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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The most important step in evaluating patients with abnormal liver enzyme levels is to take a thorough medical history and perform a complete medical examination. All the patient's medications, including over-the-counter drugs and herbal remedies need to be noted.

Any history of blood transfusion (especially if done a long time ago when screening for donated blood was much less strict), history of intravenous (injection) or intranasal (snorting) drug use or needle sharing, tattoos, sexual contact with someone with possible viral hepatitis, alcohol consumption, foreign travel, and possible consumption of contaminated food need to be questioned.

Furthermore, in addition to the liver tests (transaminases), other tests to screen the liver functions, such as a blood coagulation panel, albumin level, and total bilirubin level as well as a complete blood count need to be measured. Screening for viral hepatitis is also routinely done to detect any possible active infections of the liver (acute or chronic active) or to determine immunity against these viruses either through prior infections or vaccination.

In many instances, a physician may also order an ultrasound of the liver to assess the structure of the liver and the biliary tree as well to look for any gallstones that may be causing the liver disease.

Symptoms of the mild to moderate elevation of liver enzymes may vary from no symptoms at all to generalized:

• malaise,
  
  
• fatigue,
  
  
• fever,
  
  
• poor appetite,
  
  
• abdominal pain,
  
  
• jaundice (yellowing of skin),
  
  
• itching,
  
  
• nausea, or
  
  
• vomiting.

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