The ultrasound of the abdomen, which must always be done in these cases, allows to evaluate the presence of anomalies in the liver, the biliary tract (for example stones) and possibly other typical characteristics of cirrhosis
I am 38 years old, I am thin and I play sports regularly, I follow a healthy diet, I consume very little alcohol and I do not take drugs. For 15 years now I have discovered that I have altered transaminase values, apparently without cause. I have undergone many tests, from the most trivial such as those for hepatitis to those for rarer diseases, all negative. A very slight steatosis emerged from the ultrasound, but to date there is no diagnosis. Should I consider myself suffering from liver disease or do I simply have higher than normal values? Can I lead a normal life (and diet)?
He answers Roberta D’AmbrosioHead of Ambulatory Activities Center AM and A. Migliavacca for the study of liver diseases, Operational Unit of Gastroenterology and Hepatology, IRCCS Ca ‘Granda Foundation, Maggiore Policlinico Hospital, Milan (GO TO THE FORUM)
Persistent alteration of transaminase values may be indicative of a condition inflammation Chronic (hepatitis) of the liver, which needs to be investigated. L’ultrasound of the abdomenwhich must always be done in these cases, allows you to evaluate the presence of abnormalities in the liver (for example steatosis), of the biliary tract (for example calculations) and possibly other typical characteristics of the cirrhosis, indicative of a quietly already evolved disease. In the presence of long-lasting hypertransaminasemia, even if not yet in possession of an etiological diagnosis, the measurement of stiffness (stiffness) hepatic through Fibroscan (or other similar methods) can provide important information with respect to the severity of the damage and the timing with which to proceed with the investigations.
Viral infections
The exclusion of chronic viral infections usually represents the first step in the management of chronic hypertransaminasemia, especially in those born before the 1990s, potentially exposed to risk factors related to the parenteral transmission of the virus.epatite C e B and in those who have specific risk factors. Once chronic viral hepatitis is ruled out, many blood tests are helpful in suspecting, diagnosing, or ruling out other less common diseases: autoimmune disorders, storage diseases (iron and copper), often genetically determined, or rarer conditions. We must always remember that some drugs, some supplements and some herbal products can also cause hypertransaminasemia, generally through toxic mechanisms. Finally, we must not forget the role ofalcohol.
Liver biopsy
When all of these causes of chronic damage are ruled out, the presence of steatosis (Nafld), which a very frequent condition (about 25% of the general population and> 50% of diabetic and / or obese subjects), may be a sufficient cause to explain hypertransaminasemia. There non-alcoholic steatohepatitis (Nash) and hypertransaminasemia are infrequent (~ 5%) in subjects suffering from steatosis and are more frequently associated with diabetes and hang. Among thin subjects, Nafld is rarer (0%) and hypertransaminasemia is very uncommon. Therefore, in cases where the diagnosis remains doubtful, such as yours, and especially when Fibroscan seriati demonstrate values of stiffness impaired or progressively increasing liver function, a liver biopsy may be helpfuladding complementary information to those already suggested by the other tests (exams, ultrasound and Fibroscan) and thus allowing to define the cause of the chronic damage.
June 26, 2022 (change June 26, 2022 | 12:57)
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