Liver enzymes, from the traditional liver enzymes test, are proteins produced in the liver. These enzymes are produced by the liver and are used to perform different functions inside the organ.
Liver enzymes do not belong to the bloodstream, but several medical conditions can cause elevated liver enzymes in the blood. It is usually when liver cells die and spill their contents into the blood.
In this article, we will explore some of these diseases and offer guidance on the usual treatment when your liver enzymes are elevated.
What diseases cause elevated liver enzymes?
Elevated liver enzymes, also known as transaminitis, are a sign of a wide range of diseases, including hepatitis, cirrhosis, and drug toxicity. The most common cause of elevated liver enzymes is hepatitis, an inflammation of the liver that a virus, alcohol intake, or autoimmune conditions can cause.
Other causes of elevated liver enzymes include biliary cirrhosis, non-alcoholic fatty liver disease, acute liver failure, drug-related liver toxicity, and certain inherited diseases. Hepatitis C is the most common form of chronic hepatitis in the United States and is caused by a virus transmitted through contact with infected blood. In some cases, drug-related liver toxicity can lead to elevated liver enzymes. This may occur as a result of taking medications in higher doses than prescribed or taking multiple drugs at the same time. Certain inherited diseases, such as Wilson’s disease and alpha-1 antitrypsin deficiency, can also cause elevated liver enzymes.
1. Alcoholic hepatitis
A) Causes of alcoholic hepatitis
Hepatitis is an inflammation of the liver. There are several types of hepatitis depending on the causes and the onset of the disease—for example, acute and chronic, alcoholic or infectious hepatitis.
Alcoholic Hepatitis is a form of liver inflammation caused by excessive drinking. It is one of the most severe forms of alcoholic liver disease and can cause permanent damage to the liver if left untreated.
As the name implies, the cause of alcoholic hepatitis is chronic alcohol ingestion, especially in heavy doses. Alcohol is a toxin for the liver. This substance creates free radicals, which react against the cell wall and causes the breakdown of cell membranes. As a result, these cells become damaged and die off. The inflammation that follows is called acute alcoholic hepatitis. If this condition is not treated properly, it can lead to cirrhosis.
B) Symptoms of alcoholic hepatitis
Symptoms of alcoholic hepatitis can range from mild to severe, and the most common include:
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- Jaundice: It is caused by a buildup of bilirubin in the blood. The liver will try to eliminate the excess bilirubin through the urine and stool. However, if the liver can’t do that, then the bilirubin builds up and causes jaundice.
- Abdominal pain: Abdominal pain can be caused by hepatitis, which is usually located in the upper right portion of the abdomen. Sometimes, a perforated peptic ulcer, ascites, or pancreatitis can worsen abdominal pain.
- Fatigue: It is often the earliest complaint, along with weakness, nausea, and vomiting. Fatigue is particularly important in chronic hepatitis because the organism doubles energies to eliminate the problem.
In more severe cases, it can lead to liver failure and death.
C) Treatment of alcoholic hepatitis
Treatment of alcoholic hepatitis usually involves stopping the consumption of alcohol and following a healthy lifestyle. A doctor may prescribe medication to reduce this condition’s symptoms and prevent further liver damage. Other dietary and lifestyle modifications, such as eating a balanced diet, exercising regularly, and avoiding alcohol, are fundamental parts of the treatment. In some cases, surgery may be required to remove a portion of the damaged liver or to repair the liver.
It is essential to seek medical attention if you are experiencing any of the symptoms of alcoholic hepatitis or if you suspect that you may be at risk for this condition. Early diagnosis and treatment can prevent further damage to the liver and help reduce the risk of complications.
2. Autoimmune hepatitis
A) Causes of autoimmune hepatitis
The exact cause of autoimmune hepatitis is unknown, but it is believed to result from an abnormal response from the body’s immune system. In this process, the body attacks itself by producing antibodies attacking liver cells. These antibodies can also attack other body parts, causing symptoms such as muscle weakness.
The body attacks its own liver cells, leading to inflammation and progressive liver scarring that ends up in cirrhosis. Various factors, including genetics, certain medications, and certain infections, can cause this. An infectious disease can trigger underlying genetics in the immune system and start a process of autoimmune damage to the liver and other tissues.
Autoimmune hepatitis can be a part of another autoimmune syndrome, such as systemic lupus erythematosus and rheumatoid arthritis.
B) Symptoms of autoimmune hepatitis
The most common symptoms of autoimmune hepatitis include jaundice, abdominal pain, and fatigue, which is similar to alcoholic hepatitis. Other symptoms include:
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- Joint pain: In autoimmune hepatitis, joint pain can be caused by inflammation of the synovium in joints. This inflammation can also be triggered by autoimmune damage and can be linked to lupus or rheumatoid arthritis, which are also autoimmune conditions.
- Dark urine: In all types of hepatitis, dark urine is associated with increased bilirubin levels in the blood. Bilirubin is a waste product from the breakdown of red blood cells. As bilirubin accumulates in the blood, it turns brownish-red, creating a dark color in the urine.
- Pale stools: All types of hepatitis also feature pale stools, which are also caused by an exchange of bilirubin. Instead of being released by the gallbladder to the gut, it stays in the liver and accumulates in the blood.
C) Treatment of autoimmune hepatitis
Treatment for this condition can include corticosteroids, immunosuppressants, and other medications. Another autoimmune disease is the root cause in many cases, and treating this condition will also improve autoimmune hepatitis. Additionally, lifestyle changes such as maintaining a healthy diet, exercising regularly, and reducing stress can help manage the symptoms of autoimmune hepatitis.
In some cases, a liver transplant may be recommended, but that only happens when the liver damage is too much to handle with medications. It is essential to receive regular check-ups and treatments, as autoimmune hepatitis can be a progressive and potentially life-threatening condition if left untreated.
3. Infectious hepatitis
A) Causes of infectious hepatitis
Infectious hepatitis is triggered by a viral infection that affects the liver, caused by one of the hepatitis viruses or another agent with hepatic involvement. It is one of the most commonly diagnosed diseases worldwide and can be classified into five different types depending on the strain of the hepatitis virus: A, B, C, D, and E.
It is most commonly spread through contact with infected blood or body fluids, sharing needles, contaminated food, and water, or through sexual contact. Since the cause of infectious hepatitis is very clear and concise, it is one of the only types of hepatitis that can be prevented through hygiene, safe sex, and security measures when handling blood and needles.
B) Symptoms of infectious hepatitis
Symptoms of hepatitis are similar to the ones mentioned above, even joint pain, which can sometimes happen in this case, but it is not so common. Other symptoms of this disease include:
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- Fever: In infectious hepatitis, fever is one of the most common symptoms, as it happens with all contagious diseases. The fever can be higher in hepatitis A and low-grade fever in chronic hepatitis (as in B and C). The temperature may be increased or low and can persist for many days.
- Nausea and vomiting: This symptom is particularly prevalent and more severe in hepatitis A. In these cases, the patient may vomit many times a day and have diarrhea, as described below.
- Diarrhea: In infectious hepatitis, diarrhea is a frequent complication. Diarrhea occurs after the onset of jaundice. It usually lasts two to three weeks but can be prolonged. It is not always accompanied by fever or abdominal pain
C) Treatment of infectious hepatitis
The most effective treatment for hepatitis is prevention, which can be achieved by avoiding risky behaviors, such as sharing needles, unprotected sex, and drinking contaminated water. Vaccines are available to protect against some types of hepatitis; these are particularly recommended for individuals in high-risk groups.
If the infection does occur, treatment options depend on the type of hepatitis virus. Antiviral medications can be used to treat hepatitis B and C. At the same time, liver transplantation is an option in the most severe cases when the disease has progressed nonstop for many years.
Additionally, lifestyle modifications such as avoiding alcohol, engaging in regular exercise, and maintaining a healthy diet can help to reduce the risk of hepatitis and its complications.
4. Fatty liver disease
A) Causes of fatty liver disease
Fatty liver disease is an increasingly common condition, often caused by an unhealthy lifestyle and poor dietary habits. It occurs when excess fat accumulates in the liver and can lead to severe complications if left untreated.
The two most common types of fatty liver disease are alcoholic fatty liver disease, caused by excessive alcohol consumption, and non-alcoholic fatty liver disease (NAFLD), which is caused by other factors such as obesity and diabetes.
As noted, fatty liver disease is sometimes considered under the spectrum of alcoholic liver disease, but that is not always the case. Sometimes dietary choices are the cause, and sometimes there is no traceable cause, probably due to genetic predisposition.
B) Symptoms of fatty liver disease
Unlike other conditions mentioned above, fatty liver disease does not always have symptoms. Patients start to feel something different when the disease is very severe, and the infiltration of fat is in an advanced state.
In an advanced state of fatty liver disease, the symptoms are similar to hepatitis and include abdominal pain, swelling, loss of appetite, and fatigue. If left untreated, fatty liver disease can lead to cirrhosis, liver cancer, and even liver failure.
However, many patients are diagnosed when screening as healthy or when doctors try to diagnose another disease. Thus, instead of waiting for the symptoms, it is recommended to perform regular check-ups with your doctor to detect this and other diseases.
C) Treatment of fatty liver disease
Treatment of this ailment involves lifestyle changes such as eating a balanced diet, exercising regularly, and quitting smoking, as well as medications to reduce inflammation and limit fat accumulation in the liver.
Early diagnosis and treatment are vital for the successful management of fatty liver disease. Regular medical check-ups and blood tests can help identify the condition and allow for early intervention, reducing the risk of complications. With a combination of lifestyle changes and medications, many people with fatty liver disease can lead healthy and fulfilling lives for many years without experiencing complications.
However, patients may need medical treatment and sometimes liver transplantation in advanced cirrhosis when complications arise.
5. Other causes of elevated liver enzymes
There are many other causes of elevated liver enzymes. For example, you could have a multi-organ failure due to decompensation in type 2 diabetes, which usually happens to late-stage patients and the elderly.
An elevation of liver enzymes can also happen in patients with celiac disease because of the inflammatory process that is part of the disease. A small percentage of patients with celiac disease have extra-intestinal symptoms, such as fatigue, weight loss, and bone pain. The most common extra-intestinal symptom is diarrhea, and the liver can also be involved.
The third cause of elevated liver enzymes worth considering is drug-induced hepatotoxicity. In other words, consuming drugs harmful to your liver or a high dose of a given medicine for a very long period.
Conclusion
Liver enzymes are normal proteins found in the liver cells and are not found in other parts of the body. They shouldn’t be in the bloodstream. Thus, if you have elevated liver enzymes, it is a sign that your liver cells have broken down and spilled their contents into the blood.
This can happen in different forms of hepatitis, including infectious hepatitis (hepatitis A, B, or C), autoimmune hepatitis, drug-induced hepatitis, fatty liver disease, cirrhosis, and other conditions not directly associated with the liver, such as celiac disease.
It is essential to have a precise diagnosis of the condition before starting your treatment, and it is sometimes possible to prevent hepatitis through lifestyle changes (a healthy eating pattern and frequent exercise).