AST decreased sharply but ALT went up also sharply

[TKW2K]

I am a Chinese male living in HKG, age 45.

I took the liver function test a week ago and have subsequently
been dignosed to have hepatitis B in another test. As the AST and ALT were "alarmingly high", 1,053 and 1,028, the second medical doctor I consulted arranged for me to take the second LFT yesterday and the results are sort of strange: AST dropped to 259 but ALT rose to 1,415. Is there any explanation why the two go in the opposite direction? I had a common cold a couple of days before and had taken the Panadol (cold & flu) before the LFT. Will this be somehow affecting the test result?

The 2 LFT results are:
                          1 st           2 nd
Total Bilirubin           47             23
AST                       1,053          259
ALT                       1,028          1,415
Alkaline Phosphatase      253            167
Gamma GT                  NA             252

Though all the above tests show out of range problem, all except
ALT have fallen.

The MD suggested to do the third LFT 3 days later. If ALT is still so high, I might have to be hospitalized.

Any help will be highly appreciated.




  

[TKW2K]

Thank you for the comments.

I recalled I got tired easily a couple of weeks before the first LFT, which I thought was resulted from flu. Only when I began to notice the yellowish urine (excessive bilirubin) and felt itchy (deposit of bile pigement in skin) that sent me to visit the MD.

[tikerberi]

Frankly, I'm surprised they didn't hospitalize you immediately upon those AST/ALT readings, but I know that medical standards are different in different parts of the world.  

I'm female, 53.  I live in Ohio (USA) and in May my ALT was in the 900's and my AST was also up in the 700's (as I recall).  I had been physically ill for two weeks, taking many drugs that included acetamenophen (Tylenol, etc.)  I went to the Emergency Room and was told that I was in liver failure, and they put me into the intensive care until immediately.  After a week, I was released, but my ALT was still abouit 527 and my AST was lower than that, but still high (I forget the numbers).

My GI later told me that generally, when the AST goes up it's a pretty good guess that it's been caused by alcohol.  If the ALT goes up, it can be anything else, which can't be determined without further tests.  I took this to mean that the AST and ALT don't go up and down at the same time--it depends on what the problem is.

So, I figure my AST was high because I had, in fact, been drinking when the tests were taken, and quite intensively for the year prior to taht.  The AST moved down much more quickly than the ALT over time.  It was the ALT that continued to concern my doctor, because he said that if it was so high only due to the acetimenophen it would have gone down more than it did after I was hospitalized and stopped using acetimenophen.  This meant that there was more going on, including possible liver damage, which could not be determined without a biopsy.  After several more followup visits and much lab work, I was diagnosed as having hep C.  Biopsy showed inflammation, but no cirrhosis.

In the end, it seems that my liver failure episode in May was an acute attack of hep C, made worse by the acetimenophen rather than caused by it.

I had hep A back in hippie days, and was vaccinated for hep B several years ago, so I have surface antibodies for both.  However, my doc also told me that there are several kinds of hepatitis and sometimes more than one may be invading the body.  I imagine that hep C and B infections can be acquired at the same time, since both are transmitted in the same manner (blood, etc.)

However, I'm no doctor and can only share what my own experience has been.  The only advice I have, is to get as much testing done as possible to rule out other infections, stay away from alcohol and recreational drugs, and follow what your doctors tell you.

It occurs to me, after reading this, that this post is probably not helpful at all.  In any case, I wish you well.

[lackalustre]

Alt is directly related to liver damage.   yes medicines can affect the ALT and AST.

you may not be getting answers here because we simply dont know what to tell you.  hep c  seems to be the most common topic here. but many of us have had hepb too and cleared it on our own.    maybe that would be harder when you are older. (no 45 is not old!)

There is a nurse practitioner named Erin that comes to this site.  maybe she will help you.