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Have elevated AST, ALT and ALP. Something wrong with liver, can this be hepatitis?

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Hi my AST is 141, ALT 47 and ALP 137 and LDH 816.
Is there something wrong with my liver? Can this be hepatitis?
Posted Mon, 9 Sep 2013 in Liver and Gall Bladder
 
 
Answered by Dr. Anjana Rao Kavoor 55 minutes later
Brief Answer:
Need to rule out hepatitis by lab tests and scan

Detailed Answer:
Hi XXXXX
Thanks for writing in to us.

I would like to explain the significance of elevated liver enzymes with respect to hepatitis.

AST (aspartate aminotransferase): Increased levels can be seen in any condition causing damage to liver cells (hepatocytes) including hepatitis.

ALT (alanine aminotransferase): Increased levels can be seen in any condition causing damage to liver cells (hepatocytes) including hepatitis.

ALP (alkaline phosphatase): Obstruction of bile (cholestasis) stimulates increased synthesis of liver ALP and leakage of the enzyme into blood. Cholestasis can be due to any cause including hepatitis.

LDH (lactate dehydrogenase): Increase of LDH activity in serum may occur in any injury that causes loss of cell cytoplasm. More specific information can be obtained by LDH isoenzyme studies. LDH-5 is highest in the liver and is elevated in liver disorders.

Coming to your specific question, you may have hepatitis. It can be infective hepatits (commonest hepatitis A, less common hepatitis B and C) or drug induced hepatitis if you take any medications.

Please consult a gastroenterologist and get required tests to rule out hepatitis. An ultrasound scan of abdomen might also be necessary to assess any liver problem by imaging. Bilirubin levels also must be assessed.

Hope your query is answered.
Do write back if you have any doubts.

Dr. A. Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Have elevated AST, ALT and ALP. Something wrong with liver, can this be hepatitis? 23 minutes later
Thank you for your prompt reply.

Just to inform you that the bilirubin level is 14. I did an ultrasound scan of the abdomen and the doctor told me that it is negative.

Coming back to the AST and ALT levels my question is the following: if I had hepatitis A,B,C the ALT level shouldn't be higher? and also the AST/ALT ratio is higher that 2 which normally suggests alcoholic liver disease and not Hepatitis A,B,C?

Thanking you in advance
 
 
Answered by Dr. Anjana Rao Kavoor 16 hours later
Brief Answer:
Please get Gamma Glutamyl Transpeptidase test done

Detailed Answer:
Hi,
Thanks for writing in with an update.

Interpretation of AST/ ALT ratio is as follows

•     When greater than 2.0, it is more likely to be associated with alcoholic hepatitis or hepatocellular carcinoma

•     When greater than 1.0 but less than 2.0, it is likely to be associated with cirrhosis

•     It is normally less than 1.0 and is less than 1.0 in viral hepatitis (albeit with extremely high levels of AST and ALT).

I confirm that the pattern of AST/ ALT ration falls under alcoholic hepatitis but that needs to be correlated with your alcohol intake history. In viral hepatitis AST and ALT are abnormally very high.

ALP levels at 137 are normal. Normal Adult Range: 30 - 120 IU/L

LDH level is found in many tissues and not very specific in you unless sub type assessment is done.

As your bilirubin level is 14 (Normal Adult Range 0.2 - 1.2 mg/dL), this is a concern and needs to be investigated further.

I would suggest you to get GGT (Gamma Glutamyl Transpeptidase) levels done. Elevated levels may be found in liver disease, alcoholism, bile duct obstruction, cholangitis. GGT may be elevated with even minor, sub-clinical levels of liver dysfunction.

Hope this answers your query
Do write back in case of doubts.

Dr A. Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Have elevated AST, ALT and ALP. Something wrong with liver, can this be hepatitis? 30 minutes later
Thank you for your reply doctor.

Just to clarify regarding the Bilirubin total in the lab I took the tests the range is 1-20.50 so the price of my bilirubin test (14) was within the range.
As gor GGT my price was 29 (range 0-73).

My question is whether the pattern of viral hepatitis would imply that I should higher ALT level than AST?
Since this is not the case in my case should i be looking for a different problem??
I also did an ultrasound of the abdomen and the doctor told me that it was negative.

Kind Regards
 
 
Answered by Dr. Anjana Rao Kavoor 1 hour later
Brief Answer:
Repeat ALT. AST after discussing with your doctor

Detailed Answer:
Hi,
Thanks for your update.

1. Total bilirubin in your report might be in mmol/ L where the normal upper limit can be 20.50 mmol/ L

2. Your GGT at 29 is normal.

3. The ALT and AST can also be normal in patients having viral hepatitis. Elevated liver enzymes can be caused by many things other than hepatitis C, such as obesity, hepatitis B, autoimmune hepatitis, certain medicines, or long-term alcohol use. If liver enzymes are raised at one time (even if detected to be hepatitis infected), the test needs to be repeated after a while to watch for recovery or worsening of liver function.

These tests (ALT, AST) do not always detect all liver disease. Some very patients with severe advanced liver disease will have normal or nearly normal enzyme levels. ALT is more specific for liver disease than AST because AST is made in more places (e.g. heart, intestine, muscle).

I have noted that your ultrasound scan was negative.

Finally, as your ALT, AST levels are not very high above normal range, you may discuss the same with your doctor and get a repeat test done accordingly, after an interval of time.

You may get tested for viral hepatitis for peace of mind.

Hope your query is answered.
Do write back in case of doubts.

Dr A. Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Have elevated AST, ALT and ALP. Something wrong with liver, can this be hepatitis? 39 minutes later
Dr.
I just got back results of new blood test. My AST is 27, my ALT is 35, my ggt 27, my ALP 158 (70-290 range), Bilirubin, total 11 (1-20,5 range), Bilirubin direct 2 (0,01-4 range), LDH 280, CK total 157.

Should I still be worried about viral hepatitis?

thank you
 
 
Answered by Dr. Anjana Rao Kavoor 42 minutes later
Brief Answer:
Viral hepatitis unlikely

Detailed Answer:
Hi,
Thanks for your quick update.

I have noted your new test results:

AST is 27
ALT is 35
GGT 27
ALP 158 (70-290 range)
Bilirubin, total 11 (1-20,5 range)
Bilirubin direct 2 (0,01-4 range)
LDH 280
CK total 157

With these levels you should not be worried about hepatitis.

Nowadays hepatitis tests are also done for screening purposes and hepatitis vaccines are also available. I would recommend you to get vaccinated for protection from hepatitis B if not already taken.

Hope your query is answered.
Wishing you good health.

Dr A. Rao Kavoor
Above answer was peer-reviewed by
 
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