Question

My doctor ran some blood tests, and then a few days later the receptionist called and told me the liver function tests were high. I should refrain from using any Tylenol tablets or alcohol. I hardly use either. What could be causing the problem?

Answer

The liver performs many functions, including detoxification and purification of the blood. It participates in many critical metabolic functions in the body and serves as a storage bin for certain nutrients. The problem that you are describing is a common situation that is seen in practice. Often patients are found to have elevations of certain blood tests that signal liver inflammation. These are the so-called liver function tests. In many cases the tests are simply done as a routine part of the annual physical exam or as part of a laboratory general screening when you come in for another complaint.

Elevated liver function tests can mean many things. Many types of disorders, both mild and serious, can cause elevations in the liver enzymes. Very often medications, inflammatory conditions, infections (especially viral types of hepatitis), metabolic disorders (fat accumulation in the liver), alcohol, gallstones, and some autoimmune disorders can all lead to liver dysfunction. Getting additional historical information from the patient can help to narrow down the possibilities. For example, a thorough medication history is needed. A history of right-sided abdominal pain can point to gallbladder disease. Other symptoms can indicate a generalized infection or an autoimmune disorder.

Evaluation of the elevated liver tests usually involves more blood tests to rule out metabolic and inflammatory disorders such as hemochromatosis (too much iron in the liver) and autoimmune liver disease. An ultrasound of the liver and gallbladder may be done as well. Other tests, such as CT scanning or nuclear tests to evaluate the function of the liver, may also be needed. It is a good idea to avoid any potential medications or toxins that can injure the liver. Alcohol is directly toxic to the liver and may have a profound effect on the liver already damaged by another problem. Acetaminophen (Tylenol) can also lead to liver disease if taken in large quantities, but much smaller doses can do damage in an unhealthy liver, especially if alcohol is also playing a part. You should follow-up with your doctor to have the proper tests done in order to make a complete diagnosis. Ultimately you may need to see a gastroenterologist (who specializes in liver diseases as well as stomach and bowel disorders) for further evaluation.

Links

• Liver Function Tests