sometimes the pain also occurs during physical exertion, for example, while running. In people who play sports irregularly, pain in the right hypochondrium is caused by intense filling of the liver with blood – the organ sharply increases in size and the capsule stretches.

  Read also

  About the most common diseases

  – If we talk about the rating, then in the first place I would put fatty degeneration of the liver. With this diagnosis, the organ tissue is replaced by adipose tissue. Many have probably heard about the foie gras dish – this is a goose or duck liver with fatty degeneration, or fatty hepatosis, which is provoked in a bird by a special “diet”. Unfortunately, many people are so accustomed to unhealthy eating that they develop a similar disease, says Maxim Rykov.

  If you do not change your menu in time, then fatty degeneration is replaced by what is called the frightening word “cirrhosis”. In this case, the liver tissues are replaced by connective tissue, the organ can no longer fully perform its functions.

  Interesting fact

  The liver has a very large margin of safety. It can regenerate well, regenerating itself on its own. But until a certain point! With frequent use of alcohol, the safety margin of the liver will be enough for about 15 years. For some people, it may take 5-10 years longer, it all depends on the individual characteristics of the organism.

  But this does not mean, , that all other organs have the same margin of safety, primarily the brain and intestines. They can suffer from alcohol much earlier. Therefore, doctors advise drinking as little as possible, and ideally completely abandoning alcohol.

  It is important to mention tumor diseases of the liver.

  – I mean both metastatic liver damage, when metastases of cancer or tumors appear on it, the primary localization of which falls on another organ, and primary tumors – hepatocellular carcinoma or adenocarcinoma of the liver, which begin to develop directly in the organ.

  It should be understood that liver metastasis in malignant tumors is actually an incurable situation. That is, the patient is incurable. With primary liver tumors, the prognosis is also unfavorable; liver and pancreatic cancer are one of the most aggressive forms of cancer. Therefore, it is so important to undergo regular examinations and take tests,” the expert explained.

  Not only alcohol and junk food destroy the liver

  Many are well aware that the liver suffers from fatty foods, alcohol and frequent medication. However, for some reason, people often forget about cigarettes. Nicotine destroys not only your lungs, but also the liver, because it is absorbed into the blood, and it will inevitably be “driven” through the body’s main filter.

  – This is not only about cigarettes, but also about all nicotine-containing products: vapes, electronic cigarettes, sticks, which have been very popular over the past few years. Although they have a lower burning temperature and no smoke, still has a toxic effect on the liver. Moreover, we still do not know how electronic smoking will affect health in 10 or 15 years,” says the doctor.

  Read also

  How to understand that something is wrong with the liver

  Some external signs can sometimes give out problems with the liver:

  • the skin has acquired a yellowish tint. It can vary from pale yellow to bright orange, which is associated with impaired bilirubin metabolism.

  • The whites of the eyes can also become yellow , mucous membranes can also change color.

  – These are the most important indicators, which very often the patient himself does not pay attention to, even when he looks at himself in the mirror. Most often, this is noticed by a person’s relatives or his entourage,” Maxim Rykov explains.

  If you notice that your skin or the whites of your eyes have turned yellow, then this is a good reason to make an appointment with a general practitioner or hepatologist.

  As for the pain syndrome, unpleasant sensations appear quite rarely. The pain is usually dull, but sometimes more acute, appears in the right hypochondrium, may worsen at night. Most often, the increase is explained by the psychological effect of pain perception, since at night, when a person is not busy with any business, is in peace and quiet, the pain is subjectively perceived as more severe, although its true intensity remains the same.

  By the way

  There is a myth that fasting and drinking warm mineral water helps to cleanse the liver. This is not true. In order for the liver to really cleanse, a person must fast for 1.5 months, drink only pure water without any additives or drugs. Naturally, this is impossible. Therefore, you need to understand that saving the liver is not in fasting, but in leading a healthy lifestyle, trying to eat right and refrain from alcohol and cigarettes.

  Many liver diseases can be asymptomatic, so laboratory test results are necessary and informative in the following cases:

  • you need to check for abnormal liver function;

  • assessment of severity of liver injury required;

  • need to monitor the course of liver disease and understand how the treatment is going;

  • clarification of the diagnosis is required.

  – Some biochemical tests are called liver tests. They can measure the amount of enzymes entering the bloodstream or assess liver function by examining hepatobiliary excretion. Other tests are used to assess the synthesizing function of the liver, says Marina Fursova.

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  About informative indicators in analyzes

  1. notransferases. They are one of the first to react to the fact that the liver undergoes some changes or suffers from frequent alcohol intake. AST and ALT are considered the two most important indicators of liver damage, although ALT is more specific than AST. So, in some cases, AST is directly compared with ALT and their ratio is calculated, which is can clarify why exactly the organ is damaged. Blood AST is also often compared with other tests such as alkaline phosphatase (AP), total protein, and bilirubin to determine a specific form of liver disease;

  2. Biochemical blood test for bilirubin. Bilirubin is a bile pigment produced by the breakdown of hemoglobin proteins, aging red blood cells. It is prescribed for liver diseases, violation of the outflow of bile and diseases of the biliary tract, the appearance of yellowness of the eyes and skin. This indicator is gives the doctor an understanding of how a person’s liver works;

  3. Alkaline phosphatase. Elevated levels of this hepatocyte enzyme suggest cholestasis , a condition in which bile cannot flow from the liver into the duodenum. The activity of alkaline phosphatase is sometimes increased in healthy people, this does not necessarily indicate any pathology. In order to correctly interpret the change in the activity of alkaline phosphatase, a comprehensive assessment of the results of other tests, as well as other medical data, is needed;

  4. Gamma-glutamyl transpeptidase (GGTP) . This is a protein found in the liver and pancreas, its activity in the blood increases with various liver pathologies, as well as with alcohol abuse . It reflects the state of the tissues of the liver and biliary tract;

  5. Prothrombin time (PT) and international normalized ratio (INR) are significant indicators of the ability of the liver to synthesize fibrinogen and vitamin K, on ​​which blood coagulation depends. In chronic liver diseases, an increase in INR or PT in indicates progression of liver failure . INR or PV levels do not increase in mild hepatocellular dysfunction and are often normal in cirrhosis;

  6. Whey proteins. Most whey proteins are synthesized by hepatocytes (liver cells) and help in the diagnosis of specific diseases. They also usually rise in response to damage (eg, inflammation) to various tissues, so the rise may be non-specific and unrelated to liver disease.

  See also

  “In order to diagnose various liver problems, a blood chemistry test is often sufficient. An increase in the level of ALT, AST and bilirubin will indicate that it is time to make an appointment with a hepatologist,” says Maxim Rykov.

  Venous blood test must be taken on an empty stomach. 12 hours before donating blood, exclude physical and emotional overstrain, do not smoke for 30 minutes before the test.