Do you have ongoing elevated liver enzymes? Are you wondering what you should test to figure out why these are elevated? In this article, we break down further testing for elevated liver enzymes. We will look at things like viral hepatitis, fatty liver, and more.
If you want to understand what to test when you have elavated liver enzymes, keep reading.
Testing for Elevated Liver Enzymes
Anytime there is consistently elevated liver enzymes, further testing should be done. By consistently we mean that several tests have been done and the results have been high ongoing for several weeks, if not months. Also, it is assumed when doing further testing for elevated liver enzymes that the tests are done because you don't really know why the liver enzymes are high to begin with. For instance, you are not drinking alcohol on a regular basis, you're not taking Tylenol on a regular basis, and you're not consuming medications that are known to cause your liver enzymes to be elevated.
Just to be clear, I mean, consuming Tylenol every single day. Or alcohol regularly every day or every other day. It has to be consistently and at least close enough to the test to expect that that could affect it. So it's has to be within a few days of the test, maybe even up to four days, depending on the amount of alcohol or acetaminophen, that's consumed. Now, assuming that you have already ruled out that those things are causing your elevated liver enzymes, what then?
In this scenario, there are a couple things right away that you want rule out. These are fairly straightforward to test for. One thing to rule out is exercise. Another is viral hepatitis, and the last is Nash also known as fatty liver or non-alcoholic hepatitis. If you don't really exercise, we know that's probably not an issue. However, there are some finer details about exercise and liver test that you might want to look at. Maybe you went for a hike that weekend close to your test or something along those lines. For finer details about exercise and liver testing see this article.
Can exercise affect liver enzyme tests?
The viral hepatitis tests are fairly black and white. It's just a blood test that you do. There are three different types of viral, hepatitis A, B, and C. Hepatitis A is fairly short lived, and usually accompanied by some digestive symptoms like diarrhea, even vomiting and nausea. So because it is short lived, you probably don't need to be tested for that one, unless you're in an area where that is common. It's not that common in the US, but if you are having those GI symptoms, this could be the cause. For hepatitis B and C, a simple antibody test blood test is done. If that test is negative, then you should move on and have the testing for non alcoholic hepatitis. Now, these all can be done at the same time. You can do the testing for Nash or fatty liver at the same time that you're getting your blood test done. If your antibody test for viral, hepatitis B or C are positive, you will need to follow up tests to confirm that it actually is present. I'm not going go into that here. However, just because you have positive antibodies, does not mean that you have viral hepatitis.
So how do you test for fatty liver? Basically it's an ultrasound of the liver that looks for fatty infiltrates in the liver tissue itself. If you have elevated triglycerides or blood sugar, it's likely that you also have fatty liver. Some people can still have fatty liver, even if their liver enzyme are not that high. The ultrasound will confirm how much fatty liver is there or if it's there at all.
So if there's nothing going on exercise wise, you don't have anything going on in terms of fatty liver, and you have ruled out viral hepatitis, then it's time to see a GI specialist. They can do an internal check for anything obvious. Usually they'll do a colonoscopy and make sure there's no, obvious signs there that could be impacting your liver. The most worrisome of course, would be some kind of GI cancer. Now the testing that they do is very important, but they are not really looking at microscopic things. Sometimes there will be biopsies done and they will look a little closer at the tissue. However, they are typically not looking for bacterial or fungal overgrowth. This can be part of the problem.
This leads to the next thing to think about in general which is overall toxic exposure. This can be any kind of chemicals that you are exposed to consistently. They could be work chemicals or heavy metals from a well water. It could be something in your house, maybe even mold in your house, which would be a major thing. These things can definitely cause elevated liver enzymes. There are lots of specialty lab tests that you can do to look deeper at some of these problems like chemical exposures and things coming from your digestive tract. Whether it's bacteria or yeast, heavy metal testing, lots of other testing can be done to identify where the problem is coming from. The first step though, is test for the more serious things. They are a little more obvious, and once those are ruled out, then you can move on to test for some of these more nuanced things.
That should give you a better understanding of testing for elevated liver enzymes. If you have questions about the content in this article, please ask it in the comment section below.
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