Aspartate aminotransferase high why

In addition, we used the key words nonalcoholic fatty liver disease, alcoholic liver disease, viral hepatitis, hemochromatosis, alpha 1 -antitrypsin deficiency, autoimmune hepatitis, and Wilson's disease alone or in combination with aminotransferases. Search dates: May 1, , to April 8, The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the U.

Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Community Hospital. Address correspondence to Robert C. Reprints are not available from the authors. A systematic review of the prevalence of mildly abnormal liver function tests and associated health outcomes. Eur J Gastroenterol Hepatol. The prevalence and predictors of elevated serum aminotransferase activity in the United States in — Am J Gastroenterol.

Changes in the prevalence of the most common causes of chronic liver diseases in the United States from to Clin Gastroenterol Hepatol. Consensus recommendations for managing asymptomatic persistent non-virus non-alcohol related elevation of aminotransferase levels: suggestions for diagnostic procedures and monitoring. Dig Liver Dis. Investigating mildly abnormal serum aminotransferase values. ACG clinical guideline: evaluation of abnormal liver chemistries.

Muscular exercise can cause highly pathological liver function tests in healthy men. Br J Clin Pharmacol. The ratio of aspartate aminotransferase to alanine aminotransferase: potential value in differentiating nonalcoholic steatohepatitis from alcoholic liver disease.

The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology [published correction appears in Gastroenterology.

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Clin Liver Dis. Department of Health and Human Services, U. Department of Agriculture. December Accessed April 8, Eur Radiol. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease.

Pitfalls of liver stiffness measurement: a 5-year prospective study of 13, examinations. Louvet A, Mathurin P. Alcoholic liver disease: mechanisms of injury and targeted treatment. Nat Rev Gastroenterol Hepatol. Clinical differences between alcoholic liver disease and nonalcoholic fatty liver disease.

World J Gastroenterol. Utility of a new model to diagnose an alcohol basis for steatohepatitis. Drug-induced liver injury. Mayo Clin Proc. Aminotransferase elevations in healthy adults receiving 4 grams of acetaminophen daily: a randomized controlled trial. Serum alanine aminotransferase elevation during 10 days of acetaminophen use in nondrinkers.

Drug-related hepatotoxicity. N Engl J Med. Food and Drug Administration. FDA drug safety communication: important safety label changes to cholesterol-lowering statin drugs. February 28, Accessed March 24, Centers for Disease Control and Prevention. Surveillance for viral hepatitis—United States, Updated June 22, Accessed August 6, Preventive Services Task Force. Hepatitis C: screening. June Hepatitis B virus infection: screening, May Diagnosis and management of hemochromatosis: practice guideline by the American Association for the Study of Liver Diseases.

Hereditary hemochromatosis. Screening for hemochromatosis. Clinical practice. Alpha 1 -antitrypsin deficiency. Bals R. Alphaantitrypsin deficiency. Best Pract Res Clin Gastroenterol. If elevations persist after an appropriate period of observation, further testing may include ultra-sonography and other serum studies. In some cases, biopsy may be indicated.

Hepatic transaminase tests such as alanine transaminase ALT and aspartate transaminase AST often are part of standard laboratory panels in asymptomatic outpatients, similar to screening tests for blood donors and for life insurance applicants. The evaluation of an abnormal ALT or AST level in an asymptomatic patient therefore is a common challenge encountered by primary care physicians. According to the American Gastroenterological Association AGA , 1 to 4 percent of the asymptomatic population may have elevated serum liver chemistries.

Although one study 2 of 19, asymptomatic young Air Force trainees found that only 0. Given the frequency of this problem, physicians should develop an informed approach to the investigation of transaminase elevations. An audit of primary care practices found that these abnormalities are not always investigated appropriately and that opportunities to intervene in treatable cases sometimes are missed. However, the AGA recently published a technical review 1 and a position statement 4 on the evaluation of liver chemistry tests.

An algorithmic approach to evaluating mildly abnormal liver functions is recommended. In the asymptomatic patient with negative serum testing and mild transaminase elevations, a period of lifestyle modification can be tried. If abnormalities persist at the six-month follow-up visit, an ultrasonography of the liver is the recommended imaging modality. See page for more information. Their levels can be elevated in a variety of hepatic disorders.

Of the two, ALT is thought to be more specific for hepatic injury because it is present mainly in the cytosol of the liver and in low concentrations elsewhere. AST has cytosolic and mitochondrial forms and is present in tissues of the liver, heart, skeletal muscle, kidneys, brain, pancreas, and lungs, and in white and red blood cells.

AST is less commonly referred to as serum glutamic oxaloacetic transaminase and ALT as serum glutamic pyruvic transaminase. Although levels of ALT and AST can be extremely elevated exceeding 2, U per L in cases of hepatocyte injury and necrosis related to drugs, toxins, ischemia, and hepatitis , elevations less than five times the upper limit of normal i. The range of possible etiologies at this level of transaminase elevation is broader Table 1 5 , 6 and the tests less specific.

It also is important to recall that patients with normal ALT and AST levels can have significant liver disease in the setting of chronic hepatocyte injury e. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med ; , with additional information from reference 5. In many forms of acute and chronic liver injury or steatosis fatty infiltration of the liver , the ratio is less than or equal to 1. This is particularly true in patients with hepatitis C. A mean ratio of 1.

Lactate dehydrogenase LDH is a less specific marker of hepatocellular necrosis and usually does not add diagnostic information to that obtained with ALT and AST testing. An exception to this is the transient but massive rise of LDH in cases of ischemic hepatitis and its sustained elevation that, along with elevated alkaline phosphatase levels, suggests malignant infiltration of the liver.

A study 9 of Danish twins showed that genetic factors accounted for 33 to 66 percent of the variation in ALT, gamma glutamyl transpeptidase, LDH, and bilirubin in patients 73 to 94 years of age. The AGA technical review states that serum ALT has diurnal variation, may vary day to day, and may be affected by exercise. It also notes that serum AST may be 15 percent higher in black men than white men.

Another cause of elevated liver transaminase levels is muscle injury. Strenuous exercise or myopathy can cause elevations especially of AST without causing any other symptoms. A creatine kinase or other muscle marker can be obtained to confirm or exclude such a process. A Japanese study 10 assessed the accuracy of ALT and AST for detecting hepatitis C, excess alcohol use, and fatty liver disease in male bank employees and found the positive predictive value of the test to be low.

Only 3. A thorough medical history and physical examination are the cornerstone of the evaluation of patients with mildly elevated liver transaminase levels. Table 2 6 lists selected medications and herbal supplements that may cause elevated transaminase levels. Nonsteroidal anti-inflammatory drugs. Phenytoin Dilantin. Protease inhibitors. Trazodone Desyrel. Information from reference 6. The presence of other significant health conditions that can cause or augment liver transaminase elevations also should be noted; examples are diabetes, heart disease including congestive heart failure , thyroid disease, muscle disease, and cancer.

Physical findings and sequelae of liver dysfunction are given in Table 3. Once the history and physical examination are completed, additional testing can help discern the etiology of the transaminase elevation Figure 1. Adapted with permission from American Gastroenterological Association. Medical position statement: evaluation of liver chemistry tests. Gastroenterology ; Additional laboratory tests should be obtained when the history and physical examination show no obvious etiology for ALT and AST elevations.

Ferritin, total iron-binding capacity, and serum iron can be used to look for hemochromatosis, while hepatitis A, B, and C serologies are used to rule out acute or chronic hepatitis. Despite the emergence of widespread vaccination, hepatitis B remains a common cause of chronic liver disease in adults.

Testing for hepatitis C is essential because its incidence has increased in the past decade, and new treatment strategies have been developed that can address this frequently missed problem. A prothrombin time PT and serum albumin should be ordered to identify patients with abnormalities of protein synthesis and liver function.

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If you have ascites, you have fluid in the space between the abdominal lining and the organs. Health Conditions Discover Plan Connect. Medically reviewed by Judith Marcin, M. What is the purpose of the AST test? How is the AST test administered? What are the risks of the AST test? How are the AST test results interpreted? Liver Function Tests. Read this next.