Let's say you went to see the doctor for a routine check-up and got your blood test results. The doctor, who looked at the report, said, "Your liver enzymes are a little elevated." You see that the values in front of the two letters ALT and AST in your report are higher than normal. It's normal to feel a little scared when this happens. But don't panic. Today we're talking about a condition called ``Transaminitis'', in which liver enzymes are elevated.
Simply put, what is Transaminitis?
`Transaminitis` is not a serious medical condition. It means that the levels of certain enzymes called `transaminases` in your blood have increased significantly. The two main enzymes are `Alanine Transaminase (ALT)` and `Aspartate Transaminase (AST)` .
Think of your liver as a big factory. These enzymes are the workers inside the cells of that factory. Normally, these workers are inside the factory. But when the liver is under some kind of pressure, damage, or stress, the liver cells are damaged and some of these workers leak out, that is, into our blood. With a blood test report, we measure the amount of enzymes that have accumulated in the blood.
Most of the time, this condition is discovered by chance. High ALT and AST levels are found during a blood test done for another reason. However, some people develop symptoms like jaundice, yellowing of the eyes and skin, or pain in the upper right side of the abdomen, and their doctor may order these tests, specifically to check liver function.
Is it dangerous for these enzymes to be elevated?
This problem is something that many people have. `Transaminitis` is the first warning that there is some damage to the liver cells. It's like the `check engine` light on a car coming on. It tells you that there is something wrong with the car, and you need to look into it. And so is this.
The severity of this depends on the underlying cause .
- Temporary causes: These enzymes can be elevated temporarily when taking certain medications or due to a temporary infection. Once the cause is gone, the liver recovers and the enzyme levels return to normal.
- Long-term causes: However, if this damage continues due to a chronic disease, it can become serious over time. Our liver has an amazing ability to heal, but when damage continues, it loses that ability and can lead to a condition called liver failure.
So, this is not just a single number. It is an important indicator that gives you an idea of your overall health.
What are the possible causes of transaminitis?
There can be many reasons for this. Let's divide them into two categories: the most common reasons and the relatively less common reasons.
| Cause | Simple explanation |
|---|---|
| Common Causes | |
| Fatty Liver Disease | Currently, it is a very common cause in Sri Lanka. Specifically, a condition called Metabolic dysfunction-associated steatotic liver disease (MASLD) . Metabolic factors such as poor diet, weight gain, diabetes, and high cholesterol contribute to this. |
| Excessive alcohol use (Alcohol-induced Hepatitis) | Excessive alcohol consumption directly damages the liver, which can lead to temporary or long-term liver damage. |
| Viral Infections (Viral Hepatitis) | Viruses such as hepatitis A, B, C, D, and E can cause inflammation of the liver. This can lead to chronic hepatitis B and C. |
| Drug-induced effects (Toxic Hepatitis) | Some painkillers, cholesterol-lowering drugs, tuberculosis drugs, and other medications can affect the liver. The doctor is always on the lookout for this. |
| Less Common Causes | |
| Other reasons | Conditions such as immune system problems (autoimmune hepatitis), hereditary diseases (hemochromatosis, Wilson disease), heart attack, jaundice, thyroid disease, and very rarely liver cancer. |
Does it mean anything special if AST is higher than ALT?
Usually, when the liver is damaged, both of these enzymes increase together. The enzyme ALT is more specific to the liver. That means it is mainly found in the liver. However, the enzyme AST is also found in the heart muscle, skeletal muscle, and other tissues in addition to the liver.
Therefore, if the AST value is significantly higher than the ALT value , the doctor will also consider other factors. For example:
- Alcohol-induced liver disease: In this condition, the AST/ALT ratio increases.
- Cirrhosis: This pattern can be seen even as the disease progresses.
- Extrahepatic causes: AST levels can also be elevated in cases such as myocardial ischemia or severe muscle damage (rhabdomyolysis).
Most importantly: These are just tips. Don't try to diagnose yourself based on your report. That should definitely be done by your doctor.
How does the doctor treat this?
First of all, remember that there is no direct cure for `Transaminitis`. Because it is not a disease, but a symptom. Therefore, the doctor's main goal is to find the cause of the elevated enzymes and treat that cause.
The treatment process usually goes like this:
1. Medical history: The doctor will ask you about your lifestyle (diet, exercise, alcohol use), medications you take, and any medical conditions in your family.
2. Further tests: More tests will be ordered to confirm the cause.
- Repeat blood test.
- Tests for hepatitis B and C viruses.
- An abdominal ultrasound scan.
- If necessary, other specialized blood tests.
3. Treatment according to the cause: Treatment is determined after the cause is found.
- Fatty Liver: Lifestyle changes are key. A healthy diet , regular exercise , and weight loss are essential.
- If due to alcohol: The only solution is to stop using alcohol completely .
- If it's due to a medication: The doctor will decide whether to change the medication or reduce the dosage.
- If it is due to a virus: Treatment for that virus will begin.
In most cases, when the underlying cause is properly treated, the damage to the liver stops and enzyme levels return to normal.
Take-Home Message
- Transaminitis (elevated liver enzymes) is a warning sign that your liver is under some stress. Don't panic when you see it.
- There can be many reasons for this. Fatty liver, alcohol use, viral infections, and certain medications are common causes.
- Treatment is not directed at the enzyme level, but at the underlying condition that caused it to rise.
- If you see elevated ALT and AST levels in your blood test, never ignore it. Be sure to see your doctor for proper advice and treatment.
- In many cases, adopting a healthy lifestyle (good diet, exercise) is a great help in maintaining liver health.
👩🏽⚕️ Additional questions (FAQs)
💬 What is Syncope / Fainting?
This is not just a sleepy/bored moment! 'Syncope' in medicine is a very dangerous medical emergency in which, due to some fatal or sudden cause, the blood and oxygen to the brain stops completely for a few seconds (Temporary loss of blood flow to the brain), causing the person to suddenly collapse to the ground (Loss of consciousness/Postural tone collapse) and lose consciousness!
💬 What are the main causes of syncope/fainting when a person is standing/walking?
There are 4 main causes of this: 1) 'Cardiogenic Syncope' - If the heart suddenly stops beating/has a heart attack, the heart cannot pump blood to the brain, causing loss of consciousness! 2) Hypoglycemia (in diabetics). 3) Vasovagal syncope - Loss of consciousness due to nerve shock in unbearable pain/at the sight of blood/extreme fear. 4) Seizures/Epilepsy.
💬 When someone faints, what are the 'fatal/emergency situations' that require immediate hospitalization, rather than just pouring water on their face and staying at home?
If you fall and get up within a few seconds/if you fall after lying down, try giving some water/sugar. But the biggest danger! Before you lose consciousness and fall, if you 1) have chest pain/heart attack or difficulty breathing, 2) when you fall, your whole body shakes and convulses/foams at the mouth (seizures/fits), 3) if you fall and don't say a word/are in a coma for several minutes, you should call an ambulance immediately and take them to the hospital!
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