Elevated liver enzymes in children are often discovered incidentally during routine blood tests, such as those performed at an annual check-up. A healthcare provider may also order liver enzyme tests if a child presents with symptoms that suggest a liver problem. These symptoms can include abdominal pain, vomiting, diarrhea, or jaundice, a condition characterized by yellowing of the skin and eyes.
What Does It Mean if a Child Has High Liver Enzymes?
It’s important to understand that elevated liver enzyme levels, on their own, do not provide a definitive diagnosis. They serve as an indicator that the liver may be experiencing stress or damage. Therefore, if your child’s blood test reveals high liver enzymes, follow-up with their healthcare provider is crucial. Further investigations are necessary to pinpoint the underlying cause of these elevated levels.
In some instances, the reason for high liver enzymes might be relatively straightforward. For example, if a child has recently had a viral infection, a healthcare provider might attribute the elevated enzymes to the virus. In such cases, a watchful waiting approach may be adopted. As the child recovers from the viral illness, liver enzyme levels are expected to return to their normal range.
Common Causes of Elevated Liver Enzymes in Children
Several conditions can lead to high liver enzymes in children. These can range from mild and temporary to more serious and requiring specific medical attention. Some of the most common causes include:
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Viral Infections: Viruses are a frequent culprit behind elevated liver enzymes in children. Common viral infections that can affect the liver include viral hepatitis (such as hepatitis A, hepatitis B, and hepatitis C), Epstein-Barr virus (which causes mononucleosis), cytomegalovirus (CMV), and adenovirus. Even common illnesses like the flu or colds can sometimes cause a temporary rise in liver enzymes.
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Medications and Toxins: Certain medications, both prescription and over-the-counter, can have side effects that impact the liver. Acetaminophen (Tylenol), when taken in excessive doses, is a well-known cause of liver enzyme elevation. Other medications, including some antibiotics, anti-seizure medications, and nonsteroidal anti-inflammatory drugs (NSAIDs), can also affect liver function. Exposure to certain toxins can also lead to liver damage and elevated enzymes.
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Non-Alcoholic Fatty Liver Disease (NAFLD): NAFLD is becoming increasingly common in children, often linked to obesity and unhealthy diets high in sugar and processed foods. In NAFLD, excess fat accumulates in the liver, which can lead to inflammation and elevated liver enzymes.
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Autoimmune Hepatitis: This is a condition where the body’s immune system mistakenly attacks the liver cells, causing inflammation and damage. Autoimmune hepatitis can lead to elevated liver enzymes and requires specialized medical management.
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Genetic and Metabolic Disorders: Several inherited conditions can affect liver function and result in high liver enzymes. These include Wilson’s disease, which causes copper to build up in the liver, hemochromatosis, which leads to iron overload, and alpha-1 antitrypsin deficiency. Cystic fibrosis and galactosemia are other genetic conditions that can impact the liver.
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Biliary Tract Issues: Problems with the bile ducts, which carry bile from the liver, can also cause liver enzyme elevation. Conditions like biliary atresia (a blockage of the bile ducts) or choledochal cysts can obstruct bile flow and affect liver function.
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Less Common Causes: In rarer cases, elevated liver enzymes in children may be due to liver tumors, heart failure, shock liver (ischemic hepatitis), or certain infections like bacterial or parasitic infections.
Diagnosis and Further Evaluation
When elevated liver enzymes are detected, a healthcare provider will take several steps to determine the cause. This typically involves:
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Reviewing Medical History and Symptoms: The doctor will ask about the child’s medical history, including any pre-existing conditions, medications they are taking, recent illnesses, and specific symptoms like abdominal pain, fatigue, jaundice, or changes in urine or stool color.
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Physical Examination: A physical exam will be performed to look for signs of liver disease, such as jaundice, an enlarged liver (hepatomegaly), or an enlarged spleen (splenomegaly).
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Further Blood Tests: In addition to repeat liver enzyme tests to confirm the initial findings, other blood tests may be ordered. These can include:
- Specific Liver Enzyme Tests: To look at different types of liver enzymes (ALT, AST, ALP, GGT) more closely.
- Bilirubin Levels: To assess jaundice and liver function.
- Albumin and Prothrombin Time (PT/INR): To evaluate the liver’s ability to produce proteins.
- Viral Hepatitis Serology: To check for hepatitis A, B, and C infections.
- Autoimmune Markers: To screen for autoimmune hepatitis.
- Metabolic and Genetic Testing: Depending on the suspected cause, tests for Wilson’s disease, hemochromatosis, alpha-1 antitrypsin deficiency, or other genetic conditions may be performed.
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Imaging Studies: If blood tests are inconclusive or suggest a structural liver problem, imaging studies may be necessary. These can include:
- Ultrasound: To visualize the liver, gallbladder, and bile ducts.
- CT Scan or MRI: To provide more detailed images of the liver and surrounding organs.
- Liver Biopsy: In some cases, a liver biopsy, where a small sample of liver tissue is taken for examination under a microscope, may be needed to make a definitive diagnosis.
When to See a Specialist
While a primary healthcare provider can often manage cases of mildly elevated liver enzymes, referral to a specialist, such as a pediatric hepatologist (a doctor specializing in liver diseases in children), may be recommended in certain situations. These situations include:
- Significantly High Liver Enzyme Levels: Very high or persistently rising liver enzyme levels warrant specialist evaluation.
- Unclear Cause: If the primary care provider cannot determine the cause of the elevated enzymes after initial investigations.
- Suspected Serious Liver Disease: If there is suspicion of a more serious liver condition, such as autoimmune hepatitis, genetic liver disease, or biliary atresia.
- Presence of Symptoms: If the child has significant symptoms like jaundice, persistent abdominal pain, or signs of liver failure.
Seeking expert care ensures that your child receives the most appropriate diagnosis and management plan for their condition. It is crucial to work closely with your child’s healthcare team to understand the cause of high liver enzymes and to ensure they receive the necessary care and follow-up.
