From the Guidelines
Elevated ALT and AST levels with a total bilirubin of 1.6 suggest liver dysfunction, and a healthcare provider should be consulted for proper evaluation and additional testing to determine the cause. The severity of abnormal aminotransferase can be classified as mild, moderate, or severe, with moderate and severe being discussed collectively due to significant clinical overlap 1. In this case, the elevated ALT and AST levels indicate hepatocellular damage or bile flow alteration, which may be caused by various factors such as diffuse hepatic infiltration, acute hepatitis, or toxic or ischemic injury.
Key Considerations
- Elevated ALT levels are specific for liver injury, with normal levels ranging from 19 to 33 IU/L in men and women 1
- AST elevations can be due to disorders involving the heart, skeletal muscle, kidneys, brain, and red blood cells, but in this case, the combination with elevated ALT suggests liver damage
- The total bilirubin level of 1.6 is slightly elevated, which may indicate cholestasis or impairment in bilirubin uptake
- Additional testing, such as a complete liver panel, hepatitis testing, and possibly imaging studies like an ultrasound of the liver, may be recommended to determine the cause of the liver dysfunction
Recommendations
- Avoid alcohol and medications that can stress the liver, including acetaminophen (Tylenol) 1
- Stay well-hydrated and maintain a healthy diet
- If symptoms like jaundice, abdominal pain, dark urine, or light-colored stools are experienced, seek medical attention promptly
- Consult with a healthcare provider for proper evaluation and guidance on further testing and treatment.
From the Research
Implications of Elevated ALT and AST Levels
Elevated Alanine Transaminase (ALT) and Aspartate Transaminase (AST) levels, along with a total Bilirubin of 1.6, may indicate liver damage or disease. The implications of these elevated levels can be understood by considering the following points:
- Elevated liver enzymes are a common scenario encountered by physicians in clinical practice, and may reflect potential liver injury 2.
- The most common causes of transaminase elevation are non-alcoholic fatty liver disease (NAFLD), alcohol intake, and hepatitis C virus infection 3.
- Elevated serum levels of transaminases (AST and ALT) usually indicate hepatocellular damage, while ALT elevations can also be of extrahepatic origin (muscle) 4.
- A hepatic enzyme pattern (predominant transaminase elevation) should be discriminated from a cholestatic pattern (predominant AP and G-GT elevation) 4.
Possible Causes and Diagnostic Approaches
Possible causes of elevated ALT and AST levels include:
- Alcoholic liver disease
- Viral hepatitis
- Drug-induced liver disease
- Non-alcoholic steatosis
- Other liver diseases A diagnostic approach to elevated liver enzymes should involve a step-wise algorithm, classifying enzyme alterations on the basis of pattern (hepatocellular, cholestatic, and isolated hyperbilirubinemia) 2, 5. Further investigations, such as viral serology, autoantibodies, and abdominal ultrasound, may be necessary to determine the underlying cause of elevated liver enzymes 3, 5.
Clinical Significance and Management
Elevated liver enzymes can be a sign of underlying liver disease, and it is essential to evaluate and manage these patients appropriately. An algorithmic approach can be taken to help narrow the spectrum of a differential diagnosis and ensure appropriate management and evaluation of the patient with elevated LFTs 5, 6. In some cases, elevated liver enzymes may be self-limited, and a definitive diagnosis may not be reached 3. However, it is crucial to confirm transaminase elevation before starting a more thorough work-up 3.