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What Causes Elevated Liver Enzymes?

Posted on Tue, 3 Mar 2015

Question: Dear Doctor,
I am male, 58 yrs, BMI:24. take Lipitor (20 mg/daily) and Aspirin (100 mg/daily) for 11 years. last week, my abdomen US said that I have mildy diffused fatty liver and my
S.G.P.T: 91U/L (ref:0-55U/L)
S.G.O.T: 39U/L (ref:5-34U/L).
LDL cholesteral 65 mg/dl (ref: <130)
Triglycerides: 102mg/dl (ref:<200).
Total Cholesterol: 138 mg/dl (ref:<200).
Bilirubin total:1.47 mg/dl (ref:0.2-1.2)
Bilirubin direct:0.45 mg/dl (ref:<0.4)
Haemoglobin: 17.6 g/dl (ref: 13.5-18)
I was scared and surprised that I have fatty Liver, not sure if it is NAFLD or XXXXXXX the latter is more severe. I did have fatty liver before 2011, but over the past 3 years I have lost 6 kg as I swim for 30 minutes everyday and all my quarterly US and liver tests were normal over the past years.
question:
[1] Why my ALT and AST were suddenly elevated and my fatty liver is still there?
[2] is it possible that my AST/ALt elevation is due to the accumulated side effect of taking Lipitor for 11 years?
[3] what should I do to my fatty liver?

thank you, any kind doctor who is willing to answer my questions and help me with diagnosis and or treatment.
XXXX

Answered by Dr. Dr Samir Patil (8 hours later)

Brief Answer:
get tested for hepatitis B and C

Detailed Answer:
Hello,
I have gone through the description you have provided.
It seems that you have fatty liver and raised ALT levels.

NAFLD / XXXXXXX or drug induced transaminases is always a diagnosis of exclusion.

I would advise you to get tested for hepatitis B and hepatitis C both of which can cause fatty liver and raised liver enzymes.

Do you consume alcohol?

In case the answer is 'no' and hepatitis B and C are negative then it could be due to liptor( raised ALT) or NAFLD.

I would advise to repeat the AST and ALT levels after 4 to 6 weeks and invade they are still high I would consider stopping lipitor if possible ( as your LDL cholesterol is normal) in case the high ALT persists after stopping lipitor then it probably is due to XXXXXXX

In that case regular exercise( which you are already doing) along with Vitamin E should help.

Hope this helps
Do get back in case you have further queries
Regards
Dr Samir Patil

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Dr Samir Patil (2 hours later)

Dr. XXXXXXX
many thanks for your quick reply, I still have a few questions. appreciate if you can help:
[1] why after two years of daily exercise and 6.9% of weight loss, my fatty liver does not disappear?
[2] since over the past 3 years, none of the several ultrasonic tests and CT reported I had fatty liver, can this time the US be wrong?
[3] in case I have fatty liver, would I have NSAH or NAFLD? I guess XXXXXXX is a worse case. Any test to differentiate the two types?

Answered by Dr. Dr Samir Patil (4 hours later)

Brief Answer:
More like XXXXXXX

Detailed Answer:
Hello,

Fatty liver does not always disappear with exercise.
Fatty liver can develop at any time hence the previous could be normal.
In case your enzymes are raised after 3 months then it is likely to be XXXXXXX

The way to get a definitive diagnosis is to get a liver biopsy.(which I wouldn't suggest to undergo now)

A simple way to look at it is fatty liver + raised enzymes = XXXXXXX

Hope this helps
Regards
Dr Samir Patil

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Above answer was peer-reviewed by : Dr. Ashwin Bhandari