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Dr. Andrew Rynne

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What causes elevated ALT and AST levels when diagnosed with fatty liver?

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Dr. Abhijit Deshmukh

Gastroenterologist

Practicing since :2001

Answered : 492 Questions

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Posted on Sat, 7 Nov 2015 in Digestion and Bowels
Question: my doctor thinks that I have fatty liver. I have a very mild alt ast elevation less than 2 times the upper limit of normal. because the alt is elevated does this mean that I have XXXXXXX and not simple fatty liver? the information I have been reading is very confusing. to me it seems like once fatty liver progresses to XXXXXXX is when you would see the elevated alt and simple fatty liver does not cause an elevated liver enzyme. I have also read that both can cause elevated alt increases and the only way to determine the difference is through biopsy and they would not do this unless the liver enzymes do not improve after lifestyle modifications. are you able to clarify?
doctor
Answered by Dr. Abhijit Deshmukh 2 hours later
Brief Answer:
Hello

Detailed Answer:
Welcome to HCM
Thank you for the query
Well presence of fatty liver on ultrasound and normal liver enzymes suggest a diagnosis of fatty liver, a relatively benign condition with no obvious ongoing liver damage.
But this fatty liver may further lead to inflammation or swelling in liver ( termed as Nash) as seen by rise in Ast and alt levels with suggest an ongoing liver inflammation and damage which needs to be evaluated and confirmed first by ruling out other causes of liver disease like hepatitis b, c, alcoholic liver disease, XXXXXXX autoimmune liver disease etc.
Further after the diagnosis the initial treatment is lifestyle modifications like diet control weight control, regular walk etc if no response other treatment options like vitamin E etc can be added.
Hope this answers your query
Happy to help
Wish you an speedy recovery

Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Abhijit Deshmukh 31 minutes later
actually only my alt is elevated. the ast is normal. just to clarify though since the alt is elevated this is XXXXXXX as regular steatosis would not cause elevated liver enzymes?
doctor
Answered by Dr. Abhijit Deshmukh 12 hours later
Brief Answer:
Hello

Detailed Answer:
Possibly it is XXXXXXX if other causes of rare liver diseases like XXXXXXX autoimmune hepatitis, hepatitis b and c are ruled out ( looks unlikely in you).
Best wishes
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Abhijit Deshmukh 14 hours later
the results of my ultrasound came back and the liver was normal. No fatty infiltration. Now we just have to figure out why my alt is elevated.
doctor
Answered by Dr. Abhijit Deshmukh 3 hours later
Brief Answer:
hello

Detailed Answer:
Thank you for the query
Well need to rule out other causes as mentioned earlier
Also some times ultrasonography may not pick up fat, biopsy of liver is gold standard, but not necessary most of times
Best wishes
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Abhijit Deshmukh 19 hours later
got blood results back. Hep a,b,c, and ana+ sma antibodies are negative. alt is still elevated at 72.
doctor
Answered by Dr. Abhijit Deshmukh 2 days later
Brief Answer:
It is relieving to hear that your results are normal.

Detailed Answer:

Good to hear the reports are normal.

You will need to check your lipid profile test and for Wilson's too (Serum ceruloplasmin levels, discuss with your doctor).

Need to keep a watch on Liver function tests (LFT) once every 3 months.


Best wishes
Above answer was peer-reviewed by : Dr. Yogesh D
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