Plan of management for asymptomatic raised ALT and AST Other non-hepatic medical diseases associated with raised ALT and AST include musculoskeletal disorder such as polymyositis, acute muscles injury, acute myocardial infarction and hypothyroidism.Ģ. In chronic viral hepatitis, the elevation of liver enzyme may not correlate well with the degree of liver damage. 3Ĭhronic liver disease such as cirrhosis and chronic hepatitis C may cause mildly elevated AST and ALT.
Obesity and insulin resistance are associated with a condition known as non-alcoholic steatohepatitis (NASH) which also presents with mild elevation of ALT and AST. In the community, use of traditional or complementary therapy must also be excluded. Cholesterol lowering agents (such as HMGCo-A reductase), anti tuberculosis drugs, non steroidal anti-inflammatory drugs including aspirin are all known to cause mild elevated liver enzyme. Many prescription drugs also induce elevated ALT. If the AST:ALT ratio is greater than two, it is more suggestive of alcoholic liver disease. 2 This is a common finding even if the patient does not have alcoholic hepatitis or alcohol related liver cirrhosis or failure. One of the most common causes of mild elevation of ALT and AST in asymptomatic persons is chronic alcohol consumption. Common causes of mild elevation of ALT and AST in an asymptomatic person However, the elevation of ALT and AST in asymptomatic subjects in primary care setting is usually in the range of 1.5 to 2 times the normal value. Clinically patient will present with symptoms such as jaundice and abdominal pain. This is the result of leakage of these enzymes into the systemic circulation.
When there is acute necrosis of the liver, caused by ischaemia, viral hepatitis, chemical or toxin, the ALT and AST levels can go up to hundreds or thousands IU/L. 1 ALT and AST are produced by hepatocytes, therefore raised ALT and AST are laboratory indicators for hepatocellular injury. The upper normal limit of ALT and AST varies from lab to lab, and is usually from 25 to 50 IU/L. The most common abnormalities of liver function test in an asymptomatic person is raised alanine aminotransferase (ALT) and raised aspartate aminotransferase (AST). It may lead to visits to family doctors to seek advice, or demand for more investigations to ascertain if there is underlying serious liver disease. Abnormal results in the liver function test often cause considerable anxiety in asymptomatic subjects. Liver function test is one of the most common blood tests requested by primary care doctors in clinical practice.
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