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Elevated liver enzymes
I'm a 31 yr old female an I'm 4 ft 11 in an weigh 220. I recently went an had an annual physical with routine blood work, I got my results an they said my liver enzymes were elevated. A few years ago I had the same thing happen but when retested they were fine. I struggle with anxiety an I'm scared to death that there is something wrong with me(my liver). I would appreciate any advice???? I am on medication for blood pressure but other than that I am healthy.
Clinical Aspects of Fatty Liver Disease: Diagnosis of Fatty Liver Disease
"...Laboratory Abnormalities in NAFLD
The definitive diagnosis of NAFLD is based on histologic examination of liver biopsy samples (see Table 3 ). However, ethical considerations as well as inherent risks associated with this procedure limit its widespread applicability as a screening test in apparently healthy individuals or even to those with significant risk factors. It is therefore essential to have sensitive and specific surrogate markers to screen those individuals at highest risk before subjecting them to liver biopsy.
The measurement of serum ALT levels has been used most commonly as a screening test to diagnose presumed NAFLD on a population-wide basis.[27,33] However, there are multiple problems associated with this test in terms of its specificity, sensitivity, and predictive value. Serum ALT levels may be completely normal in patients with advanced grade of steatohepatitis or even cirrhosis.[17] It is also well known that the degree of ALT elevation does not correlate with the extent of hepatic damage.[50] Another commonly encountered problem with the use of ALT as a population-based screening test is related to the cutoff value used to detect normality. The use of ALT values of > 43 U/L in subjects surveyed in the NHANES study showed that 4.8% of the men and 1.7% of women in the population had elevated ALT.[51,52] However, when the ALT cutoff values are lowered to > 30 U/L in men and > 19 U/L in women, the prevalence of abnormal ALT in the population increases to 12.2% in men and 14% in women.[53] The sensitivity and specificity of ALT values in discerning hepatic steatosis and steatohepatitis have been studied in morbidly obese individuals undergoing bariatric surgery. It was seen that by using a cutoff value > 40 U/L, ALT values diagnosed steatosis with a sensitivity of 45% and specificity of 100%.[54] While diagnosing steatohepatitis, the sensitivity of the same ALT values remained the same but the specificity decreased to 64%. When the diagnostic net was expanded to include ALT, alkaline phosphatase, or gamma glutamylytransferase (GGT), the sensitivity was increased to 53% but specificity dropped to 75% for steatosis and 50% for steatohepatitis. An elevated transaminase level had a positive predictive value of 90% for NAFLD and 34% for NASH.[55,56] Although the value of transaminases as a population-based screening test has its pitfalls, it continues to be commonly used in clinical practice to stratify patients with appropriate risk factors for NAFLD to be directed for further investigations. Most subjects with NAFLD have an ALT value < 250 IU/L and values over 300 IU/L warrant a search for additional or alternative causes of ALT elevation.
The near-universal presence of metabolic syndrome in patients with NAFLD makes these patients present on numerous occasions with evidence of target organ dysfunction related to the effects of this syndrome. Hence, almost 30 to 50% may present with overt diabetes or glucose intolerance and may have evidence of diabetic target organ damage.[6,9,57] Also, 20 to 80% of patients have evidence of dylipidemia.[15,57,58] The significance of elevated antinuclear antibody that has been reported across several studies is currently unclear.[9,59] ..."
See: http://www.medscape.com/viewarticle/497001_5
"...Laboratory Abnormalities in NAFLD
The definitive diagnosis of NAFLD is based on histologic examination of liver biopsy samples (see Table 3 ). However, ethical considerations as well as inherent risks associated with this procedure limit its widespread applicability as a screening test in apparently healthy individuals or even to those with significant risk factors. It is therefore essential to have sensitive and specific surrogate markers to screen those individuals at highest risk before subjecting them to liver biopsy.
The measurement of serum ALT levels has been used most commonly as a screening test to diagnose presumed NAFLD on a population-wide basis.[27,33] However, there are multiple problems associated with this test in terms of its specificity, sensitivity, and predictive value. Serum ALT levels may be completely normal in patients with advanced grade of steatohepatitis or even cirrhosis.[17] It is also well known that the degree of ALT elevation does not correlate with the extent of hepatic damage.[50] Another commonly encountered problem with the use of ALT as a population-based screening test is related to the cutoff value used to detect normality. The use of ALT values of > 43 U/L in subjects surveyed in the NHANES study showed that 4.8% of the men and 1.7% of women in the population had elevated ALT.[51,52] However, when the ALT cutoff values are lowered to > 30 U/L in men and > 19 U/L in women, the prevalence of abnormal ALT in the population increases to 12.2% in men and 14% in women.[53] The sensitivity and specificity of ALT values in discerning hepatic steatosis and steatohepatitis have been studied in morbidly obese individuals undergoing bariatric surgery. It was seen that by using a cutoff value > 40 U/L, ALT values diagnosed steatosis with a sensitivity of 45% and specificity of 100%.[54] While diagnosing steatohepatitis, the sensitivity of the same ALT values remained the same but the specificity decreased to 64%. When the diagnostic net was expanded to include ALT, alkaline phosphatase, or gamma glutamylytransferase (GGT), the sensitivity was increased to 53% but specificity dropped to 75% for steatosis and 50% for steatohepatitis. An elevated transaminase level had a positive predictive value of 90% for NAFLD and 34% for NASH.[55,56] Although the value of transaminases as a population-based screening test has its pitfalls, it continues to be commonly used in clinical practice to stratify patients with appropriate risk factors for NAFLD to be directed for further investigations. Most subjects with NAFLD have an ALT value < 250 IU/L and values over 300 IU/L warrant a search for additional or alternative causes of ALT elevation.
The near-universal presence of metabolic syndrome in patients with NAFLD makes these patients present on numerous occasions with evidence of target organ dysfunction related to the effects of this syndrome. Hence, almost 30 to 50% may present with overt diabetes or glucose intolerance and may have evidence of diabetic target organ damage.[6,9,57] Also, 20 to 80% of patients have evidence of dylipidemia.[15,57,58] The significance of elevated antinuclear antibody that has been reported across several studies is currently unclear.[9,59] ..."
See: http://www.medscape.com/viewarticle/497001_5
My recent blood test shows my ALT at 31 with a range of 10-35 and although its still in normal range I'm concerned since its a the high side. my AST was 26 with range of 8-39. Does the AST mean you have a fatty liver? I'm not on any meds.
I got a call from my doctors office my test for hepatitis came back NEGATIVE!! She said they were only slightly elevated an could been due to meds I was taking....might retest liver enzymes in a few months.
Thanks for the reassurance!! I really hope it turns out to be nothing. I dont feel ill and i have been working on loosing weight. It just takes time... I'll get my results Friday so Im keeping my fingers crossed!
If those numbers are your ALT and AST they are not extremely high. They'd probably be characterized as moderately elevated.
I think Zeak's post was very good. Fatty liver is not uncommon and especially in overweight patients. If you are diagnosed with fatty liver you'll probably be advised to lose some weight. There are no specific medications to treat fatty liver and weight loss and diet and lifestyle change is the typical approach.
Good luck,
Mike
I think Zeak's post was very good. Fatty liver is not uncommon and especially in overweight patients. If you are diagnosed with fatty liver you'll probably be advised to lose some weight. There are no specific medications to treat fatty liver and weight loss and diet and lifestyle change is the typical approach.
Good luck,
Mike
Thanks alot. My doc did another test for Hepatitis and im awaiting the results of that. Im just a nervous wreck cause I am thinking I have liver failure or something like that! I just dont feel sick and I think that my levels were like 70 on one and 45 on anthother so im not sure if that is extremely high. Does that make sense?!
Hey there I know how it is to have anxiety about health issues. Well first off I am not a doctor or in the health field Im just goin thru some liver concerns myself, mine are from poor life choices (drinking) but Ive made a 180 turnaround and am gonna finish right. Anyway, as you probably know medication can affect the liver especially some cholesterol and BP medications. Drinking alcohol and being overweight can as well. The most common reason for abnormal liver tests is fatty infiltration of the liver is what my doc told me and I had that 18 mos. ago. My labs were ok but CT scan showed it. I imagine they'll retest you. It may just be the meds and they can adjust that and your enzymes should level. That happened to a relative of mine they adjusted the meds and in 6 mos they leveled out. Good luck to you.
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