Elevated Serum Transaminases: Causes and Next Steps - Gastroenterology and Hepatology

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Elevated serum transaminases, specifically alanine aminotransferase (ALT) and aspartate aminotransferase (AST), can indicate liver inflammation or damage. The normal range for these enzymes typically falls below 40 U/L, so values of 86 U/L and 90 U/L are indeed elevated and warrant further investigation.
Causes of Elevated Transaminases:
There are several potential causes for elevated transaminases, including:
1. Liver Conditions:
- Hepatitis: Viral infections (like hepatitis A, B, or C) can cause liver inflammation.

- Fatty Liver Disease: Non-alcoholic fatty liver disease (NAFLD) is increasingly common, especially in individuals with obesity, diabetes, or high cholesterol.

- Alcoholic Liver Disease: Excessive alcohol consumption can lead to liver damage.

- Liver Cirrhosis: Scarring of the liver due to chronic liver disease can elevate transaminase levels.

2. Medications and Toxins:
- Certain medications, including over-the-counter pain relievers like acetaminophen, can cause liver damage if taken in excess.

- Exposure to toxins or chemicals can also lead to liver injury.

3. Metabolic Disorders:
- Conditions like hemochromatosis (iron overload) or Wilson's disease (copper accumulation) can affect liver function.

4. Other Conditions:
- Muscle disorders, thyroid disease, and even strenuous exercise can lead to elevated AST levels, as AST is also found in muscle tissue.

Next Steps:
Given that your husband has consistently elevated transaminase levels, it is advisable to consult a healthcare provider for a thorough evaluation. Here are some recommended steps:
1. Detailed Medical History and Physical Examination: The doctor will likely ask about your husband's medical history, medication use, alcohol consumption, and any symptoms he may be experiencing (like fatigue, jaundice, or abdominal pain).

2. Further Laboratory Tests:
- Liver Function Tests: Additional tests to assess other liver enzymes (alkaline phosphatase, bilirubin) and proteins (albumin) can provide more insight into liver function.

- Viral Hepatitis Panel: Testing for hepatitis viruses can help identify any viral infections.

- Autoimmune Markers: If autoimmune hepatitis is suspected, specific tests can be conducted.

- Imaging Studies: An ultrasound or CT scan of the liver may be recommended to visualize any structural abnormalities.

3. Lifestyle Modifications:
- Diet: Encourage a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while avoiding excessive fats and sugars.

- Exercise: Regular physical activity can help maintain a healthy weight and improve liver health.

- Limit Alcohol: If your husband consumes alcohol, reducing or eliminating intake can significantly benefit liver health.

4. Monitoring: Regular follow-up with blood tests to monitor transaminase levels and liver function is essential. Depending on the underlying cause, the doctor may recommend specific treatments or lifestyle changes.

In summary, elevated serum transaminases are a signal that should not be ignored. It is crucial to follow up with a healthcare provider for a comprehensive evaluation and appropriate management. Early detection and intervention can prevent potential complications and promote better liver health.