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Causes of High Liver Enzyme Test

Author:   Peter Sedesse MD

Medical testing of liver enzymes ALT, AST and ALP

There are three major enzymes found in liver cells for which medical testing is frequently performed.  These include Alanine Transaminase (ALT), Aspartate Transaminase (AST) and Alkaline phosphatase (ALP).  Liver enzymes are normally located within the cells and are only released into the bloodstream when the cell is destroyed.  For this reason, there are normally very low levels of these liver enzymes in the bloodstream and a test result that indicates elevated amounts of the enzymes indicate increased levels of liver cell death.  AST is also found in cardiac muscle so is frequently tested to see if heart tissue destruction has occurred.  In that instance, test results would indicate a raised AST level, but ALT would remain within normal ranges.   Normal liver enzyme levels for ALT, AST and ALP are listed below.

Normal Ranges of Liver Enzymes
ALT    9-52 IU/L
AST  10-35 IU/L
ALP  30-120 IU/L

Diagnostics of high liver enzyme test results

Many different conditions could cause liver enzymes to be elevated.  They are broken down into two major categories, chronic and acute.  Acute occurrences of elevated liver enzymes are not uncommon and can occur because of infections or even just taking certain medications can cause short-term increased liver cell death.  Chronic elevated liver enzyme test results indicate a much more severe underlying problem.

Each enzyme has particular uses that allow a doctor to help determine the underlying cause.  For instance, as mentioned, AST is also found within cardiac muscle as well as red blood cells.  The cells that contain ALP reside around the duct system within the liver, so elevated levels of ALP without corresponding AST and ALT levels pinpoint the issue to the duct system.

Cirrhosis as a cause of liver cell death and high liver enzymes

Cirrhosis is long term damage to the liver that results in scarring.  Liver cells are similar to normal body cells where cell death and cell reproduction are constantly occurring.  In the case of cirrhosis however, the damage to the tissue is so severe that the body no longer attempts to repair the tissue, but instead produces scar tissue to isolate the damage.  The most common cause of Cirrhosis is alcoholism.  As the scar tissue develops, cell death within the specific region escalates resulting in long term high liver enzyme levels from alcoholism and cirrhosis.

Medications can cause elevated liver enzyme test results

Some medications can also lead to a temporary increase in liver enzyme levels.  Statins are a class of medications used to treat high cholesterol that can cause elevated ALT, AST and ALP levels.  If these medications are anticipated to be used for a long period of time, the doctor will frequently order periodic liver enzyme tests to ensure the damage to the liver is minimal.  Acetaminophen (commonly known as Tylenol) can also lead to short term high enzyme levels.  Overdosing or abuse of Acetaminophen can cause permanent liver damage resulting in scarring and chronic elevated enzyme levels.

High ALP levels from Gallstones

As mentioned previously, the cells that contain ALP are found around the ducts of the liver.  One of the most common causes of high ALP enzyme levels is gallstones or other diseases of the gallbladder that block the ducts.  It is also possible for a growth, like a cyst or tumor to impede the ducts and cause excessive death to the liver cells surrounding them.

Obesity, toxins and food choices as a cause for high liver enzymes

Finally, obesity must be mentioned.  There are direct links to obesity and chronic liver problems that is usually associated with poor food choices by individuals.  The liver is responsible for removing many toxins from the body, which is why poor food choices causes stress on the liver and subsequently could lead to excessive cell death and elevated liver enzymes.

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