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Elevated Liver Enzymes - What Are They?

The human liver contains thousands of enzymes, which are special types of protein cells that help necessary chemical reactions to take place. Enzymes trigger activity in the body's cells, speeding up and facilitating naturally occurring biochemical reactions, and maintaining various metabolic processes within the liver.

Why Do Enzymes Become Elevated?

An elevated liver enzyme reading may be an indication of a liver disorder, damage to liver cells, or an obstruction to the biliary tract (also known as the gallbladder and bile ducts).

This list of enzymes and their functions outlines possible indications when elevated amounts of liver enzymes are detected:

• Alanine transaminase (ALT): An enzyme that helps metabolize protein. When the liver is damaged, ALT is released in the bloodstream. An increase in ALT levels may indicate hepatocellular disease, active cirrhosis, metastatic liver tumor, infection or toxic hepatitis, severe burns, pancreatitis, myocardial infarction (heart attack), trauma, severe burns, acute hemolytic anemia, crushing injuries, gangrene, or shock.¹
  
  
• Alkaline phosphatase (ALP): An enzyme needed in small amounts to trigger specific chemical reactions. Normally present in the liver, bone, kidney, and intestine, higher than normal levels may indicate disorders as common as gallstone disease, alcohol abuse, and drug-induced hepatitis, or in less common disorders, such as primary biliary cirrhosis or biliary tumors.²
  
  
• Aspartate transaminase (AST): This enzyme plays a role in the metabolism of the amino acid alanine. An increase in AST levels may indicate hepatocellular disease, active cirrhosis, metastatic liver tumor, infection or toxic hepatitis, severe burns, pancreatitis, myocardial infarction (heart attack), trauma, severe burns, acute hemolytic anemia, crushing injuries, gangrene, or shock.³
  
  
• Gamma-glutamyl transferase (GGT): The GGT enzyme plays a role in metabolism, specifically in the transference of certain chemical groups from one molecule to another. Higher than normal levels may indicate liver or bile duct injury.
  
  
• Lactate dehydrogenase (LDH): An enzyme found in blood and body tissues, LDH is involved in energy production in cells. Elevated levels of LDH may indicate liver damage.

Causes of Elevated Liver Enzymes

A wide range of health problems can lead to elevated liver enzymes. Some common causes include,

• Adrenal insufficiency (inadequate levels of hormones released by the adrenal gland)
• Alcohol abuse
• Alpha-1-antitrypsin deficiency (a disorder caused by defective production of the glycoprotein alpha-1-antitrypsin)
• Autoimmune disorders of the liver and bile ducts, such as autoimmune hepatitis
• Celiac disease
• Diabetes
• Elevated triglycerides (fat tissues)
• Excessive use of certain herbal supplements, such as comfrey, kava, pennyroyal, and skullcap
• Hepatic steatosis and steatohepatitis, and non-alcoholic steatohepatitis (NASH)
• Infections such as viral hepatitis and mononucleosis
• Medications including certain nonsteroidal anti-inflammatory drugs, cholesterol-lowering medications, antibiotics, anti-seizure medications, and acetaminophen
• Metabolic liver disease such as hemochromatosis and Wilson's disease
• Muscle disorders
• Obesity
• Thyroid disorders
• Tumors of the liver or bile ducts

Elevated Liver Enzymes – Further Testing

Having elevated liver enzymes isn't an indication of a specific liver disease. And while it is not uncommon to have elevated liver enzymes, in order to determine the underlying cause, additional tests – including a physical examination, ultrasound, a CAT scan (computed axial tomography), an MRI (magnetic resonance imaging), a biopsy, and liver blood tests – are usually necessary.

For more information on the liver, please review the liver cleansing overview article, or search for related articles by using the search box.

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Notes:
1. Healthscout.com, Health Encyclopedia - Diseases and Conditions, "Description of Liver Enzymes (Elevated)," http://www.mayoclinic.com/health/liver-function-tests/AN00876 (accessed October 19, 2007).
2. Ibid
3. Ibid