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Gastroenterology (Expert Forum)
Elevated ALT/AST
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Elevated ALT/AST
by rasticle, Jan 16, 2007 12:00AM
Hi I have posted here before, just want to thank you for the service you provide people like me!
My situation is this: 26/M seemingly healthy diagnosed with Anxiety and Hypertension. My anxiety sometimes gets the best of me; I went to see a cardiologist for tightness of the chest and palpitations. He ordered EKG, Holter Monitor, echocardiogram, and blood studies. All of the tests came back normal the only diagnosis was hypertension and rare isolated Premature Ventricular Contractions. All of this anxiety came about because my PCP found elevated liver enzymes on a follow up examination. This sent me into full blown panic. I was referred to a GI and he administered all the usual tests for possible liver disease and some extras I asked for including: ferritin, AMA, ANA, lipid profile, abdominal ultrasound, Celiac panel, LFT, hepatitis panel (A,B,C, Autoimmune), and a thyroid panel. All of these tests came back normal except the ALT/AST. My liver enzymes ALT and AST have been mildly to moderately elevated for over a year. They have spiked once to alt:195 ast:80, but they typically hover between normal to alt:+-90 ast:+-60. I finally had a liver biopsy at the end of November. The results came back normal and the official diagnosis was “minimal histological change” all stains were normal. GI said the good news is that whatever is going has not damaged my liver in over one year’s time. Also I should say that I am asymptomatic, no weight loss, healthy appetite, no malaise (no more than a normal college student anyway).
So I have several questions about this:
1) Is it possible that I do have a liver disorder that is still undiagnosed, to me it seems like I have been run through just about every test possible?
2) Could these elevations of ALT/AST be caused by anything else in my body (I know ALT is fairly specific to the live but AST is not so liver specific)?
3) With all the tests coming back normal is it possible that this is a natural level of these enzymes in my body?
4) Do you have any further suggestions or thoughts?
My situation is this: 26/M seemingly healthy diagnosed with Anxiety and Hypertension. My anxiety sometimes gets the best of me; I went to see a cardiologist for tightness of the chest and palpitations. He ordered EKG, Holter Monitor, echocardiogram, and blood studies. All of the tests came back normal the only diagnosis was hypertension and rare isolated Premature Ventricular Contractions. All of this anxiety came about because my PCP found elevated liver enzymes on a follow up examination. This sent me into full blown panic. I was referred to a GI and he administered all the usual tests for possible liver disease and some extras I asked for including: ferritin, AMA, ANA, lipid profile, abdominal ultrasound, Celiac panel, LFT, hepatitis panel (A,B,C, Autoimmune), and a thyroid panel. All of these tests came back normal except the ALT/AST. My liver enzymes ALT and AST have been mildly to moderately elevated for over a year. They have spiked once to alt:195 ast:80, but they typically hover between normal to alt:+-90 ast:+-60. I finally had a liver biopsy at the end of November. The results came back normal and the official diagnosis was “minimal histological change” all stains were normal. GI said the good news is that whatever is going has not damaged my liver in over one year’s time. Also I should say that I am asymptomatic, no weight loss, healthy appetite, no malaise (no more than a normal college student anyway).
So I have several questions about this:
1) Is it possible that I do have a liver disorder that is still undiagnosed, to me it seems like I have been run through just about every test possible?
2) Could these elevations of ALT/AST be caused by anything else in my body (I know ALT is fairly specific to the live but AST is not so liver specific)?
3) With all the tests coming back normal is it possible that this is a natural level of these enzymes in my body?
4) Do you have any further suggestions or thoughts?
Doctor's Answer
by Kevin Pho, MD, Jan 17, 2007 12:00AM
, Jan 17, 2007 12:00AM
To answer your questions:
1) With the negative testing you have had, including a biopsy, a liver disorder is unlikely.
2) Celiac disease and muscle disorders can also lead to an elevation of AST and ALT.
3) I would evaluate for the aforementioned diseases before coming to that conclusion.
4) A blood test looking for celiac disease, as well as an aldolase level or a creatinine kinase level to look for muscle disease, can be considered.
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_
1) With the negative testing you have had, including a biopsy, a liver disorder is unlikely.
2) Celiac disease and muscle disorders can also lead to an elevation of AST and ALT.
3) I would evaluate for the aforementioned diseases before coming to that conclusion.
4) A blood test looking for celiac disease, as well as an aldolase level or a creatinine kinase level to look for muscle disease, can be considered.
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_
