Extremely Elevated AST and ALT, with Jaundice

[jasonnd]

Hello,

I am a 31 year old male, about three weeks ago I noticed my eyes turned a slight yellow.  This prompted me to see my physician.  My lab test showed an ALT of 2400, an AST of 1300 and a direct billirubin of 6.2, and an indirect of 10.2.  At this point I had not had an alcoholic beverage for 2 weeks.  It is also worth mentioning that I do not take any over the counter or prescription medication - including Acetaminophin.  A repeat of the ALT 5 days later showed 2000.   All other liver function and CBC tests were normal.  I also underwent a CT scan of the liver and spleen, the liver was negative, and my spleen was mildly elarged.  I was referred to a Gastro Intestinal Specialist, and more tests are underway, including auto immune, Wilson's, and a few others.  I have tested negative for hep A, B, and C.  I was a  heavy drinker for approx. 10 years, probably close to daily the past 5 years, but haven't drank for the past 4 weeks.  Ironically, I quit drinking permanenlty one week prior to noticing any liver symptoms. Prior to this time I have not experienced any symptoms of any kind of disease or problems.  I feel fine, other than not knowing what is going on in my liver.  I am not scheduled to see my specialist for another 3 weeks, and in the mean time, he has ordered once a week LFPs.

My questions are:

1. Can alcohol abuse lead to liver enzymes that high?  Especially after 2 weeks of abstinence prior to my first blood test?
2. Can alochol give an AST:ALT ratio of approx. 0.5?
3.  With enzymes this high are my chances high for the development of fibrosis/scarring leading to cirrhosis even with permanent abstinence?

Thanks for your time.

[jasonnd]

Thanks for everyone's response - I appreciate it.

I just recieved results from some iron tests and new LFPs.

My ferritin is 5200 and my iron is 340.

My ALT and AST are 1500 and 1000 respectively now, and my billirubin direct and total are 3.2 and 6.3 respecitively.  I do not have yellow eyes anymore.

Everything seems to be coming down, but it seems to be slow.  

I am now very concerned about my feriritin.  My specialist scheduled a biopsy one week from today because of the level, but I have no answers until then.  

Has anyone heard of ferritin this high?

[Kevin Pho, MD]

To answer your questions:
1) Although possible, it would be uncommon for alcohol abuse to lead to LFTs that high.  Acute hepatitis, toxic hepatic medications, and shock liver (due to heart failure) can all be considered.  A liver biopsy can be considered if the enzymes continue to be that high.

2) Typically the ratio for alcohol abuse is an AST:ALT ratio of 2:1.  I would pursue other causes before settling on alcohol abuse.

3) If a cause cannot be found and appropriate treatment started, eventually the liver will start to fail and possibly lead to cirrhosis.  

These options can be discussed with your personal physician.

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_

[Kalio1]

Good thing you tested negative for hep a, b and c. What a relief. I can understand your fears, that is a very high LFT reading. Your doc is testing you for another set of possible issues, I know the waiting is very hard. Liver damage works in a progressive fashion and can progress without you even having a symptom, you will need a liver biopsy to make a definitive determination of your liver status but for now you have to get to the bottom of the problem. I dont think you stopping drinking and this problem is anything but coincidence. There are too many possibiilities to say what it is yet that is why your doc is testing more and ruling things out one by one. It is hard to be patient but hopefully he can rule out this next set of issues and move down the diagnostic line. Thankfully you are off alcohol.
Yes, alcohol abuse or the cumulative damage from alcohol abuse can cause very high enzymes so the best thing is no alcohol. Clearly there is inflammation going on, inflammation leads to scarring then the scarring progresses as you probably know. Sounds to me like your doctor is doing all the right things. You can maintain a liver friendly diet, stay away from medications and booze and get some regular exercise. I know it is very hard to be patient with this type of thing, all the stressful waiting is typical with liver problems. Hang in there.

[Yezinki]

Hello,

Do keep Autoimmune Hepatitis into consideration.

Good Luck.