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HIGH ALT AND AST ENZYMES
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HIGH ALT AND AST ENZYMES

Hi,
I am looking for some information on ALT and AST enzymes. I was scheduled for major back surgery tomorrow but it was canceled due to high enzymes in my blood test.tHE AST-181 AND ALT-210

In 1990 I was told I had Hep c. In 1997 a Doctor suggested a liver biopsy. The liver biopsy was clear, perfect in fact.

I have never been told I had Hep C by anyone before and then the red cross told me it showed up in my giving blood IN 1990.

I now need to know what could cause high ALT or AST other than than Hep C virus. I have never been sick a day in my life. In fact my medical history is near nothing. I do not ever get sick or catch the common flu's other people do. Do you have any info for me? I would appreciate it. By the way I am 53 years old.

I was scheduled for major back surgery for a plate to be put in my back. I have 3 herniated disk and bulging. I think something with my vertebrae with a hole in it. I have had 3 eperderals this year and cannot have anymore until August so I need this surgery. I was in a position before the eperderal not being able to even sit down. Please tell me what I need to do to get the prepare for the back surgery to get the enzymes down. Also I have nerve damage in my left leg with numbness down into my foot. I read that enzymes could be increased due to muscle damge??

Thankyou
Kathy
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Any liver or gallbladder disease can lead to elevated enzymes.  This can include fatty liver, gallstones, anatomical abnormalities, cancer, alcohol, medications, hemochromatosis amongst other diseases.  

I would consider a liver ultrasound to further evaluate the elevated enzymes.  

Repeating the liver biopsy can be considered if the enzymes remain elevated, or are rising.  

These options can be discussed with your gastroenterologist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b
18 Comments
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Avatar_f_tn
ALT and AST both mainly detect liver inflamation (inflammation) in the liver, but can also detect inflamation (inflammation) in the heart or kidneys. In your case, I am going to guess that you've been using a lot of pain medication lately. This will increase liver enzymes even in healthy people. Naprosyn is one major culprit. Also, overuse of Tylenol is hard on the liver. Ask your Dr. for a "liver safe" painkiller, and stay away from anything that is processed through the liver. Your enzymes will likely come down within a week or two. You may be wise to be tested for Hep. A,B, & C just to be safe. There is also autoimmune hepatitis, in which your immune system attacks your liver for no apparent reason.
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Avatar_n_tn
Hi
thankyou for the info. As I said I was told in 1990 I had Hep c virus and had a biopsy of my liver 7 years later (1997) I cannot remember the last time I was sick even from a cold. I think in 1996 I had a viral infection but other than that I am never sick.

I did take 10 mg 650 Percocette for the pain from the herniated disk but from the first test of the high alt and ast I went completely off all medication for a week to be tested again with a little lower enzyme but not much. Alt is 210 and Ast 181.

I have done alot of research on this but cannot see I even fit with the Hepititis (hepatitis) C virus.

thanks for your help.
Kathy
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Avatar_m_tn
I relate so much to your story, I have similar back issues and Hep C. Hang in there, I had two fragmented discs and thought I'd never be ok again but 5 years later it is managable. I also found out about Hep C the same way as you,raised enzymes, I had no idea I had it. That is precisely why it is known as a "silent killer" disease, many patients has no symptoms. I think it is problematic to do surgery given the high enzymes, I say they are due to the Hep C. Do you have your viral load? What genotype are you? I'd see a heptologist if I was you and see about it if at all possible . try to find one that deals with Hep C patients often. I believe treatment is recommended if your enzymes are 1.5 over normal and yours are but talk to your doc and try to see a specialist.
You might be able to get those enzymes down through diet,If you drink, do not drink any alcohol, it is like an accelerant to the Hep C virus. That might bring them down some. I wouldnt start ingesting supplements or other things until you speak to a specialist. Hep C has been associated to other diseases and illnesses, diabetes for one so you might consider treating the hep c.
good luck
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Hi
Thankyou for the information. The surgeon cancelled the surgery due to the gastroenterologist Dr.gastroenterologist recommendation.

The gastroenterologist only ran a blood test and was my first visit to him for surgery clearance. The cardiologist whom tested me for a preclearance found the enzymes were elevated in a routine blood test and sent me to the gastroenterologist. the cardiologist gave me clearance.

I do not know anything about viral load or geno type, forgive my ignorance. I have an appointment today with a specialist at another gastroenterologist. The surgeon will not touch me until I receive clearance for the gastroenterologist says 5 1/2 hrs under anesthesia is very hard on the liver.

I have been on pain medication for my back but because of the eperdural I was only taking one or 2 on the weekends when I did not have to drive to work. I had several glasses of wine 2 weeks before the test so I am sure that has something to do with the elevation. I am not a drinker but have drank on a occassion when there was a social event and that was one of those times. From the research I did on the net I found no alcohol at all was I to have.

How long after you have had alcohol does it not elevate. I would have thought a week had passed since the wine that my enzymes would have not been so high. I am not one to take pills or alcohol daily.

thanks for your time and concern.
Kathy
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Avatar_n_tn
Hi
I had a stress test for surgery clearance and was wondering if the iodine that was injected has anything to do with the enzymes? Also I did some research on the gallbladder since my family has a history of gallbladder and because I do have pain that runs from my right shoulder up to my neck and down my back is that something to do with gallstones and does it increase alt and ast levels?

I have virtually no medical history and have never had to go to the Doctor outside of my back problems this is all new to me so I am a little anxious.

I was also wondering how smoking affects the enzymes? I know I have to quit and am using the patch but does the patch effect the enzymes?

Thanks for your help
Kathy
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Avatar_m_tn
I dont think it is the wine you had, Hep C cause the enzymes to rise because it indicates inflammation(which is what hepatitis is) It is showing you your liver is in stress.
Many folks are led to believe Hep C is no big deal. For many, it isn't causing symptoms(yet) but it is a blood disorder so in essence your whole body is affected. Though you dont have symptoms now, as it progresses problems can arise. It is also an infectious disease, so bear that in mind also. Do not share toothbrushes or razors with anyone, do NOT exchange blood with others,have sex whie menstrating and be very careful if you are bleeding not to let anyone touch it.
Some symptoms go unnoticed, light colored stools, dark urine, constipation, diarrhea, fatigue. Many women pass it off as "menopausal" symptoms. Odd sometimes transient issues we dont identify as an ongoing underying thing. It affects your bones and can be related to bone mass loss, your back issues could be connected to having had Hep C for many years for instance.
It is linked to diabetes, meaning it can cause diabetes. it increases your chances of contracting various cancers. Some Viruses CAUSE cancer, this is one of them. This link was proven back with the "boy in the bubble" so bear that in mind. Your risk for lymphoma for instance is 4 times higher than someone who doesnt have the hep c virus. This virus is affecting millions world wide and is at epidemic levels. 38 percent of folks with this got it from somewhere OTHER THAN from past drug use, lots of people like me were given this in clinical settings much ike those given AIDS from transfusions.You can contract it from the dentist or from manicures...if their steriization procedures are ax. THis virus can ive for TWO WEEKS on any surface. Very scary.
So bear that in mind. It is a relatively new disease, named in 1989 I think) and all the ramifications of it are still not known but the fact remains that it leads to liver cancer.
Hep C is the NUMBER ONE reason for liver transplants in America. There is a lot of stigma attached to the disease, sadly.
I hate to tell you this, but I got my Hep C from a spinal epidural procedure in a hospital. So did several other people treated on that day. It is more common in clinical settings than we are told. I did not have it prior to the procedure according to my bloodwork, then 3 weeks later it was discovered.
I have been treating it ever since trying to get rid of it.
MedHep has a forum devoted to Hep C, if you click on Hepatitis and there are lots of folks there with this disease and lots of info. The treatment is long and not very easy but it works for some. I know it is hard to face dealing with Hep C but you run the risk of it causing you much larger health problems down the road so I am glad you are dealing with it while you are young.
My enzymes remained high no matter what I did until I started treatment.
I still recommend you see a Heptologist if possible, they are the most saavy when it comes to dealing with Hep C. but if you feel your gastro is on top of it then that is the next best option.
The treatment is not perfect but new drugs are being developed as I type that are suppossed to be more effective.

good luck, I know how hard it is dealing with major back issues and then being faced with Hep c. Keep your spirits up, this too shall pass. It just wont be easy or fun to go through.

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Avatar_n_tn
Hi
i just came back from the Gastroenologist. I had a liver ultrasound . I was told the results would be in about a week. The lab tech told me because I pleaded with him of my aniety to tell me if he saw anything. He said the liver looked fine,just a little bit of fat and I had a small gallstone. Other than that he said it looked fine so now I was wondering what is the cause of the Alt @210 and the Ast 181.

Also what causes gallstones? Can anyone relate? I am being reschedules for back surgery so I am hoping this is not going to stop it.
Kathy
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Avatar_m_tn
Ultrasound can see masses and fatty liver but not fibrosis or cirrosis (cirrhosis), the names for scarring, only a biopsy can. The gold standard worldwide to determine the amount of scarring is a biopsy only, other methods are not effective. A new scanner is being tested now (Fibroscan) that looks promising, but for now only a biopsy can  tell you the level of damage if any. Hep C plus fatty liver would both explain the high enzymes. Both should be dealt with and treated. I believe good diet and exercise help to reduce fatty liver.
When you go back to the GI be sure and ask quesitons, prepare them ahead so you get answers and get copies of all your bloodwork, also try to get a copy of the ultrasound report. The person doing the test is not quaified to read it so dont go by that! I strongly encourage you to see a heptologist because clearly you have liver problems to deal with and they are liver specialists.
Waiting on results and tests is difficult, hang in there.
You can do some research on your own about these conditions, that might be helpful. try googling fatty liver and hep c, also cirrosis (cirrhosis) and fibrosis for more info.regarding diet and what you can do while you wait on appointments. You can have liver scarring going on and have no other symptoms aside from raised enzymes. Some folks have cirrosis (cirrhosis) and normal enzymes too. You can have fatty liver and not be fat...this is why they are known as "silent killer" diseases, for many the damage is going on and you have no outward sign.
Have you seen your cbc's? Do you have any other blood values out of normal range? Platetets? Protein? Glucose? If all is normal except raised enzymes, I really think it is due to hep c plus fatty liver going on on top of the virus. I am no doctor but from what I have read since I found I had hep c, that is what I have learned. Raised enzymes are a big red flag.
Livers are very durable and lots can be done to halt and/or reverse some damage. Try not to worry too much.
Hope your back is not giving you a lot of pain.
Once I recovered from the shock of finding out I had a liver problem and began to deal with it I realized how lucky I was to have had that flag raised. Multitudes of people have no idea and continue to drink and do other damaging things to their livers inadvertently.
Remember that old adage, "trouble never comes singularly"
when it rains it pours! Stay positive.
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Avatar_n_tn
Hey
Thanks for all your time and valuble insights to me. I really appreciate the feedback and the knowledge!

I really donot know about anyother blood values out of range but I am printing a copy of your reply to take home tonight to look at the results I do have at home.

I have been quite anxious and this is not normally me to be anxious over physical problems since I have never been one to run around to Doctors.

The back surgery is what I am most anxious to get done and out of the way but my doc. would not touch me until everything was clear with these enzymes. I was very relieved today though but I know I still have to wait until May 1 for the Doctor to actually give me his diagnosis. If I can just get the clearance for the surgery and get that done than i will take care of seeing a heptoloist a.s.a.p.

My left leg is numb from the knee down and then my foot goes numb quite often and is painful. I deal with it very well though if i must say so myself. lol.... I have so much nerve damage in my leg from the 3 herniated disk and a hole of some sort in my vertebrae.

Thanks so much for your time.
Kathy
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Avatar_m_tn
Your problem there is that the surgeon won't operate on you because it can be detrimental to your health and complications can arise, dangerous complications. Too risky.
Unfortunately, with the fuel in your liver you have going, fatty liver and hep c, they become the focus as they block your path to attempting to fix your back issues at this point.
Since normal range for them are AST 0-43 and ALT 3 -42, you can see yours are far enough out of range to stop the surgery.
Be careful what drugs you are using to control the back pain in the mean time, you don't want to take anything that isnt liver friendly that is worsening the situation, some drugs can also raise enzymes. You are sort of forced into a pain management/control situation until you resolve the liver issues which means primarily controlling your pain with drugs. I take Vicoprophen which is metabolized by the kidneys not the liver to avoid stressing my liver and still manage the back pain. My surgery was successful and did improve things greatly, but I was left with nerve damage I control daily. Pain management specialists are a god send, if you dont have one now you might consider one since you cant get surgical relief for some time.
There are various products out there that claim to lower enzymes, be careful of those, they can sometimes raise enzymes contrary to the ads.

The whole thing just drives you batty dealing with it all and can be frustrating and scary. It is hard when you are in pain (ie your back)
I thought I was the only person who had both of these issues, although I am sorry to hear you are going through this, Iam glad I could be of any help to you, I wanted you to know you are not alone. I know what it is like and it is stressful and frightening, it can get depressing.
You will get past this! Get the best docs you can!



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Avatar_n_tn
Hi
I just came back from the Dr from the ultra sound and the blood work
Ast-200
Alt-219
Genotype 1
viral load-9590000
alpha-fetoprotein-6.7
I am scheduled for a biopsy May 10th
In the meantime what does the viral load mean? He said I had inflamation (inflammation) of the liver. Should I be worried.
Can you help me I am really stressed.
Kathy
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Avatar_n_tn
Hi
I just came back from the Dr from the ultra sound and the blood work
Ast-200
Alt-219
Genotype 1
viral load-9590000
alpha-fetoprotein-6.7
I am scheduled for a biopsy May 10th
In the meantime what does the viral load mean? He said I had inflamation (inflammation) of the liver. Should I be worried.
Can you help me I am really stressed.
Thanks
Kathy
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Avatar_n_tn
I am 34 and have ALT&AST of 471 & 297. I have had every blood test they can think of still no answers. I had a Compleat hysterectomy 2years ago 5 months later I had my gulbladder taken out (Lots of stones). when I had my first surgery thats when the found the high enzymes. they were not that high then but keep going up now. I dont have hep c. have had a CT scan , having a ultrasound wednesday may 10th . Monday may 8th they are going down my throat with a light to look around. I have been having severe belly pain. They said they think that my liver is inlarged I have never smoked, or drank. Im really starting to get scared dont know what to expect.  I also found a small black spot on my tounge today I dont know if it is related to any of this?
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Avatar_n_tn
Hello All,

   I just got a blood report from the Lap. My AST and ALT are more than they should be. The AST is 74 U/I and ALT is 52 U/I. I am really worried regarding my AST and ALT elevation. Please let me know what could cause the enzyme to go up.
   I do not have any history of HEP A,B,C. I had abdominal TB couple of years ago and I completed my medication about a year ago. I had ultra-sound of my abdomen and the report said everything is normal. Lately I have been doing heavy exercise lifting weights. Do you think the AST and ALT elevation could be due to my everyday heavy exercise? I am not in any regular medication. I took antibiotic few weeks ago for a sore throat. I haven't taken para-cetamol at all. I used to drink but I stopped drinking alcohol about three years ago.
   Please tell me what is causing my liver enzyme to up. By the way I am 32 years old.
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Avatar_n_tn
Hi
My enymes flucuated so much it scared me also. My first alt and ast were 9x higher than my second were 6x higher and then my third were 7x higher. I was really dumbfounded because I was very careful after the first tests not to take any type of meds (I have 3 herniated discs and a transitional vertabrae that has been torn) so I have been in much pain. I stopped ALL pain meds and the only thing that went into my body was food and drink. And I donot mean alcohol. I donot drink at all.......

I went to the gastro doctor for a liver ultrasound and when I say I was scared I say it wholeheartedly. I donot get scared about anything so this was very difficult for me to wait. As it turned out my liver was fine just what they called a fatty liver and I am about 30lbs overweight. They also saw 3 small gallstones .

The bottom line is I have hep C and that from what I understand causes your enzymes to elevate. I donot have all the answers but I am working on my weight and watching what I eat which I THINK may very well have much to do with the elevated enzymes as well as the hep C.

Have you been tested for Hep C? This is a serious virus and is very hard for me anyway to determine how I got it. They say many things could have caused us to get them but I really donot buy into all the hype with this disease and mainly because they only discovered scientifically in 1990 or 1991 there even was such a thing as hep C and all the ramifications to having it. I was always a blood donor and then like many others in 1991 I was told I had this virus. I went for a liver biopsy and my liver was perfect. They go so far as to say it can take up to 20 or 30 years for the damage to appear or something to that affect. I am healthy as a horse and never felt sick a day in my life. They wanted to put me on this experimental drug back in the 90's in which I refused because of the severe side affects to this drug. It makes you sick!!! Flu like symthoms,fatique and hair loss. Who wants to go through that.

I am not saying their research is not valid only questionable. I know my enymes are high and I realize there is a reason for it but I am a very determined positive person and believe we can create our own sickness somethings because of thought process. My Doctor told me I had high blood pressure recently and I found myself when I was upset of saying oh my God my blood pressure is going up. lol...... Then he told me a week later it was from the stress test but my blood pressure is fine. I am just trying to say be positive and try to relax and pray ALL IS WELL.

I pray you will be fine.
Kathy
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Avatar_n_tn
Hi everyone,

Last month (April) my primary physician ordered blood work for me because I was having abdominal pain. My ALT count came out as 57 while AST was 30. One year ago these numbers were 37 and 27, respectively. My primary physician who looked at these results diagnosed me with H Pilori as the primary cause of my stomach problem and prescribed medication for it. However, at the same time I had scheduled an apmpt with a GI. When I visited the GI last week, she saw the ALT number and ordered Hep B test. BTW, I do not drink alcohol, and I am not Obese.  I was just wondering how concerned should I be about the Hep B?

Thanks a lot.
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Avatar_n_tn
Hi
Well I had the Altrasound done and the tech said that she saw some fatty deposits but she would'nt say any thing more, she said she could get in trouble.  I also had a endoscope and a colonoscpy done they cut out 5 pollops from my colon and found something like an ulcer in my stomach they said it could be crones disease . I should know something more in 10 to 14 days from the pathology results.. I have been tested for hep c.. They have tested me for everything they can think of that might be causing all of this ... Still no answers.... I am just trying to keep  from worrying and pray that it will all turn out good... but like I told my kids and husband If it dose come back bad then God has a reason for it all..  it's all in his hands now...
Thanks for the input and I hope that all goes well with you I will say a prayer for you.   Tammy G
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Avatar_n_tn

Hi,

I have a one year old son, after his annual medical check-up and hepatitis vaccination, it found out that his ALT and AST enzymes reaches to as high as 500U/L. This really troubles me because prior to his hepatitis vaccine his AST and ALT enzymes was only 50. right after his hepatitis vaccine it rose to 250 then just recently it registers 500U/L.

I just want to know what causes this problem.


thank you
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Avatar_n_tn
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