Cirrhosis of the Liver Community
ast/alt ratio
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Cirrhosis is the end result of chronic liver damage caused by chronic liver diseases. The purpose of the community is to share support and information with Cirrhosis of the Liver patients and their loved ones. Topics in the community include: causes, clinical trials, complications, family issues, living with Cirrhosis of the Liver, prognosis, research, surgery, treatments

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ast/alt ratio

I had an ultrasound 8/12 that indicated an "echogenic" liver - impression fatty liver. (which I now understand can also be cirhosis - rest of ultrasound was "normal") At the time blood work was all good and ast 12 alt 18 (1.5) ratio.  Dr. diagnosed fatty liver and discontinue alcohol.  I have and received new blood work. alt 8 & ast 12 so ratio is still 1.5. All other labs great (albumin, bili, etc). We are not sched to do an ultrasound for another few weeks but i'm freaking out that this is cirrhosis.  No Symptoms / signs.  Anyone have any input?
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I am glad you stopped drinking for good which is essential for treating alcoholic fatty liver disease.

It appears you have been given a lot of misinformation about Alcoholic Fatty Liver Disease.

Ultrasound of the abdomen usually shows the liver is “echogenic,” that is more dense than usual toward sound waves.  The liver can also be enlarged due to fat.  Ultrasound does not really measure fat, but the great majority of the time an echogenic liver is found, this is related to excess fat.  Excess liver fat can also be detected by CT scan.

Ultrasounds do not stage liver disease so they will not tell you what stage of liver disease you have including cirrhosis. The only way to know for sure if you have cirrhosis is to have a liver biopsy. If diagnosis is in question a biopsy should be done away. So worrying that you have cirrhosis is not going to change anything. apparently your doctor has concluded that you have early liver disease not cirrhosis.

Your AST and ALT are NORMAL. That is what we all want. Makes no difference if AST is more than ALT is is normal. Why you think otherwise I don't understand. Normal levels Indicate that nothing is injuring your liver when you had the tests performed. There is nothing to worry about.

Fatty liver disease is the build up of extra fat in liver cells. It is the EARLIEST stage of alcohol-related liver disease. There are usually no symptoms. If symptoms do occur, they may include fatigue, weakness, and weight loss. Almost all heavy drinkers have fatty liver disease. However, if they stop drinking, fatty liver disease will usually go away.

Abstinence is the cornerstone of treatment of alcoholic liver disease.
The diagnosis of alcoholic liver disease requires a detailed patient history, with supportive laboratory and imaging studies.
Liver biopsy may be useful to confirm the diagnosis, rule out other diseases.

Good luck.
Thanks so much! Your explanation is quite helpful.  I am confused because I don't feel I have had much guidance from Dr,'s other than that they are not worried. I am reading however 1) Echogenic could also be cirrhosis and 2) 1.5 AST ratio = Cirrhosis.  My Dr. does not feel that there is any evidence of injury that warrants a biopsy. My blood work all looks good and my physical exam is as well.  Ultrasound was good except for the echogenic.  I am just trying to move foward happy and healthy and sometimes get stuck with.. but what if I have cirrhosis and don't know it and there is something I should be doing about it?Should I contact a heptalogist? etc.  Please know I am going through this while also trying to recover from sever OCD and Hypochondranosis and trying to figure out which fears are real and which are not.  I know that I drank wayyy more than I should have for many years and am very lucky that I am not symptomatic now. I just want to keep it that way and be the best Mom I can for however long. Your help and support is so appreciated!!
Whatever you are reading you is either wrong or you are misinterpreting it I', afraid and feeding your OCD and hypochondria. Are these papers written by gastroenterologist or hepatologist? I doubt it.

"1) Echogenic could also be cirrhosis"
No, this is not correct. “Echogenic,” means it is more dense than usual toward sound waves. A cirrhotic liver may have increase or NORMAL echogenicity depending on amount of fat, inflammation and fibrosis.
ONLY fatty infiltration causes an increase in echogenicity!

Cirrhosis has other obvious indications. Enlarged spleen, portal hypertension, regenerative nodules,etc,  

2) 1.5 AST ratio = Cirrhosis.
* Cirrhosis is easily diagnosed by any good gastro or hepatologist. It is no mystery how to do it. I have had expert doctors who can diagnose cirrhosis with just a stethoscope and tapping on the abdomen.
* Patients with cirrhosis often have normal or only slightly elevated serum AST and ALT levels.
* Only ELEVATED AST and ALT levels indicate current liver injury. Yours levels are normal. All blood levels will vary over time anyway.
* An AST:ALT ratio of 2:1 or 3:1, especially when associated with elevated GGT, strongly suggests alcohol induced injury not cirrhosis. More than 90% of patients with an AST:ALT ratio of 2:1 have alcoholic liver disease. Alcoholics commonly have fatty livers.

I would suggest you find a doctor (gastro/ or hepatologist) you can communicate with so they can answer your concerns, which are based of misinformation and are not something you have to even worry about. Your fears are based on nothing factual and are not real.

Best of luck to you.
Thanks again!  great info. I have had numerous physical exams & blood work.  (including pt time to satisfy me)  None show sign for concern.My internest has done extensive work with cirrhotic patients and continues to work with patients with hepatitis.The only problem is he doesn't answer my questions the way you do.. he just say's "no... your liver is normal" He doesn't feel a gastro/ or hep is needed at this time and I need a rec from him to move on. Do you think I should push it? I have one question for you, do i understand correctly that fibrosis is echogenic? Isn't fibrosis cirrhosis? That's why I thought my echogenic liver could be cirrhosis.  I was also concerned because at the time of the ultrasound I was drinking and my levels were normal (liver was of normal size and no inflamation (inflammation) though) so since levels can be normal with cirrhosis I assumed it MUST be that and not fatty liver. After talking with you I think I am hearing that I should accept the "Alcoholic Fatty Liver Diagnosis", keep taking my anti anxiety meds (which I of course went off of because I thought they were harming my liver....) and move on with my life! Thank you so much!!  
fibrosis is echogenic?
An ultrasound can not detect fibrosis reliably. That is why a biopsy is needed to diagnosis the stage of liver disease.

Isn't fibrosis cirrhosis?
No. Cirrhosis is stage 4 liver disease. Fibrosis is stage 1-3. When a person  has cirrhosis the architecture of the liver is changed (It is scared and develops regenerative nodules which can be seen on ultrasound) and the blood circulation through and around the liver changes creating many of the symptoms of cirrhosis.

"he just say's "no... your liver is normal"
Your liver isn't "normal".
Stages of alcoholic liver disease

There are three main stages of alcoholic liver disease, although there is often an overlap between each stage. The three stages are explained below.

Alcoholic fatty liver disease
Alcoholic fatty liver disease is the first stage of alcoholic liver disease.
Drinking a large amount of alcohol, even for only a few days, can lead to a build-up of fatty acids in the liver.
Fatty liver disease rarely causes any symptoms but it is an important warning sign that you are drinking at a level that is harmful to your health.
Fatty liver disease is reversible. If you stop drinking alcohol for two weeks, your liver should return to normal.
Alcoholic hepatitis

Alcoholic hepatitis (not related to infectious hepatitis) is the second, more serious stage of alcoholic liver disease.
Prolonged alcohol misuse over many years can cause the tissues of the liver to become inflamed. This is known as alcoholic hepatitis. Less commonly, alcoholic hepatitis can occur if you drink a large amount of alcohol in a short period of time (binge drinking).
Alcoholic hepatitis is usually reversible, although you may need to stop drinking alcohol for several months or years.

Cirrhosis is the final stage of alcoholic liver disease. Cirrhosis happens when prolonged inflammation causes scarring of the liver and loss of function. Loss of liver function can be life threatening.
The damage caused by cirrhosis is not reversible. In mild to moderate cases, stopping drinking alcohol immediately should prevent further damage and lead to the gradual recovery of liver function. In more severe cases, a liver transplant may be required.
I would get an appointment with a liver specialist department at a teaching hospital near you. You don't always need a referral. You can find one on the internet. It will say the hospital has a gastroenterology department or they treat fatty liver disease.

I should accept the "Alcoholic Fatty Liver Diagnosis",
Yes, AND take steps to reverse your fatty liver! You can never drink again is the number one factor in AFLD. Fatty liver has a wide variety of outcomes over time. Fatty liver is certain circumstances can over time lead to cirrhosis and liver failure where only a liver transplant can save your life. Only a liver specialist (hepatologist) can tell you how serious your fatty liver is. In fact fatty liver is expected to be the number one cause for liver transplant in the coming years in the US.
OK, thanks for this info but now i'm in a tizzy again. This whole thing is so confusing to me. So, do I not necessarily have fatty liver and are you suggesting a biopsy to do staging?  I assume that since chronic liver disease changes were not seen on ultrasound and bili/albumin/pt etc have been fine that I am not end stage however, what I've been trying to figure out is where am I in this whole thing.. and i'f I have stopped drinking, eating right and exercising is there anything else I should be doing? I am so confused!!  And so scared and really don't know what do to.
To tdig:

Friend, please quit worrying!  You have been provided extremely detailed (and accurate) responses from Hector, a gentleman who is more knowledgeable about liver disease than the average medical doctor.

Continue to refrain from alcohol in any form.
Eat healthily and exercise regularly.
If you will do all of the above faithfully - then within another year or two your liver will be in absolutely perfect condition!

Best of luck to you!
Thanks pugdaddy!  So, do we all agree with the dr.s. that I am currently not stage 4 (liver and spleen normal size on ultrasound all bloodwork normal) and that this is reversable or I at least have the ability to stop the progression?  Hector, I really appreciate all of your knowledge and advice.  I wish you both the very best and will keep you in my prayers.
Doesn't Fibroscan work?

Good advice! As my doctor tells me "Go live your life"!

Glad to see you back Hector!!!
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