elevated Liver Enzymes

[Lresinger]

Hello,

I am in need of advice. I have had mildly elevated liver enzymes and can’t figure out the cause of it. I have been tested for everything and anything related to the liver (autoimmune, hepatitis, liver diseases) I have had a normal ultra sound and fibroscan. All lab work is normal except AST and ALT is elevated (127/90) taken after a strenuous workout. I don’t drink alcohol or take any medication except vitamin D. My GI doctor wants to do a liver biopsy. But I don’t want a biopsy done. All of my clinical work up is normal. Can exercise cause increase of liver enzymes?

[AyrshireK]

Yes your bloods can be elevated if they are taken following strenuous exercise and like you say they are only moderately elevated - not into the 100's or 1000's that you might expect in active hepatitis of some kind.

Was this a one off blood test or have you had several and there is a continued pattern of elevation?

No way in the UK would any doctor be suggesting liver biopsy as a first course of action. They only do that here if there is a continued pattern of elevation and there is no obvious known cause of elevation - they'd do scans, further blood tests including auto immune markers, genetic markers etc before putting you through liver biopsy to see what is going on in the liver on a cellular level.

Katie

[Lresinger in reply to AyrshireK]

Thank you for your response! Yes, this high of an elevation happened only once. My previois results were only raised very slightly, but it all started after I began exercise around 5 months ago. I’m supposed to get my labs repeated this week and they said they’d order a liver biopsy if still elevated. I’ve withheld exercise now for 2 weeks, kind of nervous to get repeat labs. They’ve ran every other test for me here and all the scans are normal. So I guess the biopsy is the next step if my labs are abnormal. I did have my gallbladder removed one year ago. I don’t have any other health issues. Thanks again.

[AyrshireK in reply to Lresinger]

It sounds like they are jumping the gun talking liver biopsy for a single (mild/moderate) elevation which could easily be a result of your strenuous exercise or even if you've recently fought any sort of illness. Usually doctors don't panic unless bloods are 3-4 times upper limits of normal or a continued pattern of elevation.

Hopefully your next set of bloods have returned to normal levels.

Did you have some symptoms or something that caused concerns to trigger these tests?

Katie

[Lresinger in reply to AyrshireK]

thanks, I agree with you. I haven’t had any symptoms of anything or really any cause of concern to get all the testing done. They were just mildly elevated and my GI doctor decided to run all of the testing. The only thing I can really think of is having my gallbladder out last year could’ve been the reason they wanted all the tests done.

[Anon888]

I was in a similar situation -50/80s for liver enzymes/mildly elevated. Fluctuated for 2 years.Like you the specialist wanted a liver biopsy. I reluctantly accepted - luckily it didn't happen - that's another story. When you have a liver biopsy, bloods are taken a week before to make sure you're coagulating properly etc and to take a reading. Mine had returned to normal. Bloods are a good guide but it has limitations as it's that snapshot in time.

If you read the guidelines for Drs and liver biopsy - specialists will be using their "flowchart" for liver biopsy referral and you may fall into that criteria "just".

Some people live with mildly elevated liver enzymes and find out when tested. Who is not to say this is their norm? Especially when most of the population are not tested regularly.

[carmik]

Have u been tested for alpha 1 anti trypsin deficiency.it is a genetic fault.

[Lresinger in reply to carmik]

Yes, I have been tested for that and every other blood test that can be done I’ve been checked for. Everything shows normal, even my cholesterol is normal. The only thing that was abnormal for me last year was my vitamin D level which I fixed and I had emergency surgery to remove my gallbladder, but everything else is ok. Except these elevated LFT’s.