FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

"DOCTOR SLEUTH" NEEDED TO FIND REASON FOR ELEVATED LIVER ENZYMES

Question: I'm a 56-year-old woman who recently had routine blood tests as part of my annual physical exam. The liver tests came back abnormal. I don't drink and have been feeling well. What could cause the results to be abnormal?

Answer: First, I want to commend you for getting a periodic health exam. This is a bit like periodic maintenance on your vehicle. It is better to keep all systems working than to have an unexpected breakdown. You'll notice that I used the term "periodic health exam" instead of "annual physical." This is because it is no longer recommended to routinely have a physical exam ever year. Instead, the frequency of the exam and the things that are checked during it, including the tests that are ordered, vary depending upon your age, family health history and your personal health history.

The liver is one of the body's most complex chemical factories. It is responsible for modifying almost everything we consume so that the body can either utilize or eliminate it. In addition, the liver also modifies some of the body's waste products so that they can be recycled or gotten rid of. The scope of these contributions to the process we call metabolism is so broad that life without a liver is impossible.

Individual liver cells wear out and are replaced by new ones. As the old cells fail, they spill some of their metabolic enzymes into the blood. When a condition produces a greater than normal rate of liver cell death, the resultant level of enzymes in the blood rises. This is what your lab tests showed. Actually, as you might have guessed from the diverse range of things that the liver must metabolize, there are several different enzymes covered under the broad category of liver enzymes. Aspartate aminotransferase (AST, SGOT), Alamine aminotransferase (ALT, SGPT), Alkaline phosphatase (ALP), lactic dehydrogenase (LDH), Gamma-glutamyltransferase (GGT), and total bilirubin are the ones that are most commonly checked for.

The liver tests your doctor ordered as part of your periodic exam may be elevated for a number of reasons. The specific enzymes and the degree of their elevation often helps direct the search for the cause of the liver injury. Since I don't have that information, I'll offer some general thoughts.

Liver injury sufficient to cause this problem can result from both prescription and non-prescription drugs. In the former category, cholesterol lowering medicines, particularly those in the statin family, blood pressure medicines, seizure drugs and antibiotics are capable of causing elevated liver enzymes. In the latter category, alcohol -- as you are aware -- is a common culprit. Also, acetaminophen, particularly if it's frequently taken with alcohol, can cause liver problems. Perhaps your problem is due to a drug that you are taking.

Another cause of enzyme elevation is infection. This can include infectious hepatitis (most commonly the A, B, or C type), AIDS and mononucleosis. Parasites can also invade the liver and, thereby, cause enzyme elevation.

Tumors of the liver cause cell destruction and, therefore, cause elevated enzymes. Both malignant and non-malignant ones can do this. 

Unfortunately, I can't offer a simple answer to your question other than to recommend that you go back to your doctor. As you have probably figured out, it will take an experienced sleuth to track down the answer to your mystery.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.