From the Guidelines
Elevated AST and ALT levels themselves do not directly cause physical discomfort, but rather indicate liver cell damage, and any associated symptoms are typically due to the underlying condition causing liver inflammation or damage. When AST and ALT are elevated, the discomfort a person experiences is usually a result of the underlying condition, such as viral hepatitis, alcoholic liver disease, fatty liver disease, or medication-induced liver injury, rather than the enzyme elevations themselves 1. Common symptoms associated with these conditions might include:
- Fatigue
- Abdominal pain in the right upper quadrant
- Jaundice
- Nausea
- Loss of appetite The liver has a remarkable regenerative capacity and can function adequately even with some degree of damage, which is why many people with mildly elevated liver enzymes remain asymptomatic 1. Treatment should focus on addressing the underlying cause rather than the enzyme elevations themselves, and if you have elevated liver enzymes, it's essential to work with your healthcare provider to identify and treat the root cause, even if you aren't experiencing symptoms, as ongoing liver damage can lead to serious complications if left unaddressed 1. In some cases, elevated AST and ALT levels can be associated with more severe liver damage, and it's crucial to monitor these levels and adjust treatment accordingly 1. Overall, while elevated AST and ALT levels do not directly cause physical discomfort, they are essential markers of liver health, and addressing the underlying cause of these elevations is critical to preventing long-term liver damage and related complications.
From the Research
Elevated AST and ALT Levels
Elevated Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) levels are commonly used biomarkers for liver damage. The following points highlight the relationship between elevated AST and ALT levels and physical discomfort:
- Elevated AST and ALT levels usually indicate hepatocellular damage 2.
- A patient with elevated serum transaminases may not necessarily exhibit physical symptoms, as seen in the case of a 40-year-old obese woman who presented with increased ALT and AST levels without any physical symptoms 3.
- The ratio of AST to ALT (AST/ALT) can be used to differentiate between alcoholic and non-alcoholic liver disease, with a ratio greater than 2.0 often indicating alcoholic liver disease 4, 5.
- Elevated AST and ALT levels can be caused by various factors, including alcoholic liver disease, non-alcoholic steatohepatitis, and viral hepatitis 2, 4, 6.
Physical Discomfort Associated with Elevated AST and ALT
While elevated AST and ALT levels can indicate liver damage, they may not always result in physical discomfort. However, some patients may experience:
- Fatigue, weakness, and weight loss, which are common symptoms of liver disease 2.
- Abdominal pain, nausea, and vomiting, which can occur in cases of severe liver damage or cirrhosis 6.
- Jaundice, which is a yellowing of the skin and eyes caused by a buildup of bilirubin in the blood 4.
Diagnosis and Monitoring
Diagnosis and monitoring of elevated AST and ALT levels involve:
- Blood tests to measure liver enzyme levels, including AST and ALT 3, 2.
- Imaging studies, such as ultrasound or CT scans, to evaluate liver damage 4.
- Liver biopsy to confirm the diagnosis and assess the extent of liver damage 5.
- Monitoring of liver enzyme levels and other biomarkers to track the progression of liver disease and response to treatment 2, 6.