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Have high AST and low ALT. Indicative of alcoholic hepatitis. History of L4/L5 disk issues. Guidance?

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Practicing since : 1996
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Hi- I have high AST (197) and low ALT (28), with bilirubin, total protein, albumin, globulin, A/G ration, and ALP all in the normal range. I know that a high AST/ALT ratio can indicate alcoholic hepatitis, and I am a moderately heavy drinker (5 drinks/day), but the low and normal ALT, bilirubin etc. tests would seem to indicate a healthy liver. I know that AST is not liver-specific- do you think its likely coming from somewhere else other than the liver? I have healthy BMI (excellent whole food diet, no smoking) and am a moderate excerciser (with once weekly heavy aerobic exercise, no weight lifting). I do have a history of L4/L5 disk issues but no recent flareups. No heart problems. Thanks-
Posted Thu, 17 Oct 2013 in Liver and Gall Bladder
Answered by Dr. Ratnakar Kini 8 hours later
Brief Answer:
More information needed.

Detailed Answer:
Thanks for posting your query.
I am Dr.Ratnakar Kini and I am pleased to assist you.
I would like to know what your GGT level and your ultrasound scan of abdomen report is before I can give my opinion. Please share those details with me. You may use this upload feature provided to you if you have scanned copies of the test results.

Awaiting your reply...

Dr.Ratnakar Kini
Above answer was peer-reviewed by
Follow-up: Have high AST and low ALT. Indicative of alcoholic hepatitis. History of L4/L5 disk issues. Guidance? 13 hours later
Hi Dr. Kini-

I have not had a GGT test or an ultrasound- it sounds like you would suggest them? Which organs would you specifically suggest for an ultrasound? I have uploaded my two blood test results over the last year (handwritten notes on the most recent one are mine). Please confirm that these will be subject to doctor-patient privilege and that you will not share them unless you need to share them with another doctor for diagnosis.

However, could you please give me your best guess based on my existing tests? In particular, I am wondering if a high AST indicates liver problems when the rest of my more liver-specific tests like ALT and bilirubin are low to normal. Thank you- XXXXXX

Answered by Dr. Ratnakar Kini 37 hours later
Brief Answer:
Detailed answer given below

Detailed Answer:
I went through the reports ( both the old and the recent ones).

In both the reports I found that other than AST, rest of the values are within the normal range.

As you said, a high AST with a normal bilrubin and ALT most often rules out liver involvement.
But sometimes there may be an isolated increase in the GGT level due to alcohol intake even with a normal AST and ALT level. You may request your doctor to order this test as well.

In your case, the isolated AST may not be due to liver condition.

One common cause of isolated increase in AST is exercise. If you been exercising recently that might explain the rise in AST in your case.

Let me know if I can assist you further.
Dr.Ratnakar Kini
Above answer was peer-reviewed by
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