ALT

For the past three years I have had blood work done through a health care service that comes to our work and provides extensive testing for employees for the convenience of not going to the Doctors office.  Each year, my ALT level has raised (54, 51,76) and this year my AST was raised for the first time as well (37).  All my other blood work is normal as well as the other Liver Function Tests.  I am a 34 year old female, I am overweight, I'm 5 ft. tall and weigh 175 lbs..

This is the first year I have forwarded the results of my health screen to my doctor.  She called to tell me she was concerned by the increased level in the ALT and AST and she told me abstain from alcohol for two months and come back in for more testing.  The truth is, I am a weekend drinker and not every weekend for that matter.  I never drink during the week so I'm skeptical of this being the problem.  Inadvertently, I had an abdominal ultrasound last May because I was having tenderness in my upper right quadrant but everything came back normal (including my liver).  Once in a blue moon I will have a little pinching in my URQ but I think it's digestive related.

Could you please shed some light on the situation?  Everything I read on the internet about raised ALT and AST levels makes references to cancer and a number of other things.  If I had something seriously wrong with my liver - would it have shown up on the ultrasound?  What is your best guess about what's happening?

Your response it greatly appreciated.

[Kevin Pho, MD]

There are many reasons why the liver function tests can be elevated.  In addition to alcohol - hepatitis, medications, any liver or gall bladder disease, and genetic diseases - can all elevate the liver function tests.

The ultrasound is a good first step.  A negative result would make any anatomical or gall bladder diseases less likely.  I would also suggest a hepatitis screen.  You may also want to consider obtaining an ANA level (looking for rheumatological disease) and iron studies (looking for any iron overload syndromes such as hemochromatosis).

If every test is negative, I would suggest continuing to obtain periodic liver function tests off alcohol.  If the tests continue to rise, a liver biopsy can be discussed with your personal physician.  

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.

Thanks,
Kevin, M.D.

[nurse12hr]

I was told long ago (after having an elevated AST) that a couple of alcoholic drinks can elevate your enzymes for several weeks.  

I abstained for a month, had it redrawn, and it was normal.  I am sure the doc here can shed furthur light on the subject.