Elevated Liver Enzymes

The liver plays a vital role in the body, like processing medications, removing toxins from the blood, and supporting nutrient absorption and transportation.

Changes in liver function can impact nearly every bodily system. If the liver is damaged or infected, it might release certain chemicals that can be detected during routine bloodwork. Healthcare providers routinely check liver function to make sure this essential organ is functioning effectively.

Elevated liver enzymes can occur for many reasons. Most often, elevated liver enzymes are temporary and resolve on their own without treatment. Occasionally, elevated liver enzymes require additional tests to find out what's going on.

This article explains elevated liver enzymes, including potential symptoms, causes, and treatments. It also provides information about when to see a healthcare provider and what to do if you learn that your liver enzymes are elevated.

What Are Elevated Liver Enzymes?

When the liver is injured or inflamed, it may release certain substances into the bloodstream. Elevated levels of these substances, including liver enzymes, might indicate a problem.

A simple blood test can detect liver enzyme levels. Your healthcare provider may discover elevated liver enzymes after a routine blood test during an annual physical, or they may test liver function if you have certain symptoms.

There are several different liver enzymes. A typical liver function test might assess the following liver enzymes:

• Alanine transaminase (ALT)
• Aspartate transaminase (AST)
• Serum alkaline phosphatase (ASP)
• Gamma-glutamyl transpeptidase
• Lactic dehydrogenase
• 5'-nucleotidase

Liver enzymes are just one piece of the puzzle. Liver function tests include several other markers and must be interpreted with respect to each individual, including their medical history, symptoms, and family history.

Symptoms of Elevated Liver Enzymes

Most individuals with elevated liver enzymes don't experience any symptoms. In these cases, elevated liver enzymes may be detected during routine screening.

Others may have symptoms of liver disease that prompt testing, like:

• Jaundice (yellowing of the skin and whites of your eyes)
• Nausea
• Vomiting
• Diarrhea
• Abdominal Pain
• Changes in stool or urine color
• Fatigue

Healthcare providers may also test liver function based on certain risk factors. These include:

• Family history of liver disease
• History of alcohol use disorder
• Possible exposure to hepatitis, particularly in IV drug users or if you've traveled to certain parts of the world
• Certain medication use

Individuals with particular medical conditions may also undergo routine liver tests. People with severe hypertension, lupus, diabetes, and colon cancer are at an increased risk for developing liver disease and may require more routine screening.

Causes of Elevated Liver Enzymes

Elevated liver enzymes alone don't indicate a specific disease or condition. Some individuals with elevated liver enzymes have no underlying cause and require no treatment.

Conversely, some individuals with severe liver impairment may have normal liver enzymes. For this reason, it's important to work with your healthcare provider to discuss your complete medical history, test results, current medications, and symptoms.

Potential causes of elevated liver enzymes include:

• Certain medication use
• Liver cancer
• Heavy alcohol use
• Infections, including cytomegalovirus, mononucleosis, hepatitis, and many others
• Non-alcoholic fatty liver disease (NAFLD)
• Celiac disease
• Wilson's disease
• Thyroid disorders

There are many other possible causes of elevated liver function. Your healthcare provider can help you understand why your liver enzymes might be elevated.

What Medications Can Cause Elevated Liver Enzymes?

The liver helps process many different medications that may result in altered liver enzymes. Your healthcare provider may sometimes test liver function before starting certain medications and repeat this test throughout your treatment to ensure that your liver function is doing well.

While there are many medications that can affect liver enzymes, these are some of the most common:

• Over-the-counter (OTC) pain medications, like Tylenol (acetaminophen)
• Drugs that control cholesterol levels, like statins
• Antibiotics like penicillin, Cipro (ciprofloxacin), and tetracycline
• Anti-seizure drugs, including Tegretol (carbamazepine), Dilantin (phenytoin), and valproic acid
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Tuberculosis drugs like isoniazid, pyrazinamide, and rifampin
• Antiviral drugs like Valtrex (valacyclovir) and Norvir (ritonavir)
• The antidepressant Prozac (fluoxetine)
• Drugs that may be abused, including alcohol, cocaine, and anabolic steroids
• Herbal supplements, including comfrey tea, kava, skullcap, yohimbe, and ephedra

It's important to tell your healthcare provider about all medications you take, including herbal medications, OTC drugs, and recreational drug use.

How to Treat Elevated Liver Enzymes

Elevated liver enzymes are only a sign of liver function, not a diagnostic tool. Your healthcare provider will need to conduct other tests to determine the cause of your elevated liver enzymes and determine the right course of treatment.

Elevated liver enzymes may result from a temporary infection or medication usage that requires no treatment. If your liver enzymes are only mildly elevated and you have no other symptoms or risk factors, your healthcare provider may choose to wait or retest at a later date.

If your healthcare provider has concerns about your elevated liver enzymes, they may do additional testing to determine the cause. Once they determine the source of your elevated liver enzymes, they can tailor the treatment to suit your particular problem.

Are There Tests to Detect the Cause of Elevated Liver Enzymes?

There are several tests that can provide additional information about your elevated liver enzymes.

• Additional blood tests: These might include serum bilirubin, serum albumin, or blood clotting tests like international normalized ratio (INR).
• Abdominal ultrasound: Ultrasound is a noninvasive test that uses sound waves to create a picture of your internal organs.
• Transient elastography: This noninvasive tool measures how sound waves move through the liver and can provide insight into how stiff the liver is due to fibrosis.
• Computerized tomography (CT): A CT scan compiles multiple X-rays into a single three-dimensional image to create pictures of internal organs. It allows healthcare providers to analyze the inside of your body without invasive testing.
• Magnetic resonance imaging (MRI): MRI is another non-invasive test that uses radio waves and magnetic fields to create pictures of internal organs. MRI typically produces better images of soft tissues (like the liver) compared to CT scans.
• Liver biopsy: This test involves removing a small amount of the liver and examining it under a microscope.

If your healthcare provider is concerned about your elevated liver enzymes, they may choose one or more of these tests to collect additional information.

When to See a Healthcare Provider

Elevated liver enzymes are typically detected during routine screenings or as part of an examination for another issue.

However, if you are experiencing symptoms of liver failure, like jaundice, nausea and vomiting, abdominal pain, dark urine, or fatigue, it's important to talk to your healthcare provider.

If you have a close family member with liver disease or concerns about alcohol use disorder or IV drug use, it's a good idea to speak with your healthcare provider since these conditions may increase your risk of liver problems.

Summary

Elevated liver enzymes may be caused by many different infections, disease processes, or medications. While elevated liver enzymes might indicate a problem, many individuals with elevated liver enzymes won't require specific treatment. Additional tests, including bloodwork, imaging, and biopsy, can help to determine the cause of your elevated liver enzymes. Your healthcare provider can help you understand your risk factors to better understand why you might see elevated liver enzymes on your bloodwork report.

A Word From Verywell

It can be concerning to receive abnormal lab results, but elevated liver enzymes aren't a reason to panic, especially in the absence of other risk factors or symptoms.

Talk to your healthcare provider about your elevated liver enzymes to better understand what might be causing your results. Be sure to mention any medications, herbal supplements, alcohol, or drug use. In the meantime, you can help keep your liver healthy by maintaining a healthy weight, exercising regularly, and eating a varied diet that includes whole foods.