When your liver enzymes go up

Our liver enzymes can be found and measured in our blood. — AFP

During a routine blood test, I was told that I had raised liver enzymes. What are liver enzymes?

Liver enzymes are proteins in your liver that speed up chemical reactions in your body.

The liver is one of the most important organs in your body, and it performs many functions to keep you alive.

Some of these functions requiring enzymatic chemical reactions include bile production, helping your blood clot, breaking down the food you eat, and helping to clear toxins from your body, as well as fighting infections.

These liver enzymes also help recycle some of your blood components, maintain your blood sugar, produce cholesterol (This is not a bad thing as you need some cholesterol in your body to live!) and regulate certain hormones.

What are these liver enzymes called?

The commonest liver enzymes are:

• Alkaline phosphatase (ALP)

  This enzyme can be found in your liver, bile ducts and bones.

  Where the liver is concerned, this enzyme can be raised if you have liver disease or some sort of blockage in your bile duct.

• Alanine transaminase (ALT)

  This enzyme helps break down proteins.

  It is raised if you have liver disease.

• Aspartate transaminase (AST)

  This is primarily a liver enzyme.

  If raised, it could signal liver cell disease.

• Gamma-glutamyl transferase (GGT)

  This signifies activity in the liver, and also, a bile duct being blocked if raised.

All these enzymes appear in your blood and can be tracked via a liver function test.

If your liver or its biliary ducts are injured in one way or another, its cells will leak or release these enzymes in higher quantities into your bloodstream.

Oh dear. Do raised liver enzymes then mean that I have a liver disease?

It may. The amount or level of liver enzymes raised is an important indicator of the severity of that liver disease.

But raised liver enzymes can also be caused by factors outside the liver, such as extreme physical exertion, bone disease (for raised ALP) and congestive heart failure.

Raised liver enzymes can also be caused by increased body weight, such as when you put on weight rapidly.

Let’s talk about the liver, however.

Raised liver enzymes usually show one or more of these types of liver problems:

• Damage to your liver cells
• Blockage of your bile ducts
• Impaired liver function.

Some causes of raised liver enzymes are:

• Certain types of medications

  Check what medicines you are on and tell your doctor.

  Even paracetamol or statins are included in this list.

  Herbal supplements can also cause raised liver enzymes.

• Recreational drugs
• Ingested toxins
• Heavy and frequent alcohol drinking
• Fatty liver
• Viral hepatitis
• Viral infections from other parts of the body that also affect the liver
• Autoimmune hepatitis
• Haemochromatosis (a genetic disorder causing iron overload)
• Excessive breakdown of red blood cells
• Blockage of the bile duct (commonly from a gallstone)
• Liver cirrhosis
• Liver failure
• Liver cancer.

I am quite worried. What should I do next?

It is best to consult a hepatologist – this is a doctor who has trained to specialise in the liver.

The pattern of your raised liver enzymes, including which liver enzymes are raised and how high are the levels, needs to interpreted by an expert.

For example, a combination of raised ALT and AST may mean injury to your liver cells by some of the causes stated above.

But a combination of raised GGT and ALP may mean bile duct blockage.

You will need further testing, such as with an ultrasound of the liver, an MRI (magnetic resonance imaging), or even a liver biopsy.

But I don’t have any other symptoms.

Many people with elevated liver enzymes have no symptoms at all.

Raised liver enzymes can be the first indicator that you will develop liver disease later on in life.

You may also be perfectly well for the rest of your life, and the cause of your raised liver enzymes may never be found.

But if you do have symptoms, look out especially for abdominal pain, abdominal fullness (which may signify liver enlargement), bloating, jaundice, fever, vomiting and diarrhoea, itchy skin, pale stools, and tiredness.

Whatever it is, if your blood test shows that you have raised liver enzymes, you need an expert opinion and other tests to ascertain the cause.

And if no cause is found, you need to monitor yourself for as long as it takes, just in case something develops along the way,

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email [e-mail]. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.