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.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
What conditions can cause very high aminotransferase levels?
AST and ALT serum levels in some liver conditions can range anywhere from ten times
the upper limits of normal to thousands of units/liter The highest levels of AST
and ALT are found with disorders that cause rapid death of numerous liver cells
(extensive hepatic necrosis). Although this degree of liver enzymes elevation is
not common, it can occur in such conditions as:
Prolonged collapse of the circulatory system (shock) when the liver is
deprived of fresh blood providing oxygen and nutrients
Also, very high AST and ALT levels can be a result of severe muscle diseases.
What are some of the less common causes of elevated liver blood tests?
Less common causes of abnormal liver enzymes in the United States include
hemachromatosis (iron overload), Wilson's disease, alpha-1-antitrypsin deficiency, celiac
disease, Crohn's disease, ulcerative colitis,
and autoimmune hepatitis. Though not as common as hepatitis C,
hepatitis B can cause chronic liver disease with
persistently abnormal liver enzymes.
Hemachromatosis is a genetic (inherited) disorder in
which there is excessive absorption of dietary iron leading
to accumulation of iron in the liver with resultant
inflammation and scarring of the liver. If undiagnosed or untreated,
hemachromatosis can progress to cirrhosis and liver failure.
Wilson's disease is an inherited disorder with excessive
accumulation of copper in diverse tissues including the
liver and the brain. Excess copper in the liver can lead to chronic
liver inflammation, while copper in the brain can cause
psychiatric and motor disturbances.
Alpha-1-antitrypsin deficiency is an inherited disorder
in which the lack of a glycoprotein (carbohydrate-protein
complex) called alpha-1-antitrypsin lead to chronic lung
disease (emphysema) and
chronic liver disease.
Autoimmune hepatitis results from liver injury brought
about by the body's own antibodies and defense systems
attacking the liver.
disease (celiac sprue) is a disease of the small intestine where a person has an
allergy to gluten and
develops gas, bloating, diarrhea, and in advanced cases malnutrition. Patients'
with celiac sprue can also develop mildly abnormal ALT and AST
Viral infections other than common hepatitis viruses (A, B, C) can
sometimes cause elevation of liver enzymes as they can result in generalized
body infection and liver inflammation.
Non-viral infections of the liver are rare, but they can cause liver damage. Bacterial and amebic hepatic (liver) abscesses typically present as focal infection and inflammation of the liver as opposed to viral hepatitis where generalized liver inflammation occurs. Liver enzyme elevation is usually seen in the setting of these infections.
Rarely, abnormal liver enzymes can be a sign of
in the liver.
Cancer arising from liver cells is called
hepatocellular carcinoma or hepatoma. Cancers spreading to
the liver from other organs (such as colon, pancreas,
stomach, etc) are called metastatic malignancies (to the liver).
Liver hemangiomas (masses of abnormal and atypical blood vessels within the liver) are the most common tumors in the liver. Hepatic hemangiomas are benign and in general do not cause elevation of liver tests.
Another rare condition that causes elevation of liver tests is called the Budd-Chiari Syndrome. In this condition, obstruction of blood flow in the liver by a blood clot can damage the liver by limiting blood flow leading to injury of liver cells. As a result of this insult, liver enzymes may rise indicating hepatic inflammation.
Glycogen storage disorders are genetic conditions seen in pediatric population (detected at birth in severe types or later in childhood in less severe types). They impair the ability of liver to store and metabolize glycogen, a complex sugar necessary for production of nutrients and energy in the body. Glycogen storage disorders cause varying degrees of liver enzyme abnormalities.