Elevated AST, Normal ALT

[rskle]

I am a 57 yr. old male and in good health. Earlier this year (Feb. 2007)  I had my annual physical my ekg showed a slightly abnormal reading. My Dr. had me see a cardiologist to follow up and also had a blood test checking my ALT and AST. The cardiologist ruled out a heart problem but when the blood work came back my ALT was normal but AST was elevated. It read 67 with 42 being high normal reading.
My Dr. said we should follow up with another blood test in 4 months. In ealry July of this year the test was done again and as before ALT was normal but AST now came down to 51 (42 being high normal reading). The Dr. was pleased that the level reduced by more than 20% and suggested that it may have been a fatty liver or from alchohol intake. I am not a heavy drinker but drink wine 3-4 times a week (2 glasses avg on those occassions) and am not overweight by more than 10-15% so I am a bit skeptical of it being from that alone.
I am somewhat concerned that the cause may be more than he is suggesting and wondering if I should be more worried. I have no symptoms of any disease or sickness but want to know if  I should seek a more inniediate follow up than my Dr. suggests which is to have the blood work re-done when I have my next physical this fall.

[Kevin Pho, MD]

I agree with repeating the liver tests.  

Imaging the liver and gallbladder with an ultrasound can further evaluate for any anatomical liver damage.  I would also consider testing the ferritin and ANA levels to exclude hemochromatosis and autoimmune hepatitis.

If the liver enzymes are not rising, rechecking them periodically can be done to ensure they are stable.  

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_

[Eric55]

I agree with the doctor to get an ultrasound to be sure your liver is OK. I have also had elevated (slightly) ast and normal for all other liver functions. I also drink as much as you do and sometimes more particularly when watching football :). I had an ultrasound and CT scan, both normal. Alcohol affects everyone differently. Some can drink a bottle of wine a day their whole life and be just fine, others drink just a drink or two a day and have problems. Get the ultrasound for piece of mind. It may be just a case of a mildly fatty liver which is not a serious condition and is completely reversible.

[hbp702]

Fatty liver not from alcohol usually elevates ALT more than AST, often leaving AST normal.
Alcohol abuse usually raises AST more, but ALT is raised too. Drinking can cause short term increases, also.
Muscle damage (including from intense exercise) can raise AST (which is in muscle too).

Don't drink or exercise heavily within a couple of days of getting AST/ALT tests done!

[Eric55]

Very well put. I believe AST is also present in cardiac muscles and red blood cells.

[stalight64]

Hi,
I have hep C and wanted to add a few things.
Please know and remember that MANY medications including some over the counter ones can elevate your liver enzymes. The biggest one that people often don't think about is tylenol or acetaminaphen (sp).
Many years ago I was battling migraines and taking tylenol around the clock for several months. While doing routine bloodwork my Dr. noticed my elevated liver enzymes. Well, I laid off the tylenol for a while and although they were still elevated, they went down quite a bit. Not long after that I found out I had hep c after seeing  some people discussing hep-c on nightline and asking the doc to test me.  So if you are taking a pain reliever for more than just occasionally, many Dr's recommend that you alternate between tylenol and ibuprofen. Even my kid's Pediatrician recommends this. In my case though.... tylenol is up there w/ alcohol on the things to avoid list.
take care,
star****