Transaminitis

What is Transaminitis?

Having elevated levels of transaminases is known as transaminitis or hypertransaminasemia. Transaminases are liver enzymes that help with the functioning of liver cells. They also help in breaking down substances and in the removal of toxins within an individual’s body. Sometimes, elevated transaminases may occur without any apparent reason, and in such situations, they will return to their normal ranges without having any treatment. However, where an underlying condition is a culprit, it’s important for a patient to seek a physician or doctor’s help.2

Transaminases act as catalysts helping in the transamination process. The enzymes trigger or initiate the start of this process. There are various transaminases types and all α-amino acids apart from lysine and threonine comprise transaminases. The most crucial ones are alanine transaminase (ALT) and aspartate transaminase (AST). The latter (AST) helps with catalyzing the transamination between oxaluric acid and glutamic acid and the former (ALT) aids in catalyzing the transamination between pyruvic acid and glutamic acid.1,2,34,5

High AST and ALT levels may indicate an issue with the liver or heart. Usually, ALT is present and active in an individual’s liver, however, damage to liver cells may bring about an increase in ALT levels within the person’s bloodstream. Similarly, AST tends to be present and active in a person’s heart, so when there is an increase of this enzyme in bloodstream it could point to a problem like myocardial infarcation. AST levels within the bloodstream can help in diagnosis of heart attacks. Many things can lead to transaminitis for example, pregnancy, certain drugs, heart disease, liver disease, infection, biliary tract disease, and non-pathological reasons.5

Causes of Transaminitis

People having transaminitis don’t usually know about it until they have liver function tests performed. Transaminitis isn’t a disease, but a symptom that points to some illnesses in a person’s body. Also, transaminitis doesn’t present symptoms, but it indicates that something wrong is happening in an individual’s body. A doctor uses transaminitis as a diagnostic tool.

Common causes of hypertransaminasemia or transaminitis are:1,2

Alcoholic liver disease

When you indulge in excessive alcohol consumption for a long period, it may cause alcohol liver disease. This condition presents with symptoms like nausea, confusion, blood in vomit, blood in stool, a swollen abdomen, weight loss, and drowsiness. People having alcohol liver disease may show signs of jaundice or yellowing of skin or eyes and the ankles may be swollen. In one study involving 256 participants, the consumption of alcohol was linked to fatty liver disease in about 10 percent of the cases. The study was published in 2010.

Nonalcoholic fatty liver disease

In this condition, there is excess fat within liver cells. It is estimated that about 30 percent of American adults have the disease. High cholesterol and obesity are risk factors for nonalcoholic fatty liver disease, but the cause for this condition isn’t yet known. During the early stages, no symptoms present, though some individuals may have mild pain occurring with the upper-right part of their abdomen coupled with fatigue. Further damage to an individual’s liver may result in cirrhosis or scarring of their liver.

Vital hepatitis

This disease causes liver inflammation and usually occurs due to a viral infection. Hepatitis C and B are example of viral infections. A person with viral hepatitis will have symptoms like dark urine, nausea, loss of appetite, vomiting, jaundice, fatigue, and abdominal pain. Roughly only 6 to 10 percent of adults as well as older children who have hepatitis B have the condition becoming chronic, but a majority of those having hepatitis C actually have the condition turning chronic.

Hemochromatosis

With this disease, there is excess iron building up within an individual’s body. Iron is stored in organs like pancreas, heart, and the liver. When iron is in excess, it can contribute to diabetes mellitus or liver disease. Hemochromatosis can be inherited or it can arise due to other conditions like chronic liver disease or anemia. Symptoms of hemochromatosis are impotence, loss of libido, fatigue, general weakness, pancreas, liver and heart problems, and abdominal or joint pain.

Medications and herbs

Taking medications, herbs, and supplements can affect liver health. The liver itself processes these substances, but they can also harm it. Medicines that may cause transaminitis are:1,2

  • Pain relievers like acetaminophen or Tylenol
  • Antibiotics like isoniazid
  • Antidepressants like bupropion
  • Muscle relaxants like baclofen
  • Anti-fungals like ketoconazole
  • Non-steroidal anti-inflammatory drugs like ibuprofen or Advil
  • Heart medications like amiodarone
  • Anti-diabetes drugs like acarbose
  • Immune suppressants like methotrexate
  • Blood pressure medications like losartan and lisinopril
  • Muscle relaxants like baclofen

Herbal products that have ingridients like senna, chaparral, germander, kava kava, and ephedra may also result in transaminitis. When you take vitamin A in high amounts, it may damage the liver.

Other causes of hypertransaminasemia are:1,2,3

Alpha-1 antitrypsin deficiency

A genetic disorder that causes damage to an individual’s lungs and liver and the extent of damage may vary based on liver failure and transaminases levels. About 15 percent of adults who have alpha-1 antitrypsin deficiency develop cirrhosis or scarring of liver. The individuals also have an increased risk of hepatocellular carcinoma, which is a type of liver cancer.

Autoimmune hepatitis

This is hepatitis that is caused by the immune system attacking healthy liver cells. Autoimmune hepatitis presents with symptoms like an enlarged liver, jaundice, rashes, abdominal pain, loss of menstruation, fatigue, joint pain, and small blood vessels appearing on skin. If not treatment, autoimmune hepatitis can lead to liver scarring or even liver failure.

Wilson’s disease

A rare disorder that is inherited, and which causes accumulation of copper within organs like the brain and liver. The condition can be life-threatening when the levels of copper become too high. A person with Wilson’s disease has symptoms like jaundice, coordination problems, stiff muscles, loss of appetite, copper-like coloring within the eyes, a condition referred to as Kayser-Fleischer rings, and uncontrolled movements. The person may also have swelling in abdomen and legs, and difficulty swallowing or speaking.

HELLP syndrome

A serious condition affecting about 5 to 8 percent of pregnancies. This condition presents with symptoms like low platelet count, elevated liver enzymes, and hemolysis. HELLP syndrome is often linked to preeclampsia that causes increased blood pressure among pregnant women. The syndrome can cause bleeding problems, liver damage, and death if not managed properly. A person with HELLP syndrome has other symptoms like bleeding, swelling, shoulder pain, stomach pain, fatigue, changes in vision, pain when deeply breathing, and nausea or vomiting.1

Pancreatitis

A condition that causes the pancreas to become inflamed. It may be caused by gallstones and alcoholism. A person with pancreatic has symptoms like vomiting, nausea, or pain in upper abdomen. An individual may also have elevated liver enzymes.3

Liver cancer

A type of liver cancer referred to as hepatocellular carcinoma may be associated with transaminitis. That being said, it is important to realize that most cancers of the liver are by metastasis meaning they have spread to the liver from other locations. A person with liver cancer has elevated liver enzymes. A majority of cancers involving the liver occur due to unknown reasons.3

Mononucleosis

A condition arising from a virus known as Epstein-Barr virus (EBV). It is referred to as the ‘kissing disease’ or ‘mono’ and it is commonly contracted by kissing. At times, mononucleosis may arise due to cytomegalovirus (CMV). Symptoms include a sore throat, swollen lymph nodes, and high fever. Mononucleosis can cause liver problems including enlargement and inflammation of the liver resulting in increased liver enzymes in an individual’s blood.3

There are other conditions not necessarily associated with the liver that may cause transaminitis and they are:

  • Muscle disorders including polymyositis and rhabdomyolysis
  • Hemolysis involving rupturing of red cells
  • Celiac disease that occurs when there is reaction of immune system to gluten
  • Thyroid disorder like hyperthyroidism and hypothyroidism

Symptoms of Transaminitis

When a person has transaminitis, they experience symptoms like:

Jaundice

This is the yellowing of an individual’s skin, whites of eyes, and mucous membranes. Jaundice is a common indicator for liver problem and a person with the condition may have dark urine and light colored stool.

Itching of skin

A person may have localized skin itching that may arise due to presence of toxic substances in bloodstream

Swelling of the body

An individual may have edema, or swelling of the ankles, feet, and legs due to accumulation of fluids in body. Edema may be associated with elevated liver enzymes and liver disease.

Transaminitis Diagnosis

A doctor diagnosing an individual of transaminitis will look at the medical history and conduct a physical exam. Blood tests may be ordered and an individual is asked to fast before they have the tests. Blood tests help find out the levels of:

  • Ferritin
  • Iron
  • Glucose
  • Hepatis B surface antigen
  • Total iron-binding capacity
  • Hepatitis C virus antibody

A person may need further tests involving imaging tests like ultrasound or MRI and CT scans that help provide liver images to check for any anomalies like scarring. A biopsy may be ordered if transaminitis levels remain elevated for a period of more than 6 months.

Treatment for Transaminitis

An individual who has transaminitis needs to stay away from taking fatty foods or foods that are oily and spicy. Also, they should avoid taking medications known to affect an individual’s liver however, this option should be discussed with a doctor because medication known to cause transaminitis are administered to treat serious illnesses like diabetes and cancer – stopping them could worsen those conditions.

Alcohol tends to tax the liver and it should be avoided. If an individual is suspected to have liver cancer, a biopsy may be ordered to find out whether it has spread and help with the treatment.

Exercises, maintaining a healthy weight, eating balanced diet, prompt viral infection treatment, and controlling chronic conditions like autoimmune hepatitis or diabetes mellitus can help prevent transaminitis.

Reference List

  1. What Causes Transaminitis? https://www.healthline.com/health/transaminitis
  2. What does elevated transaminase mean? https://www.medicalnewstoday.com/articles/321975.php
  3. What causes transaminitis and how to treat it. https://www.belmarrahealth.com/causes-transaminitis-treat/
  4. What is Transaminitis: Causes, Symptoms, Treatment. https://www.epainassist.com/abdominal-pain/liver/what-is-transaminitis
  5. Transaminitis – What is, Symptoms and Treatment. http://www.actforlibraries.org/transaminitis/

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