The Significance of Liver Enzymes

by Michael_Koger

Evaluation of liver enzymes requires consideration of many clinical and laboratory possibilities.

Primary care physicians regularly encounter clients with abnormal chemistry profiles. The question arises—when this occurs, how can he or she manage it?

Naturally, hepatocellular injury can lead to elevation of aminotransferases. When cholestatic disorders are present, the medical doctor will have an especial interest in blood tests for alkaline phosphatase and bilirubin [1, 2].

The list of conditions which may occur in this regard is quite lengthy. Some of them include fatty liver disease, medication overdose, and alcohol toxicity. Autoimmune hepatitis, alpha-1 antitrypsin deficiency, viral hepatitis, and hereditary hemochromatosis are others [1, 2].

Diligent Investigation Necessary

     These laboratory elevations, however, do not take place only because of liver problems.  For example, rhabdomyolysis may lead to a similar outcome.  In any event, some of these patients will present to the health care facility without any complaint.  It is important that the clinician investigate these situations regardless of how benign they seem [1, 2].

     These scenarios, therefore, require a thorough history and physical examination.  The history must include questions about non-prescription drugs and herbal remedies.  Of course, the medical doctor has to inquire about medications that other physicians have administered to the patient.  It is well-known that illicit drugs may lead to liver function test abnormalities [1, 2].

     Viral hepatitis is an infirmity which clinicians have studied for many decades.  The health care team has to consider blood transfusions, unprotected sex, organ transplant, perinatal transmission, and travel to parts of the world as possible causes.  One must also remember that health care employees are at risk for it [1, 2].

     Inquiry about medications which clients take can entail quite a long list.  Other well-known infirmities to consider are non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis.  There may be 100 million people in the United States with NAFLD

[1, 2].

     Another important item is the occurrence of aminotransferase elevation during the third trimester of pregnancy.  The tests can also be abnormal with physical exercise [1, 2].


     In conclusion, the occurrence of liver enzyme abnormality is an important finding which deserves good investigation and determination of what else may be present.


  1. Agganis, B., Lee, D., and Sepe, T.  (2018).  Liver enzymes:  No trivial elevations, even if asymptomatic.  Cleveland Clinic Journal of Medicine, 85, 612-617.
  2. Malakouti, M., Kataria, A., Ali, S., and Schenker, S.  (2017).  Elevated liver enzymes in asymptomatic patients—What should I do?  Journal of Clinical and Translational Hepatology, 5, 394-403.
  3. The photo shows a library at the U.S. Centers for Disease Control and Prevention and is reprinted with permission from that organization.
  4. Copyright 2018 Michael Koger, Sr.  All Rights Reserved.


The information contained in this article is for educational purposes only, and one should not use it for diagnosis or treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.

Updated: 10/26/2018, Michael_Koger
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