Re: elevated liver enzymes

Posted By HFHSM.D.-DM on May 20, 1998 at 14:00:37:

In Reply to: elevated liver enzymes posted by Barbara on May 18, 1998 at 16:46:51:






About one year ago my husband had some blood tests done, and was told he had elevated liver enzymes.  He was then asked all the ususal questions about alcohol use (very light, maybe one beer a month), and tested for hepatitis and had an ultrasound.  A doctor of gastroenterology examined him and suggested he lose weight and have the tests run again.  He had tests last week and his enyzmes are still elevated. (He hasn't lost much weight) I have tried to find information about this condition, and have not been successful.  Could you tell me where to find more information about elevated liver enzymes and what may be the cause, if there could be some underlying cause not detected by our physician?  Thank you.  



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Dear Barbara:
Im frequently asked to comment on abnormal liver enzymes for MEDHELP and it is one of the more challenging things I do.  Identifying the cause of liver enzymes abnormalities is not always straightforward and really involves a comprehensive assessment of an individual.  This includes a careful history (including medication and alcohol use) and physical examination and usually a relatively bewildering array of blood tests to look for common and unusual liver disorders.  The evaluation can also include imaging studies of the liver (CT and/or ultrasound) and, in some cases, a liver biopsy.  In addition, commenting on abnormal liver enzymes becomes more difficult when I do not know the actual liver enzymes or what specific tests have already been done to them.  Not all liver enzyme tests are the same and certain tests point more to certain diagnoses.  As a result, I am very hesitant to make a specific diagnosis over the web.  Nevertheless, I do want provide some information that may be helpful to you.  
Typically, when we see someone with abnormal liver enzymes we look for relatively common things first.  We rule out viral hepatitis with blood tests and we take a careful history looking for alcohol and medication use.  For instance, acetaminophen (tylenol), taken in large quantities, can cause liver inflammation.  Well often do tests for other liver diseases.   These include more unusual conditions such as hemachromatosis, autoimmune hepatitis, Wilsons disease and alpha-1-antitrypsin deficiency.  We might well consider an ultrasound test of the liver just to make sure there are no mass lesions that might cause liver enzyme abnormalities.  Again, this evaluation can vary depending upon which precise liver enzymes are abnormal.
If all these tests are unrevealing we often consider a diagnosis called non-alcoholic steatohepatitis (NASH) or fatty liver.  I mention this because, it sounds like this may be the diagnosis your physician is considering.  This is a condition of typically mild inflammation of the liver seen most commonly in patients who are obese or diabetic or who have high levels of cholesterol and triglycerides.  The condition is thought to result from damage caused be excess fat in the liver.  It usually runs a very benign course and usually does not cause severe damage to the liver.  It sometimes responds to loss of weight or lowering of cholesterol/triglycerides in the blood.  The only way to make the diagnosis more accurately is by liver biopsy but we dont always advise liver biopsy when we are considering this diagnosis.
A lot of what we do as hepatologists (liver specialists) depends upon the individual patient and his/her particular clinical setting.  I also stress (as you asked) that sometimes we arent able to figure out what is causing abnormalities in liver enzymes, though we always make it a point to rule out any obvious, treatable forms of liver disease.  Probably, the most important thing to do is to find a physician with whom you are comfortable and to make sure you get an acceptable and understandable explanation for what he/she is doing and why they are doing it.  On some occasions, it can be helpful to get a second opinion. If you have additional questions or more information, feel free to post the material back to MEDHELP or you are always welcome to contact us directly at Henry Ford at [phone].  If you are in the Detroit area, you are always welcome to come see us.  We have an active group of liver specialists (hepatologists).
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.  
I hope this information is helpful to you.