Understanding Elevated Liver Enzymes: What to Do When ALT and AST Levels Rise

When medical professionals report abnormal liver enzyme levels, it can be concerning to hear about elevated ALT and AST levels. However, it's important to understand the context and potential causes of these findings. In the text you provided, there are several important points to consider, including when to seek further evaluation and the likelihood of the situation being temporary or requiring attention.

Context and Normal Ranges of Liver Enzymes

Your ALT (Alanine Transaminase) level of 149 and AST (Aspartate Transaminase) level of 66 beyond the normal range can be cause for discussion, although your doctor may not express immediate concern. ALT levels in adults typically range between 7-56 U/L, with AST levels ranging between 10-40 U/L. These levels can vary slightly depending on the laboratory. The ALT level cited (42) in the UK about 20 years ago is well within the current normal range.

Assessment and Possible Causes

Your doctor may have ordered an ultrasound as a non-invasive way to assess your liver. While this may not seem urgent at the moment, the ultrasound can provide important diagnostic information. The key is to understand that sometimes, elevated levels of liver enzymes like ALT and AST can be benign and should be monitored over time.

Common Causes of Elevated Liver Enzymes

There are several common causes for elevated liver enzymes:

**Fatty Liver (Steatohepatitis)**: This is a condition where excess fat builds up in the liver cells, leading to inflammation. **Medication Side Effects**: Certain medications can cause liver enzyme levels to rise. **Alcohol Consumption**: Excessive alcohol use can damage liver cells and cause elevated enzyme levels. **Transient Gallstones**: Gallstones can temporarily block bile flow, causing liver enzyme levels to rise. **Idiopathic Causes**: Sometimes, the cause of elevated enzymes is unknown and could be due to transient physiological changes.

When to Seek Further Evaluation

Your doctor may advise monitoring these levels for a period, such as two to three months, before deciding on further steps. If the levels continue to rise or if you experience any additional concerning symptoms, further evaluation may be necessary.

Further Evaluation and Testing

When further testing is indicated, your doctor might recommend:

**Hepatitis B and C Serologies**: These tests check for specific viral infections that can cause liver inflammation. **Basic Screening Labs**: Additional blood tests to check for other liver-related issues. **Imaging and Liver Biopsy**: Depending on your symptoms and the persistence of elevated levels, more detailed imaging or a liver biopsy may be necessary.

Conclusion

Elevated liver enzyme levels can be concerning, but it is important to understand that in many cases, these levels can be benign and non-threatening. Regular monitoring and keeping in touch with your healthcare provider is key. If you have ongoing concerns or additional symptoms, seeking a second opinion or further evaluation might be necessary.

Remember, your doctor's approach is often informed by the context and your overall health. If you have doubts or concerns, it's always a good idea to have an open conversation with your healthcare provider or seek a second opinion if needed.