Elevated AST Mild ALT Elevation

[nc33434]

Good Morning Dr. Schiano,

I am hoping you can help me sort out the results of recent blood work I had done. I had a routine physical done with my internal medicine doctor (the first after 10 years of not seeing a doctor, and the lab work was returned normal with the exception of the LFT portion, which yielded the following:

Albumin: 4.6 (3.5-5.5 in Range)
Globulin: 2.1 ((1.5-4.5 in Range)
AG Ratio: 2.2 (1.2-2.5 in Range)
Bilirubin: 0.6 (0.0-1.2 in Range)
Alkaline Phosphatase, S : 63 (25-150 in range)
AST (SGOT): 88 (abn) (0-40 in range)
ALT (SGPT) : 58 (abn) 0-55 in range)

What has me concerned is the elevated AST and ALT. It seems like the AST is more than double the normal range, are these elevated to the point where I am in grave danger?

In terms of hepatitis, the only possible exposure i could have had to hep b was from receiving unprotected oral sex, and that was well over 90 days ago. I had the hbsag test and hep c test done 9 weeks, and 12 weeks outside of exposure, so would the test for hep b at this point rule out acute hep b? Also, would my AST and ALT levels be far more elevated than this if in fact it was acute hepatitis?

Also worthy of mention, is that I am 34 years old, do not drink often (less than 5 times per year), but am overweight. 6'2 320 pds. My doctor indicated this could be fatty liver based on my size. He has ordered additional testing

To sum up my questions, they are as follows:
A) Can i rule out acute hepatitis based on the specific testing that has been done, combined with the LFT's (I have read that in the acute stages of Hep these numbers are far higher than mine if they are elevated)

B) Are my AST and ALT levels Highly Elevated?

C) How alarming are these levels?

Thank you Doctor for the work you do on this forum, I have been pretty nervous since I got the call from my doctors RN.  

[Thomas D Schiano, MD]

does not change my opinion about the HBV Ryan.  You should do fine.  good luck.

[cj07450]

Thank You Doctor for your reassuring words. I am just not sure I was ever immunized as I am 34 years old.

Does that change your opinion in terms of HBV?

I have already begun going straight to work on my diet and exercise and will absolutely drop serious weight and have already begun walking 4 miles per night. This has shaken me up some (for the good) but if you would not mind answering my final question, and then i will report back next year after these lifestyle changes have taken effect....

Thank You Doctor Schiano,

Ryan

[Thomas D Schiano, MD]

i definitely do not think that think that HBV is at work here.  the immunization is almost 100% protective.  this is fatty liver and will be reversible with lifestyle changes.

[nc33434]

Doctor,

Thank you for your follow up. My doctor tested me for Hep A, B, C Autoimmune Hep, Hemachromotosis, Wilsons Disease etc. All my tests were negative. He also ordered an ultrasound that revealed "fatty liver" which is something you also indicated could be a possibility for the raise in my liver enzymes. He has attributed my elevations to fatty liver at this point and essentially told me lose weight and control my diet (the exact same thing you told me)

My final question is this, having had testing for Hep B through the use of the HBsAG test at the 1 week, 9 week and 13 week mark post exposure can I safely rule out an acute Hep B infection?

My doctor indicated that my AST (88) and ALT (58) would have been much higher had this been acute hep b and has ruled that out as a possibility. My concern is that the test missed the surface antigen, as from my research it appears that antigen is present and then disappears in acute hepatitis.

Is this even possible (that the tests could have missed the surface antigen) and if so, does this mean my body has cleared hepatitis and it is no longer a concern?

When the antigen does show up, how long does it take before it is undetectable?

I truly tried to come up with this on my own, but I fear my doctor does not neccesarily have the expertise...

Thank you in advance Doctor for your time. I am very eager to put this behind me in terms of hepatitis b if in fact I can safely do so....

[Thomas D Schiano, MD]

no more alcohol for the time being

[nc33434]

Dr Schiano,

Thank you for your reply!  

I will absolutely continue to follow up with my doctor - when you say "stop drinking everything" - do you mean do not drink alcohol, or is there anything else I need to steer clear of, I rarely drinnk anyway, so cutting alcohol out will not be a prob...I will absolutely begin to lose weight, I just want to make sure I understood your response.

Thanks Again Doctor -

[Thomas D Schiano, MD]

these are not concerning elevations but need to be followed up.  in fatty liver the ALT is often greater than the AST, although it can still be present.  Stop drinking everything and try to lose a little bit of weight and i think these mild elevations will retunr to normal.  i do not think you have acute hepatitis.