Elevated AST and ALT

[Timmer613]

I am 43 year-old healthy male who works out fairly regularly.  I’m 6’1” and weigh about 185.   Today I went to the emergency room with what felt like a softball sized balloon inflated in my lower left stomach/side area with no pain, but a lot of pressure.  For a couple of months, I have been experiencing lots of gas and stomach rumblings and some diarrhea on a daily basis.  

After the X-ray and blood test, the doctor informed that it was a gas bubble and it would pass.  She then noted that the blood work was fine except the AST was 331 and the ALT was 151, both significantly out of range.  She seemed a little uncomfortable (my wife was there) and sort of glossed over the issue by saying – think about cutting down on your drinking.  The nurse then came in and said stop drinking now and get help much more sternly than the doctor.  Two very different levels of concern.  Note:  My last physical (15 months ago) did not show elevated AST or ALT, but did show elevated triglycerides.  All other blood work/urine testing/Hematology from today was normal.

I am what I consider to be a heavy drinker and had a particularly heavy weekend of drinking, including multiple nights of 4 – 5 beers and 4 – 5 shots of liquor, including the night before today’s hospital visit.  I’m not making any excuses for the drinking – I know it is way too much.  It is likely that I am a functional alcoholic and am looking into treatment options.  That said:  

1.  How serious of an elevation is this given the circumstances?    

2. Given the recent nature of the drinking binge, what is the likelihood that the AST and ALT are elevated and will come down over time?  I’m not looking for the crystal ball here rather an opinion on how directly elevated AST and ALT are correlated to recent, heavy drinking and how quickly those levels should/could dissipate when alcohol is not consumed.  

3.  Obviously, parts of the answer is abstaining from alcohol and getting retested and hope the levels go down to normal range.  What period of time should I wait (while abstaining from alcohol) before getting retested?

4.  Is there any possible relation between the upset stomach over the past few months and liver damage and/or significant alcohol intake?  

5.  Assuming AST and ALT do not come down over time, what is the next step in evaluating alcoholic hepatitis  and/or cirrhosis.  Are there other alternatives that could be causing this?  

6.  Is there anything else I should be considering other than getting in front of my doctor and having a frank conversation?  

I know this is not a replacement for medical advice (and it more than one question), but I am interested in your thoughts.  Thanks for your help.

Tim

[Kevin Pho, MD]

To answer your questions:
1) The elevations are moderate, and there should be further evaluation to look for the cause.  Abstaining from alcohol is recommended.

2) The ratio of the AST:ALT of 2:1 suggests alcohol as a cause.  Abstaining from alcohol and repeating the tests can be done to see if the levels normalize.

3) Retesting in 2-4 weeks can be considered.  There is no concrete time for followup.

4) It is possible that alcohol can lead to gastritis (causing stomach upset) as well as the liver symptoms.  

5) Testing for hepatitis as well as obtaining a liver ultrasound would be the next diagnostic steps.

6) The possibility of hepatitis can be considered.  The ultrasound can look for any masses or anatomical abnormalities that may lead to an enzyme elevation.  Problems with the gallbladder can be considered as well.

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.
http://www.straightfromthedoc.com

[msm0762]

I am a 43 year old male, height 6', weight 205. I am generally athletic and in good health. After a recent physical, I took some routine blood work, and everything was normal except for a mildly (according to my doctor) elevated AST level of 86. Everything else, including urinalysis, was normal and my cholesterol was 161. My triglycerides were 178, so he told me to lay off the fried foods. As for the AST level, he told me to not be too concerned about it, but that we should redo the blood work to check it again, and have me meet with the gastroenterologist for further evaluation. Since I'm used to good outcomes in my physicals, I was a bit alarmed. I want to know if recent drinking or diet could have caused this slight elevation in my AST level. I'm normally a social drinker at the most, (IE: just at restaurants, parties, barbecues). However, the last 2-3 weeks of the summer, I attended several parties, went out with friends, followed immediately by a weeks vacation where I drank at meals and at wineries. So, it was pretty much several weeks of drinking regularly and I went for the blood work the day after I returned from vacation. Could this have been the reason for the elevation in the AST level? In your opinion, is this the likely cause? Could diet also affect AST level? I've been very concerned since hearing this, so your response would be appreciated. Thanks for your help.

[Jackshack]

A related discussion, Elevated AST was started.