Getting control of deranged liver enzymes
Liver enzymes are proteins produced by the liver that play a vital role in many important bodily processes, including digestion and detoxification. When blood tests show that these enzymes are raised, this is referred to as deranged liver enzymes. While often found incidentally, raised liver enzymes can sometimes signal an underlying liver condition that requires further attention. In this article, a consultant hepatologist explains the dangers of deranged liver enzymes, and how they can be managed.
What are deranged liver enzymes?
The most commonly measured liver enzymes include alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT). When one or more of these enzymes are above the normal range, this is considered a derangement.
In many cases, people with deranged liver enzymes do not experience any symptoms. This is why they are often picked up during routine blood tests or investigations for other issues. However, if symptoms are present, they may include fatigue, nausea, abdominal discomfort, or jaundice. In more advanced cases of liver disease, symptoms may also include swelling of the abdomen or legs, confusion, or easy bruising.
What causes deranged liver enzymes?
There are numerous potential causes for raised liver enzymes, ranging from benign, temporary issues to serious liver diseases. Common causes include:
- Non-alcoholic fatty liver disease, which is increasingly common due to rising rates of obesity and type 2 diabetes
- Alcohol-related liver disease
- Viral hepatitis
- Medications and herbal supplements, which may cause liver inflammation or toxicity
- Autoimmune liver diseases, such as autoimmune hepatitis or primary biliary cholangitis
- Inherited conditions, such as haemochromatosis or Wilson’s disease
Those most at risk include individuals with metabolic syndrome (obesity, high blood pressure, high cholesterol and diabetes), heavy alcohol use, a family history of liver disease, or those taking long-term medications known to affect the liver.
How are deranged liver enzymes diagnosed?
Deranged liver enzymes are detected through a simple blood test known as liver function tests (LFTs). If one or more enzymes are raised, the next step usually involves identifying the pattern of derangement – for example, whether the issue appears to be related to liver cell injury (high ALT and AST) or bile flow obstruction (raised ALP and GGT).
Further investigations are often required and may include:
- Repeat blood tests
- Ultrasound scans or other imaging to assess liver size, texture and blood flow
- Tests for viral hepatitis, autoimmune markers and iron or copper levels
- In some cases, a liver biopsy may be necessary to confirm a diagnosis
Importantly, liver enzymes can be mildly raised for reasons that do not reflect serious disease. A careful clinical assessment is essential. Persistent derangement may be a warning sign of progressive liver damage. Early identification and management can prevent long-term complications, including liver failure and liver cancer. Therefore, even in the absence of symptoms, abnormal results should not be ignored.
How are deranged liver enzymes treated?
Treatment depends entirely on the underlying cause. In cases of fatty liver disease, weight loss, improved diet and increased physical activity are often highly effective. For alcohol-related liver disease, abstinence from alcohol is essential and can lead to significant improvement.
If the cause is viral hepatitis, treatment may include antiviral medications. Autoimmune liver disease often requires immunosuppressive therapy. Where medications are responsible, stopping or switching the drug may lead to resolution.
Regardless of the cause, regular monitoring and lifestyle changes are key. While deranged liver enzymes can understandably cause concern, they are often reversible with prompt action. With a combination of accurate diagnosis, appropriate treatment and healthy lifestyle choices, most people can expect a good outcome.
