Flank pain and mildly high ALT and AST

My husband went to the doctor last week for a pain in his right side and a right swollen ankle.  His blood test came back with everything normal except a "mildly" high ALT of 125 and AST of 52.  He went back 4 days later and they ran another test to check on his bloods coagulating ability and any hep viruses.  Again everything was normal and no hepatitis but now his ALT was 156 and his AST was 75.  His flank pain is gone, but his ankle is still swollen and he is itchy.  His stool and urine are both normal and no fatigue other than the fact that he works 80+ hours a week.  He is under a lot of stress and I worry about a heart attack.  He is a 39 year old, caucasian, height is 6" and weight is 220.  He is a software engineer so he doesn't get a whole lot of excercise, but he eats fairly healthy and only has between 1 to 2 beers at night after work.  He didn't drink at all between the first test and the second.

I have found numerous, very scary things related to "mildly elevated lft's"n, but I am having a hard time finding a case where the ALT is higher than the AST.  The closest things that I am coming up with are hepatocellular carcinoma (possibly metastatic), pulmonary emboli, cholecystitis and bile duct obstruction.  Can you shed any light on this?

Thank You, The Wife Of The Best Man In The World!

[Kevin Pho, MD]

Hepatitis and fatty liver are also possibilities that can cause the ALT to be elevated.  I would have some blood tested for hepatitis.  

Fatty liver can certainly possible as well.  The best test to evaluate this (as well as the other possibilities you mentioned) would be a liver ultrasound.  

If negative, one can consider either monitoring the LFTs to ensure they aren't rising, or consider a liver biopsy for a more definitive diagnosis.

You may want to consider these options 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.

Kevin, M.D.
Medical Weblog:
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