When liver cells are stressed or damaged, they release proteins called liver enzymes into the bloodstream. Their presence in higher-than-normal amounts indicates potential liver injury or inflammation. While discovering elevated liver enzymes in a child can cause worry, it is often a temporary situation or a manageable condition.
What Liver Enzymes Are and Why They Matter
Liver enzymes are specialized proteins found within the cells of the liver. Two of the most commonly measured enzymes are Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST), often referred to as transaminases. Other enzymes that can indicate liver health include Alkaline Phosphatase (ALP) and Gamma-Glutamyl Transferase (GGT). These enzymes facilitate various biochemical reactions necessary for the liver’s normal functioning.
Under healthy conditions, these enzymes remain primarily within liver cells. When liver cells are damaged, their membranes become permeable, allowing enzymes to leak into the bloodstream. Elevated levels in a blood test signal liver distress, but are an indicator of a problem, not a specific diagnosis.
Why a Child’s Liver Enzymes Might Be High
Many factors can lead to elevated liver enzymes in children, ranging from temporary conditions to more persistent issues. Often, these elevations are due to causes that are not dangerous, are easily treatable, or resolve on their own.
Infections are a frequent cause of elevated liver enzymes in children. Common culprits include viral infections such as mononucleosis (Epstein-Barr virus), cytomegalovirus, and hepatitis A, B, or C. Bacterial infections can also sometimes lead to liver inflammation and enzyme elevation.
Certain medications can induce liver injury, causing enzyme levels to rise. This can include over-the-counter drugs like acetaminophen, some antibiotics, and anti-seizure medications. If drug-induced liver injury is suspected, discontinuing the medication is often a primary step in management.
Metabolic and genetic conditions represent another category of causes. Non-alcoholic fatty liver disease (NAFLD), often linked to childhood obesity, is a prevalent reason for elevated liver enzymes in children. Other inherited disorders include Wilson’s disease, where too much copper accumulates, and Alpha-1 Antitrypsin Deficiency, where a misfolded protein can get trapped in the liver.
Autoimmune conditions, such as autoimmune hepatitis, occur when the body’s immune system mistakenly attacks its own liver cells. Conditions affecting other organs can also influence liver enzyme levels. For example, muscle injury can specifically elevate AST, while celiac disease, an intestinal disorder, may also be a factor. Blockages in the bile ducts can lead to elevated ALP and GGT.
How Doctors Investigate High Liver Enzymes
When a child presents with elevated liver enzymes, doctors follow a structured diagnostic process to identify the underlying cause. This evaluation begins with a thorough medical history and physical examination. The doctor will ask about any symptoms, recent medications, family history of liver conditions, and lifestyle factors.
Further blood tests are ordered to pinpoint the specific reason for the enzyme elevation. These tests can look for evidence of viral infections, specific autoimmune markers, or genetic conditions. Liver enzyme levels are sometimes retested to observe trends and determine if the elevation is persistent or transient.
Imaging studies provide visual information about the liver and surrounding structures. An ultrasound is often the first imaging test performed to visualize the liver and bile ducts. In some cases, more detailed imaging like an MRI or CT scan may be utilized to further assess the liver’s condition. A liver biopsy, taking a small tissue sample, is a less common but sometimes necessary procedure for a definitive diagnosis, especially when other tests are inconclusive.
What Happens After a Diagnosis
Once the underlying cause of high liver enzymes is identified, the approach to management is tailored to that specific condition. For instance, viral infections may be managed with antiviral medications, while non-alcoholic fatty liver disease often responds to dietary changes and weight management. If a medication is determined to be the cause, it will be discontinued. Genetic conditions may require specific therapies to manage their effects on the liver.
Following a diagnosis, ongoing monitoring is a regular part of the care plan. This typically involves follow-up blood tests to track liver enzyme levels and assess the liver’s overall health and response to treatment. The frequency of these tests will depend on the diagnosis and the child’s individual progress.
The outlook for children with elevated liver enzymes varies depending on the cause. Many cases resolve completely, especially if the cause is a temporary infection or a medication that can be stopped. Even with more chronic conditions, appropriate medical care often allows for effective management, preventing severe liver damage and ensuring a good quality of life. Parents should seek immediate medical attention if a child with elevated liver enzymes develops concerning symptoms such as jaundice (yellowing of the skin or eyes), severe abdominal pain, excessive fatigue, dark urine, or pale stools.