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What Is Transaminitis?

Reviewed by Dan Brennan, MD on April 24, 2021

The largest internal organ in your body is the liver. It performs over 500 functions including producing most of the chemicals your body needs and breaking down nutrients from food to produce energy. It does a lot of this with enzymes, which are chemicals that help speed up the reactions in your liver.

Two of these enzymes are alanine transaminase (ALT) and aspartate transaminase (AST). Transaminitis happens when the levels of one or both of these enzymes are higher than normal. This can occur because of certain diseases, medicines, or substance abuse.

What Causes Transaminitis?

When your liver cells are injured or inflamed, they leak more enzymes into your bloodstream than normal. There are a lot of different diseases and conditions that can damage your liver cells. Some of these include:

Nonalcoholic fatty liver disease (NAFLD). Nonalcoholic fatty liver disease happens when there is too much fat stored in the liver of people who don't drink much alcohol. It's the most common cause of transaminitis in the United States, affecting up to 25% of people. 

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Some cases of NAFLD can progress into more aggressive forms of liver disease that can cause liver failure. While scientists don't know exactly why some people develop NAFLD, it has been linked to:

  • Being overweight or obese
  • Having high blood sugar, such as with prediabetes or type 2 diabetes
  • Having high levels of fat, especially triglycerides, in your blood
  • Being resistant to insulin, which happens when your cells don't take up sugar when your body releases insulin

Alcoholic liver disease (ALD). Alcoholic liver disease includes a range of diseases that are caused by drinking alcohol. Alcohol is metabolized by your liver. Drinking too much alcohol can damage your liver and cause alcoholic liver disease.

Alcoholic liver disease can progress to steatohepatitis, which is an inflammation of the liver along with fatty liver or cirrhosis. There is no direct link between how much you drink and developing ALD. Some heavy drinkers never develop liver problems, and some moderate drinkers develop ALD. 

Some liver injuries can occur from binge drinking over several days. Anyone with any form of ALD needs to quit drinking completely to prevent further liver damage or death.

Viral hepatitis. Hepatitis means inflammation of the liver. When this inflammation is caused by a virus, it's called viral hepatitis. There are five types of viral hepatitis, but the three most common are:

  • Hepatitis A. Hepatitis A can cause you to be sick from a few weeks to a few months. Most people recover with no lasting liver damage. It can cause serious disease or death, usually in people who have other serious diseases as well. Hepatitis A is caused by ingesting the fecal matter, sometimes in microscopic amounts, of someone infected with it. There is a vaccine for hepatitis A that is routinely given to children between 12 and 23 months. If you didn't get the vaccination as a child, it's available and effective for anyone who wants it.
  • Hepatitis B. Hepatitis B is primarily spread through bodily fluids, including blood and semen. It can lead to chronic liver infection and liver cancer. About two-thirds of people with hepatitis B don't realize they have it. Like hepatitis A, there is a safe and effective vaccine against hepatitis B that is routinely given to infants and children. It's also available to anyone who wants it.
  • Hepatitis C. Hepatitis C is spread through contact with the blood of someone who is infected. Hepatitis C can be a mild infection that lasts for a few weeks, but most people who get it will develop a chronic infection that can be life-long. Unfortunately, there is no vaccine for hepatitis C. However, an 8 to 12-week course of medicine can cure up to 90% of people with chronic hepatitis.

What Are Symptoms of Transaminitis?

Transaminitis by itself doesn't cause symptoms, but underlying liver disorders may cause symptoms including:

  • Loss of appetite
  • Nausea
  • Vomiting
  • Weakness
  • Tiredness
  • Stomach pain or fullness
  • Yellow color of the skin or whites of the eyes called jaundice
  • Urine that is dark or looks like tea
  • Stool that is light in color
  • Itching

How Is Transaminitis Diagnosed?

Transaminitis is diagnosed with a blood test. It may be ordered in the following situations: 

  • As part of routine blood tests during a yearly physical
  • If you have symptoms of liver disease
  • If you are at risk for liver disease
  • To monitor treatment of liver disease

How Is Transaminitis Treated?

The treatment for transaminitis will depend on the cause but may include:

  • Abstaining from alcohol
  • Losing weight if needed
  • Exercising
  • Changing your diet to avoid red meat, trans fats, high fructose corn syrup, and processed carbohydrates
  • Medicines
  • Monitoring your liver function
  • Liver transplant
WebMD Medical Reference

Sources

SOURCES:

American Family Physician: "Mildly Elevated Liver Transaminase Levels: Causes and Evaluation."

Centers for Disease Control and Prevention: "What is Viral Hepatitis?"

Cleveland Clinic: "Elevated Liver Enzymes."

Frontiers in Physiology: "Acute Alcohol-Induced Liver Injury."

LAB TESTS ONLINE: "Alanine Aminotransferase (ALT)."

MAYO CLINIC: "Elevated liver enzymes," "Liver disease," "Nonalcoholic fatty liver disease."

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