Gallstones are hardened deposits that form in the gallbladder, a small organ beneath the liver storing bile. When problematic, these stones can affect the liver. This article explores their relationship with elevated liver enzyme levels and their impact on liver function.
Gallstones and Their Impact on Liver Enzymes
Gallstones can lead to elevated liver enzymes by obstructing bile flow. Bile, produced by the liver, travels through ducts to the small intestine. If a gallstone lodges in a bile duct, it creates a blockage.
This blockage prevents bile from draining, causing it to back up into the liver. This backup, known as cholestasis, increases pressure within bile ducts and liver cells. Sustained pressure and impaired bile flow damage these cells, causing their enzymes to leak into the bloodstream. This can also trigger inflammation (cholecystitis or cholangitis), contributing to cell injury.
Key Liver Enzymes and What They Indicate
Liver enzymes are proteins that facilitate reactions in liver cells. When liver cells are damaged or bile flow is obstructed, these enzymes can spill into the bloodstream, indicating an issue. Blood tests measure their levels to assess liver health.
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are found within liver cells. Elevated ALT and AST often suggest liver cell damage from inflammation or bile backup. Alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) are enzymes associated with bile ducts. High ALP and GGT levels indicate bile flow problems or obstruction, like those caused by gallstones. When both are elevated, it indicates a biliary tract issue.
Recognizing Symptoms and Seeking Care
Gallstones causing liver enzyme elevation often present with symptoms. Jaundice, a yellowing of the skin and eyes, is a common sign due to bilirubin buildup in the bloodstream. Dark brown urine and pale or clay-colored stools can also occur as bile is not properly excreted.
Pain in the upper right abdomen, often radiating to the back or shoulder, is frequent, especially after eating. This pain, known as biliary colic, can be sudden, intense, and last for hours. Nausea, vomiting, and fever, sometimes accompanied by chills, also indicate complications like inflammation or infection. Prompt medical attention is important to prevent further complications if these symptoms appear.
Diagnosis and Treatment Approaches
Diagnosing gallstones affecting liver enzymes involves a combination of tests. Blood tests measure liver enzyme levels, bilirubin, and other markers indicating inflammation or infection. If these tests show abnormalities, imaging studies are typically performed.
An abdominal ultrasound is often the initial imaging test, effective in detecting gallstones and assessing bile ducts. CT scans and MRI (including MRCP) provide more detailed views of bile ducts and surrounding structures, identifying stones lodged outside the gallbladder. In some cases, endoscopic retrograde cholangiopancreatography (ERCP) may be used for both diagnosis and removal of bile duct stones.
Treatment for gallstones causing liver issues depends on severity and presentation. If gallstones are not causing symptoms, watchful waiting may be an option. However, if gallstones cause pain or complications like elevated liver enzymes, treatment is generally recommended.
Medications can dissolve certain gallstones, though this approach is less common and often takes time. Surgical removal of the gallbladder, known as a cholecystectomy, is the most common and definitive treatment for symptomatic gallstones. This procedure, often laparoscopic, prevents future gallstone problems by removing the organ where stones form.