Hello ladies and gents I have been through hell the past month. My liver enzymes were found to be high and I have done a lot of reading. I now see many people posting the same question as I did... "My liver enzymes are high, what does that mean?"
From me to you. I have learned that your ALT and AST ratio is an indicator of liver damage and/or infection. As a general rule of thumb, if your AST is higher than your ALT (maybe doubled) then more than likely alcohol or cirrhosis is at fault. If your ALT is higher than your ALT (say almost doubled or more) then this is a sign of liver damage. Don't get scared! My ALT was 199. My AST was 92. I had a liver biopsy and I have very little damage at all. Nothing that can't be reversed in my case.
BUT you will never know until you go to your doctor. This ratio is not the end all solution and you cannot be diagnosed strictly from it alone.
ALT people. If yours is higher (<300)... You will need blood taken. Your doctor will check you first for Hepatitis A/B/C. If that is ruled out they may look at the following.
Mine ended up being Hemochromatosis. You might want to ask about that if your situation is similar to mine.
Also, I have read that very large numbers (in the thousands) can be viral such as mononucleosis.
Hope this helps and relieves some stress. The biggest thing is that you take what I say as simply a loose guide to tide you over for a day or two until you can get to your doctor. The liver heals itself VERY well so don't stress out until you have a reason to!
PS: If anything I mentioned is incorrect I'm sorry, I'm working off of memory. Google "AST ALT Elevated Liver Enzymes" and you'll get a ton of info. Later.
You neglected to mention hepatitis c which is the number 1 reason for liver transplantation in the US.
You said: "If your ALT is higher than your ALT (say almost doubled or more) then this is a sign of liver damage."
I assume you meant to say "If your ALT is higher than your AST...." If I am right about that I am not sure it's accurate. There is a lot of information about liver enzymes in the hepatitis c setting and I have read numerous articles which state that there are patients with low liver enzymes but have significant liver damage and conversely, there are patients who have high liver enzymes and little damage to the liver. I think generally speaking you make a point and that is that elevated liver enzymes should never be ignored. They demand further investigation/testing. But if, for instance, your ALT is 40 and your AST is 20 I do not think that necessarily means liver damage. I does suggest some liver problem exists and probably at least some liver inflammation but there may or may not be liver signs of liver damage such as fibrosis or cirrhosis.
I don't intend this as criticism because I thought your information was quite good overall.
BTW, are you undergoing phlebotomies for your hemochromotosis? And how are you doing with whatever treatment you're undergoing?
ALT usually tells of liver damage. It is mostly liver specific. If a person has an ALT of 40 and and AST of 20 then they would not be elevated. Exercise can cause that. It is true that a number of 100, 200 or 300 would not necessarily mean that the higher number is worse than the lower number.
I apologize for overlooking your mention of Hep A, B & C
While an ALT of 40 is within most lab reference range a good hepatologist would probably want to look a bit further at it and that is irrespective of an AST of 20.
My understanding is that strenuous exercise can significantly elevate AST & ALT.
I come from an HCV and liver transplant setting so perhaps my physicians are more sensitive to enzyme elevations than non-transplant physicians. But I have seen a few articles that suggest lowering the threshold for enzyme reference range. I believe one had it at 30 where an ALT over 30 would warrant further investigation and/or testing.
An ALT of 300 would be worse than 100 in terms of liver cell death - the more cell death the higher the enzyme elevation. In the HCV setting higher enzymes not necessarily translate into greater liver damage and that is somewhat puzzling. Though that is true I believe that most hepatologists would be more comfortable with an ALT of 100 than 300. I always like low enzymes myself.
In Jan '08 my husbands liver enzymes were normal, in Mar '08 they were evelated, over 5 times normal readings. The doctor's had him coming back every week for blood work, they took him off meat totally and he could only eat 'growing' things....they put him on fish oil. After two ERCP's they found a blockage in one of the bile ducts. They scraped the bile duct and balloon'd it then put a stent into the bile duct. The pathology report came back as cancer. In June he had a liver resection where they took out over 1/2 of his liver. He had a very small tumor in the bile duct about 1/2 CM away from the common bile duct. We are now 7 months post surgery and he still has a JP drain coming out of his right side because he developed a bile leak after the surgery. He has had 6 ERCP's and currently still has a stent in the liver which has to come out in about 3 weeks - which means another ERCP. After surgery his bile leak output was over 400 ml a day, it has slowed to around 100 ml a day.
This just goes to show that elevated liver enzymes are nothing to fool around with. Go back to your doctor again and again UNTIL they locate the problem. My husband's tumor was so small that they could not even pick it up on a CTSCAN.
His cancer was cholangocarcomia which is a slow growing cancer but will eventually cause problems and if caught early enough they can remove it. If you wait until you are experiencing issues it may be too late. Go see your doctor.
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