Aalanine aminotransferase (ALT) and aspartate aminotransferase (AST) are two enzyme measures included in commonly done laboratory test panels, e.g., when the patient has a blood draw, aka venipuncture.
(AST) are liver enzymes used to assess liver function and detect liver damage. ALT is primarily found in the liver, making it a more specific indicator of liver damage than AST, which is also found in other tissues like the heart and muscles. When liver cells are damaged, ALT and AST are released into the bloodstream, leading to elevated levels in blood tests.
And abnormalities are often detected in patients without symptoms or signs of liver disease. In these patients, LiverRight providers typically obtain a history of exposure to possible liver toxins, including alcohol, prescription and nonprescription drugs, herbal teas and botanical remedies, and occupational or other chemical exposures.
Elevated Levels
Mild isolated elevations of alanine aminotransferase (ALT) or aspartate aminotransferase (AST; < 2 times normal) may require only repeat testing; they resolve in about 33% of cases. It’s important to clarify if laboratory tests were done in the fasting state, because oral intake can cause mild elevations in tests of liver function.
If abnormalities are revealed in other laboratory tests, are severe, or persist on subsequent testing, further evaluation is typically a function of the following–
- Steatotic liver disease should be considered in patients with metabolic syndrome.
- Patients should be screened for hepatitis B and C (HBV and HCV).
- Patients over 40 years in age should be screened for hemochromatosis.
- Patients over 30 years in age should be screened for Wilson disease.
- Most patients, especially young or middle-aged women, should be screened for autoimmune disorders.
- Patients at risk should be screened for malaria and schistosomiasis.
- Most patients, especially those with early-onset obstructive lung disease, especially in the absence of smoking history, should be screened for alpha-1 antitrypsin deficiency.
- Most patients should be screened for celiac disease.
- All patients should receive a thorough review of all prescription drugs, herbals, supplements, energy drinks, and recent antibiotics to exclude drug-induced liver injury.
- All patients should be asked about history of alcohol use.
- Abdominal ultrasound, e.g., with a Hepatus 6 or a FibroScan, effectively can evaluate for steatotic liver disease, cirrhosis, biliary issues, and portal and hepatic vein thrombus.
If the entire evaluation reveals no cause, liver biopsy may be warranted in some cases.
And while liver disease is often asymptomatic, these are noteworthy symptoms–
- Skin and eyes that appear yellowish
- Abdominal pain and swelling
- Swelling in the legs and ankles
- Itchy skin
- Dark-colored urine
- Pale-colored stool
- Chronic fatigue
- Nausea or vomiting
- Loss of appetite
- A tendency to bruise easily.
