elevated AST/ALT liver enzymes

Question

I recently went to the doctor with prolonged nausea that I assumed was a result of allegies and drainage.  A blood test was given and it came back normal except for elevated AST (450) and ALT (500).  A blood test given about a year ago had my liver enzymes in the normal range (18 and 22).  About 4 days later I was given an ultrasound and the result were normal.  Another blood test was also administered and the liver enzymes were still high and hepetitis was ruled out.  I maybe take Tylenol once a month, have one margarita a month (if that) and except for the Zyrtec D the doctor suggested for my allergies, birth control, and some vitamins I don't take any other medications.  

I am now scheduled to see a GI specialist.  My question is what can I expect from the GI specialist if the ultrasound has already shown a normal liver, pancreas, gallbladder, and kidney?  From what I've read on the internet, elevated liver enzymes don't necessarily mean anything bad - but then most of the time the elevations don't seem to be as high as mine.

If she requests a liver biopsy, should I go ahead and have it done or is this something that we could wait a few months and see if the liver enzymes fall naturally?

How concerned should I be with enzymes that high?  Do enzymes that high mean that I definitely have something wrong that needs to be determined and treated?

jwood2010 · Answer

A related discussion, Elevated Liver Enzymes was started.

pt174 · Answer

Well, I went to the specialist who did more tests.  Was called in Friday (to come in immediately) as my liver enzymes have continued to climb and are now AST 625 and ALT 1139.  Every other number was normal - no high pancreas numbers, white blood cell numbers, etc/  They drew more blood Friday and will contact me Monday morning to inform me if I am to report to the hospital for a liver biopsy.  I have had to cancel a vacation as if the enzymes have not fallen, my doctor wants me to get the biopsy ASAP.  Have to say the rush has me worried more than the numbers since everything I have read indicates high numbers do not necessarily mean things are really bad.  I do wonder though, how high the numbers can get?  I mean, at what point do the numbers indicate that the liver has completely quit functioning.

The doctor still feels the issue is something viral, as all the autos were tested for and I was negative as well as the hep tests.  Unfortunately, she just can't determine what virus is causing the issue.   Hopefully if I have to have a biopsy, it will give the cause.

KMathurMD · Answer

Hi
Thanks for writing to the forum! 
You are right about the fact that many a times AST and ALT rise without any cause. However to reach at that conclusion the medical causes of these raised transaminases have to be ruled out. Causes of liver transaminase elevations include viral hepatitis, alcohol use, medication use, steatosis or steatohepatitis, and cirrhosis. Steatosis and cirrhosis are ruled out by the ultrasound. Other common health conditions, such as diabetes, heart disease, pancreatitis, hemolytic anemia and thyroid disease, can also cause liver transaminase elevations.
Hope this helps. Please let me know if there is any thing else and do keep me posted. Take care!

Imaz · Answer

I had my blood works done dec 07 and my live ALt was 51(avg was <40); GP said it was higher than normal but okay for asians. But I was worried... I too have occasional pain, not to say pain but discomfort under my ribs on the right hand side... Weird your feeling it too. I too had a ultra scan in that area but all was okay..

Lora75757 · Answer

Wow!  Your situation sounds just like mine!  My AST level is 390 and my ALT is 549.  I have some pain in my right side under my ribs but that's about all.  I, however, don't have my gallbladder.  My ultrasound looked good, too.  I did have an abnormal level on the blood test for Lupus- it was high.  We're doing a 3rd round of bloodwork to re-check liver function and adding tests for Lupus, auto-immune, etc.  If I were you, I'd be thrilled to jump on that liver biopsy.  It pretty well settles things once & for all.  I think an MRI will probably come first, though.  The doctors probably rule out the obvious problems first without getting invasive.

Good luck to you, & let us know what happens!  :)

Lora