Elevated liver enzymes occur when liver enzymes, primarily ALT and AST, increase above normal levels in the blood. This indicates that liver cells are damaged or necrotic, causing these enzymes to release into the bloodstream.

Elevated liver enzymes can result from various conditions, including viral hepatitis, fatty liver disease, liver damage due to alcohol or medication, metabolic disorders, autoimmune liver disease, or cirrhosis. Among these, hepatitis B is a common cause.

However, many individuals with chronic hepatitis B virus infection maintain normal liver enzyme levels for long periods. Therefore, liver enzyme results alone cannot confirm or rule out hepatitis B.

Dr. Hai examines a patient. Illustration: Tam Anh General Hospital

If elevated liver enzymes are accompanied by symptoms such as persistent fatigue, loss of appetite, nausea, dull pain in the right hypochondrium, jaundice (yellow skin or eyes), or dark urine, you should seek medical attention for specific tests. Early detection of the cause of elevated liver enzymes allows for timely treatment, limiting the risk of progression to cirrhosis, liver failure, or liver cancer.

When hepatitis B virus is suspected as the cause of elevated liver enzymes, doctors will order appropriate tests. These typically include:

Blood biochemistry tests: These evaluate liver function and the extent of liver cell damage through indicators such as ALT, AST, bilirubin, albumin, or coagulation tests.

Serological and molecular biological tests: HBsAg (hepatitis B virus surface antigen) is the most important marker to identify a current HBV infection. Depending on the case, doctors may order additional tests such as HBeAg, Anti-HBc, Anti-HBs, or HBV DNA quantification to assess viral activity, infectivity, and guide treatment.

In addition to blood tests, imaging methods also help assess the extent of liver damage. Liver ultrasound aids in detecting structural abnormalities in the parenchyma, while liver elastography helps evaluate the degree of fibrosis and non-invasive fatty liver disease. For a more detailed examination, patients may be prescribed abdominal CT or MRI scans to detect lesions that conventional ultrasound may not fully assess.

Dr. Nguyen Thi Thu Hai

Department of Gastroenterology - Hepatology, Biliary, and Pancreatic Diseases

Tam Anh General Clinic, District 7