Elevated liver enzymes may mean a person’s liver is not working properly. Damaged or inflamed liver cells release enzymes into the bloodstream, which a blood test will detect.
Doctors test people for elevated liver enzymes if they have symptoms of conditions that typically cause liver damage.
In this article, learn about the causes of elevated liver enzymes, as well as the symptoms and treatment of each of these conditions.
If a person’s blood test results show elevated liver enzymes, a doctor will investigate possible underlying causes. They may do further tests in addition to asking about a person’s lifestyle and dietary habits.
The most common cause of elevated liver enzymes is fatty liver disease. Research suggests that 25–51% of people with elevated liver enzymes have this condition.
Other health conditions that typically cause elevated liver enzymes include:
Other conditions that less commonly cause elevated liver enzymes include:
- autoimmune hepatitis
- celiac disease
- infection with the Epstein-Barr virus, a type of herpes
- liver cancer
- hemochromatosis, when the body absorbs too much iron
- mononucleosis
- sepsis, or blood poisoning
- Wilson’s disease
- polymyositis, which involves inflammation of the muscles
Certain medications, including some pain relievers and statins, can also cause elevated liver enzymes.
Elevated liver enzymes are themselves asymptomatic, but the underlying conditions responsible for them may cause symptoms.
Below are the common causes of elevated liver enzymes, as well as their symptoms:
Fatty liver disease
Fatty liver disease occurs when fats build up in the liver. If this buildup is due to alcohol consumption, it is called alcoholic fatty liver disease.
When alcohol is not a causative factor, the buildup of fat in the liver is called nonalcoholic fatty liver disease (NAFLD). People with metabolic syndrome are at a higher risk of NAFLD.
Fatty liver disease may sometimes cause tiredness and pain on the right side of the abdomen, but it often causes no symptoms.
A doctor may test someone with alcohol use disorder or metabolic syndrome for elevated liver enzymes to check for fatty liver disease.
Learn about what to eat to help manage fatty liver disease here.
Metabolic syndrome
Metabolic syndrome is a group of symptoms that increase the risk of heart disease. These symptoms include:
- high blood sugar
- high blood pressure
- being overweight
- high cholesterol
The doctor may test people with one or more of these symptoms for elevated liver enzymes.
Hepatitis
Hepatitis is a virus that leads to liver inflammation. There are several different strains of hepatitis, which are called A, B, C, D, and E. The symptoms of all of the strains are similar.
Common hepatitis symptoms include:
- fatigue
- muscle soreness
- joint pain
- nausea
- loss of appetite
- stomach pain
- fever
- dark urine
- skin itching
- yellowing of the eyes and skin (jaundice)
The doctor may test a person with symptoms of hepatitis for elevated liver enzymes.
Alcohol or drug use disorder
Drinking too much alcohol or using illicit drugs may lead to liver inflammation or damage.
Liver inflammation due to alcohol consumption is called alcoholic hepatitis. When drugs are the underlying cause, doctors call it toxic hepatitis.
The symptoms of alcoholic and toxic hepatitis are similar to those of other strains of hepatitis.
If a person is experiencing symptoms of alcohol or drug use disorder, the doctor may check their liver enzyme levels and offer various forms of treatment and support.
Cirrhosis
Cirrhosis is a type of liver damage. A person with cirrhosis has permanent scarring of the liver, which can prevent it from working properly. Cirrhosis may eventually lead to liver failure.
Cirrhosis symptoms include fatigue and skin itching. People are at risk of cirrhosis if they do not receive treatment for hepatitis or fatty liver disease.
If a person has cirrhosis symptoms, the doctor may check their liver enzyme levels.
A blood test can show elevated liver enzymes. The blood test checks for raised levels of AST and ALT, which are enzymes that the liver releases when it becomes inflamed or damaged.
If a doctor finds that a person has raised AST or ALT levels, they are likely to carry out further tests to determine the underlying cause.
Different ratios of AST to ALT may indicate various underlying causes.
The treatment for elevated liver enzymes will focus on managing the underlying condition causing the increased levels.
The treatments for some common causes of raised AST or ALT levels include:
Fatty liver disease
People can work with their doctor to treat NAFLD with weight loss. The doctor may advise a person to make lifestyle changes to lose weight, such as:
- exercising more
- eating a healthful, balanced diet
- trying to burn more calories than they consume
Speaking with a nutritionist or even a personal trainer can help someone stay on track with their weight loss plan.
If a person has fatty liver disease due to alcohol consumption, the doctor will support them in reducing their alcohol intake.
Metabolic syndrome
Treatments for metabolic syndrome include:
- losing weight
- exercising more
- eating a healthful, balanced diet
- managing blood sugar levels
- reducing stress levels
Lifestyle changes that may help a person manage stress include:
- exercise
- meditation
- mindfulness
- yoga
- journaling
- reducing commitments
Hepatitis
Treatments for hepatitis depend on whether it is acute or long term. A doctor may recommend the following treatments for acute hepatitis:
- bed rest
- plenty of fluids
- avoiding alcohol
Treatment for long term hepatitis usually includes antiviral medication.
Alcohol or drug misuse disorder
Treatments for alcohol or drug use disorder include:
- behavioral therapies
- medications
- support groups
Anyone who feels as though their alcohol or drug use is causing health problems or interfering with their everyday life should speak to their doctor.
Cirrhosis
Cirrhosis is permanent liver damage, so it is not always treatable. However, the underlying cause of liver damage is usually responsive to treatment. The conditions that we discussed above may all lead to cirrhosis.
Treatments such as a modified diet, weight loss, and reduced alcohol consumption can all reduce the risk of further liver damage. The prompt diagnosis and treatment of conditions that affect the liver can help prevent cirrhosis.
Elevated liver enzymes are a sign that a person has an inflamed or damaged liver. Many conditions may cause liver inflammation or damage.
Doctors use a blood test to check for elevated liver enzymes. They may test anyone with symptoms of one of the conditions that they know to raise liver enzyme levels.
If a person’s blood test results reveal that they have elevated liver enzymes, the doctor will investigate the underlying cause. Once they make a diagnosis, the doctor will recommend suitable treatments.
Fatty liver disease is the most common cause of elevated liver damage. People with fatty liver disease can manage their condition by losing weight, if necessary, or reducing their alcohol consumption. Other causes of liver inflammation are also treatable.
Elevated liver enzymes are usually a temporary sign. Liver enzyme levels may return to normal quickly if a person follows the doctor’s recommended treatment plan for the underlying condition.