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Q: elevated liver enzymes ( Answered,   2 Comments )
Subject: elevated liver enzymes
Category: Health > Conditions and Diseases
Asked by: startac-ga
List Price: $50.00
Posted: 29 Apr 2003 14:02 PDT
Expires: 29 May 2003 14:02 PDT
Question ID: 197158
I went to the doctor because I saw red blood in stools a few months
ago. Stools have been slightly greenish on occasion and a little pink
inside occasionally. Stools tend to be solid but only about 3/4 of an
inch. No prior medical problems,age 43. No family history of colon
cancer. I have hemmorhoids. Father had operation for hemmorhoids.
Blood work showed all normal except ALT 68, AST 61. Colonoscopy in a
few months ordered along with followup test in a few months. I feel fine.
Needless to say I am concerned. Could elevated liver enzymes be caused
by hemmorhoids or  what? What are your thoughts?
Subject: Re: elevated liver enzymes
Answered By: kevinmd-ga on 30 Apr 2003 06:53 PDT
Hello - thanks for asking your question.   
Although I am an internal medicine physician, please see your primary
care physician for specific questions regarding any individual cases –
please do not use Google Answers as a substitute for medical advice. 
I will be happy to answer factual medical questions.

You note blood in the stools,  hemorrhoids, liver enzymes are mildly
elevated.  You are scheduled for a colonoscopy in a few months.

It is unlikely that the elevated liver enzymes are caused by
hemorrhoids.  However, it is possible that the rectal bleeding may be
a manifestation of liver disease.

Portal hypertension is a condition associated with any liver disease. 
Simply put, portal hypertension is elevated pressure in the blood
vessels within the liver.  The most common cause for this is cirrhosis
(liver failure).

Portal hypertension can cause what are known as rectal varices.  They
can be confused with hemorrhoids:
"Visible abdominal wall collaterals are common; veins radiating from
the umbilicus (caput medusae) are much rarer and indicate extensive
flow in the umbilical and periumbilical veins. Collaterals around the
rectum can produce rectal varices, often confused with hemorrhoids;
bleeding occasionally results."

However, it is definitely possible that your elevated liver enzymes
and hemorrhoids are unrelated.  Here are some other considerations for
your elevated liver enzymes.

I have written in the past about the various causes of elevated liver
"There are many reasons that can cause elevated liver enzymes.

Medications — Almost any medication can cause an elevation of liver
enzymes. Common ones include nonsteroidal anti-inflammatory drugs,
antibiotics, HMG-CoA reductase inhibitors, antiepileptic drugs, and
antituberculous drugs.

Alcohol abuse - In a study of hundreds of patients who had liver
biopsy confirmed liver disorders, more than 90 percent of the patients
whose AST to ALT ratio was two or greater had alcoholic liver disease.


Hereditary hemochromatosis — Hereditary hemochromatosis (HHC) is a
common genetic disorder. Population screening has shown that the
frequency of heterozygotes is about 10 percent in Caucasian
populations in the United States and western Europe, with a frequency
of about 5 per 1000 (0.5 percent) for the homozygous state.

Hepatic steatosis and steatohepatitis — Hepatic steatosis and an
associated condition, non-alcoholic steatohepatitis (NASH), may
present solely with mild elevations of the serum aminotransferases,
which are usually less than fourfold elevated.

Muscle disorders — Elevated serum aminotransferases, especially AST,
may be caused by disorders that affect organs other than the liver,
most commonly striated muscle.

Thyroid disorders — Thyroid disorders can produce elevated
aminotransferases by unclear mechanisms.

Celiac disease — Several reports have described elevated serum
aminotransferases in patients with undiagnosed celiac disease.

Adrenal insufficiency — Aminotransferase elevation (1.5 to 3 times the
upper limit of normal) has been described in patients with adrenal
insufficiency (due to Addison's disease or secondary causes),
including those without obvious clinical features of the disorder.

Autoimmune hepatitis — Autoimmune hepatitis (AIH) is a condition found
primarily in young to middle-aged women. The diagnosis is based upon
the presence of elevated serum aminotransferases, the absence of other
causes of chronic hepatitis, and features (serological and
pathological) suggestive of AIH.

Wilson's disease — Wilson's disease, a genetic disorder of biliary
copper excretion, may cause elevated aminotransferases in asymptomatic

Alpha-1-antitrypsin deficiency — Alpha-1-antitrypsin deficiency is an
uncommon cause of chronic liver disease in adults."

You may want to read further articles discussing elevated liver
enzymes I have written at Med Help International:

Here are some considerations for workup.  I would first repeat the
liver tests - they are only mildly elevated.  Make sure the results
aren't the cause of lab error.

If the liver enzymes continue to be elevated, then here is a
recommended approach for evaluation.  Any medication can elevate liver
enzymes - make sure that any medications you are taking is not the
culprit.  If you drink alcohol, I would abstain and then repeat the
enzymes in a few months.  Alcohol can transiently elevate liver
enzymes.  An ultrasound to evaluate the liver is also recommended. 
This can determine if any anatomical abnormalities such as a mass or
conditions such as fatty liver is the cause.  Tests for hepatitis
should also be routinely ordered.

If those tests are all negative, then further testing for
hemochromatosis (iron, iron binding capacity, ferritin) may be
considered.  If every test continues to be negative, then a liver
biopsy may be considered if the enzymes are persistantly two-fold
above normal.  This would be the definitive diagnostic test.

Regarding the rectal bleeding, there are several causes as well. 
Hemorrhoids would be the most common cause in someone in your age
group.  Other causes include polyps, colorectal cancer,
diverticulosis, or inflammatory bowel disease.  A colonoscopy is a
wise next step.

This answer is not intended as and does not substitute for medical
advice - the information presented is for patient education only.    
Please see your personal physician for further evaluation of your    
individual case.    
Please use any answer clarification before rating this answer. I will
be happy to explain or expand on any issue you may have.          
Kevin, M.D.  

Search strategy:    
No internet search engine was used in this answer.  All sources are
from physician-written and peer-reviewed sources.   

Med Help International - Gastroenterology Forum

Lab Tests Online - Liver Panel
Subject: Re: elevated liver enzymes
From: shiva777-ga on 29 Apr 2003 16:36 PDT
Hello. I am working on this question and should have the answer soon. -shiva777
Subject: Re: elevated liver enzymes
From: shiva777-ga on 29 Apr 2003 17:00 PDT
Ok....I just finished over an hour of research on this, accidentally
clicked away and came back to an empty form. Generally I do answers in
a seperate program like Word so that doesn't happen. Major bummer. I
am just going to pass this one to another researcher. I will say that
the summary of my research was that there seemed to be little linkage
between hemmorhoids, elevated liver enzymes and green stools. I would
recommend a good liver detox program. I have done them and they are
wonderful!  Good luck. -shiva777

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