High ALT level

I'm 29 and have just had a test come back with an extremely high ALT level.

For the past three years, I have had 4 blood tests (for health & life insurance). Two years and one year ago, the test came back fine. This year, the test came back with an AST/ALT 29/49.

This took me down 1 notch in my life insurance, so I went to my doctor. He said that the 49 wasn't alarming. He suggested taking another test to try and get a lower number, so I could requalify for a better rate. I ate very well for 3-4 days and also abstained from any alcohol or OTC drugs.

When I took the test, my ALT was 344. The doctor said my AST was fine though.

He's sending met to a gastrointestigolist (SP?) but his bedside manner is terrible and I don't know what to think until then (to deliver the news - his receptionist called me and told me "your liver is messed up").

He said he didn't think it was hepatitis, because everything else was in line. He said it might be a viral infection - but then indicated it could be a thousand things.

Since I had the test that registered a 49 to the time it registered a 344 it was less than two months. This makes me feel that it isn't lifestyle (I do drink quite a bit, but have obviously since then stopped) but obviously something that's happened in the past 2 months.

The only other sympton I have experience is fatigue - but I have a pretty stressful schedule - so it may not be related.

What are the likely things this could be?

[Kevin Pho, MD]

Alcohol can certainly raise the liver enzymes - although it typically can raises the AST more.  Other causes can include medications, fatty liver, gallbladder disease as well as hepatitis.

The next steps would be a hepatitis screen and a liver ultrasound.  The GI evaluation is an appropriate next step.  If all the tests remain negative with continued elevation of the liver enzymes, you may want to consider a liver biopsy.  

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.