What causes elevated ALT and AST levels in asymptomatic individuals. How should primary care doctors approach diagnosis and treatment of high liver enzymes. When are further tests needed for patients with abnormal liver function results.

Understanding ALT and AST: Key Liver Enzymes

Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are enzymes primarily found in liver cells. When liver cells are damaged, these enzymes are released into the bloodstream, leading to elevated levels detectable through blood tests. While ALT is more specific to the liver, AST is also present in other organs like the heart and muscles.

Normal ranges for these enzymes can vary slightly between laboratories, but generally:

• ALT: 0-44 IU/L (International Units per Liter)
• AST: 0-40 IU/L

Elevated levels of these enzymes, particularly when a patient is asymptomatic, can be concerning for primary care physicians. Understanding the potential causes and appropriate next steps is crucial for proper patient care.

Common Causes of Elevated ALT and AST

There are numerous reasons why ALT and AST levels might be elevated in an asymptomatic individual. Some of the most common causes include:

1. Non-alcoholic Fatty Liver Disease (NAFLD)

NAFLD is becoming increasingly prevalent, especially in developed countries. It’s often associated with obesity, diabetes, and metabolic syndrome. In NAFLD, fat accumulates in the liver, leading to inflammation and elevated liver enzymes.

2. Alcohol Consumption

Regular alcohol consumption, even in amounts not considered excessive, can lead to elevated liver enzymes. Chronic alcohol abuse can result in alcoholic liver disease, characterized by persistently high ALT and AST levels.

3. Medications

Various medications can cause transient elevations in liver enzymes. These include:

• Statins (cholesterol-lowering drugs)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Certain antibiotics
• Anti-seizure medications
• Some herbal supplements and over-the-counter products

4. Viral Hepatitis

Hepatitis B and C can cause elevated liver enzymes, even in the absence of symptoms. These viral infections can lead to chronic liver disease if left untreated.

5. Autoimmune Liver Diseases

Conditions like autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis can cause elevated liver enzymes without obvious symptoms in the early stages.

Diagnostic Approach for Primary Care Physicians

When faced with elevated ALT and AST in an asymptomatic patient, primary care physicians should follow a systematic approach to diagnosis and management.

Initial Assessment

The first step is to confirm the elevated results with a repeat test. If the elevation persists, a thorough patient history and physical examination are crucial. Key areas to explore include:

• Alcohol consumption habits
• Medication use, including over-the-counter drugs and supplements
• Family history of liver disease
• Risk factors for viral hepatitis
• Presence of metabolic syndrome components (obesity, diabetes, hypertension)

Further Laboratory Testing

Additional tests can help narrow down the potential causes:

• Complete blood count (CBC)
• Comprehensive metabolic panel
• Hepatitis B and C serologies
• Ferritin and iron studies
• Ceruloplasmin (to rule out Wilson’s disease in younger patients)
• Antinuclear antibody (ANA) and smooth muscle antibody tests (for autoimmune hepatitis)

Imaging Studies in Liver Enzyme Elevation

Imaging can provide valuable information about liver structure and potential causes of enzyme elevation. Common imaging studies include:

Ultrasound

Ultrasound is often the first-line imaging test due to its accessibility and lack of radiation. It can detect:

• Fatty liver disease
• Gallstones
• Liver masses
• Signs of cirrhosis

Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)

These advanced imaging techniques may be recommended if ultrasound results are inconclusive or if more detailed imaging is needed. They can provide additional information about liver structure, detect smaller lesions, and help characterize liver masses.

When to Refer to a Specialist

Primary care physicians should consider referring patients to a hepatologist or gastroenterologist in the following scenarios:

• Persistent elevation of liver enzymes (>2 times upper limit of normal) for more than 6 months
• Evidence of advanced liver disease (low albumin, elevated bilirubin, or prolonged prothrombin time)
• Suspected autoimmune liver disease
• Abnormal imaging results requiring further evaluation
• Need for liver biopsy

Management Strategies for Elevated Liver Enzymes

Management of elevated liver enzymes in asymptomatic patients often focuses on addressing underlying causes and preventing further liver damage.

Lifestyle Modifications

For many patients, especially those with NAFLD or alcohol-related liver enzyme elevations, lifestyle changes can be highly effective:

• Weight loss through diet and exercise
• Reducing or eliminating alcohol consumption
• Managing diabetes and other metabolic conditions
• Avoiding hepatotoxic medications and supplements

Medication Management

In some cases, medication may be necessary:

• Antiviral therapy for hepatitis B or C
• Immunosuppressive drugs for autoimmune liver diseases
• Ursodeoxycholic acid for primary biliary cholangitis

Monitoring and Follow-up

Regular monitoring is essential for patients with elevated liver enzymes. The frequency of follow-up depends on the underlying cause and severity of elevation:

• Mild elevations (<2 times upper limit of normal): Repeat tests in 3-6 months
• Moderate elevations (2-5 times upper limit of normal): Repeat tests in 1-2 months
• Severe elevations (>5 times upper limit of normal): Immediate evaluation and possible referral

During follow-up visits, physicians should assess adherence to lifestyle modifications, medication compliance, and the need for additional testing or specialist referral.

Emerging Therapies and Research Directions

The field of hepatology is rapidly evolving, with new treatments and diagnostic tools on the horizon. Some areas of active research include:

Non-invasive Fibrosis Assessment

Techniques like transient elastography (FibroScan) and magnetic resonance elastography are becoming more widely available. These non-invasive methods can assess liver fibrosis, potentially reducing the need for liver biopsies.

Novel Therapies for NAFLD

Several drugs targeting different pathways in NAFLD pathogenesis are in clinical trials. These include:

• FXR agonists
• PPAR agonists
• CCR2/CCR5 antagonists
• GLP-1 receptor agonists

While not yet approved for NAFLD treatment, these drugs show promise in reducing liver fat and inflammation.

Gut Microbiome Modulation

Growing evidence suggests a link between the gut microbiome and liver health. Research is ongoing to explore the potential of probiotics, prebiotics, and fecal microbiota transplantation in managing liver diseases.

Primary care physicians play a crucial role in the early detection and management of liver disorders. By understanding the causes of elevated ALT and AST, following a systematic diagnostic approach, and staying informed about emerging therapies, they can provide optimal care for patients with asymptomatic liver enzyme elevations. Regular monitoring, lifestyle counseling, and timely referral to specialists when necessary are key components of effective management. As research continues to advance our understanding of liver diseases, primary care physicians must stay updated to offer the best possible care to their patients.

What Does It Mean When Your ALT Is High? > Personalabs

Getting elevated alanine aminotransferase (ALT) or serum glutamic-pyruvic transaminase (SGPT) in your liver function test can be distressing. But what high ALT means depends on factors such as the medications you’re taking, underlying liver disorders, chronic drinking, and consumption of herbal medicine. 

Understanding the roles of ALT and its sudden spike in the bloodstream will provide clues on your liver health. Read more about it in the next few lines. 

What Is an ALT Lab Test? 

An ALT blood test measures the alanine aminotransferase (ALT) enzyme level to detect liver damage caused by diseases like hepatitis or lifestyle factors such as habitual drinking. The enzyme is an ideal marker for health conditions concerning the liver as it is released to the bloodstream when the liver sustains injuries or undergoes dysfunction. 

However, ALT bloodwork does not produce conclusive results on its own. Therefore, it is usually taken as part of the hepatic function panel test and comprehensive metabolic panel, along with other blood tests for other liver enzymes.  

In some cases, you might take the ALT blood test first, followed by other labwork to confirm a suspected condition or the other way around. These tests include:

• AST (aspartate aminotransferase) test
• GGT (gamma-glutamyl transferase) test
• ALP (alkaline phosphatase) test
• ALB (albumin) test
• Total bilirubin blood test

ALT Blood Test: Preparation and Results Meaning 

Measuring ALT levels is done through blood work, wherein you will have to visit a laboratory for a phlebotomist to collect your blood sample. 

Although there is no special preparation before the blood collection for an ALT blood test, you may need to fast if you take it alongside other tests. For example, if it is part of a liver function panel where a bilirubin lab test is involved, you will need to abstain from food and drinks for about 8 hours before the test. 

What Does It Mean When Your ALT Is High?

Your ALT level is considered high if it exceeds the normal range of 0 to 44 IU/L. Some laboratories may present a slightly different reference interval, but a test result of 55 IU/L or above could indicate liver problems. If the value exceeds the upper limit of the normal range, it could suggest liver disease or cirrhosis (tissue scarring).  

However, other factors could contribute to the increase of ALT in your blood – not just liver disorders. Here are common causes of high ALT:

Infections

Patients diagnosed with hepatitis, whether A, B, or C, typically have elevated ALT liver enzymes. Hence, if you got a test value exceeding the normal range of ALT and are showing hepatitis symptoms, consult your doctor to secure the proper diagnostic lab tests.

Aside from hepatitis, studies have also shown that those with infectious mononucleosis have elevated liver enzymes, including ALT. So your doctor may proceed to check for swelling in your tonsils and liver on top of common infection symptoms. 

Did you know? Hepatitis can be prevalent among older kids. That’s why it’s vital to detect hepatitis in children at the onset of the symptoms. This allows for better treatment and speedy recovery.  

Medications

Various drugs can cause high ALT levels, such as anti-seizure medications (phenytoin, valproic acid, carbamazepine, etc.), antidepressants, antipsychotics, cholesterol-lowering drugs, heparin therapy, acetaminophen, and many others. So if you’re taking these medications, make sure to let your doctor know. 

Herbal Supplement

Herbal teas and supplements can also elevate your ALT. These include kava, chaparral, ephedra, skull cap, comfrey tea, and Yohimbe. While traditional medicine may suggest that these supplements benefit your health, consult with your healthcare provider before taking them regularly.  

Alcohol and Toxins

Alcohol has been known to cause fatty liver tissues and induce inflammation. As a result, binge drinking elevates liver enzymes like ALT and causes gradual hepatic damage. Other substances like cocaine and poisonous liquid also increase ALT, as they generate high levels of hepatic toxicity.   

Diseases

Medical conditions associated with high ALT include hemochromatosis (iron overload), fatty liver disease, cirrhosis, thyroid disease, diabetes, Celiac disease, cancer, hemolysis, etc. Heart disease has also been associated with elevated ALT. 

If you have a family history of liver disease, there’s a higher chance of getting elevated ALT in your bloodwork, especially with an unhealthy lifestyle. So opt for a CMP 14 blood test to be included in your annual wellness checkup to detect liver problems early. 

What Should I Do if My ALT Is High? 

Seeing an elevated ALT in your test results can be alarming, especially if it’s far off the upper limit and if the other parameters also go beyond the normal range. But you can lower this liver enzyme (along with the others) through the following ways:

1. Get Tested for the Cause of Increased ALT

Finding the root cause of your elevated ALT, whether it’s a disorder or a medication, is imperative for the right course of action in normalizing it. In addition, be mindful of symptoms you may have been experiencing, especially those related to liver problems. These could include abdominal pain and swelling, appetite loss, fatigue, dark urine, pale stool, vomiting, itchy and easily bruised skin, and jaundice (yellow eyes and skin). 

Your doctor will assess your symptoms and request appropriate liver function tests. Once the condition is diagnosed, you will be given proper treatment. You will most likely take another ALT test, among others, to see if you already have low ALT levels within the normal range. 

2. Limit Cholesterol and Avoid High-Carb Foods

Changing your diet typically tops the lifestyle changes that improve your liver health. In the case of high ALT, shifting to a low carbohydrate diet has a beneficial impact on normalizing the liver enzyme’s production. 

In a 2015 study, high carbohydrate intake of fructose-rich food and beverages significantly increased ALT. On the other hand, a low-carb diet decreases the enzyme twice as a low-fat diet.  

While carbohydrates seem to trigger the spike in liver enzymes, fat, specifically bad cholesterol, doesn’t do any favor. High cholesterol overloads liver function, increases ALT, and even promotes the risk of liver cancer. That said, it’s best to avoid fatty foods such as whole-milk dairy, red meat, and those smothered in oil. 

Think you have high cholesterol? You will know for certain when you take the comprehensive lipid profile blood test. Doing so allows you to have a base record of your lipid levels, helping you assess your risk for heart and liver disease. 

3. Drink a Cup of Coffee a Day

Coffee comes with plenty of health benefits. However, it can be subjective depending on your physical and mental state. But in the case of liver function, studies have shown that drinking coffee aids in preventing high serum ALT.

Moreover, a 2015 study says that drinking coffee reduces your risk for liver cancer and chronic liver disease, bordering cirrhosis. So secure one cup of coffee daily, especially in lieu of alcohol. If you have anxiety disorders, consult your doctor first, as too much coffee can aggravate the condition. 

4. Be More Physically Active

Exercise promotes liver health and allows you to lose weight. By being physically active for about 30 minutes daily, you improve your metabolism, which involves the oxidation of fatty acids. This helps ease liver function and, by extension, prevents injuries that lead to increased liver enzymes in the blood. 

Consistent physical activity is particularly helpful for those with fatty liver. In a 2018 review, evidence shows that regular exercise aid liver functions in people with nonalcoholic fatty liver disease (NAFLD), from damage reduction to improved insulin resistance. 

5. Avoid Alcohol and Smoking

It’s no secret that alcohol can cause severe liver damage if consumed habitually. Heavy drinkers are prone to alcoholic liver disease and alcoholic hepatitis. On top of that, alcohol is also the most significant risk factor for liver cirrhosis. 

Smoking is another habit you should shake off if you plan to lower your serum ALT. According to an article published in the Journal of Hepatology, cigarette smoking aggravates liver problems and contributes to the impediment of hepatic treatment. This remains true with secondhand smoke. 

If you’re having trouble leaving these unhealthy habits behind, seek help from professionals and support from your social circle. 

6. Rethink Taking Supplements, Drugs, or Herbal Medicines

As herbal teas and vitamin supplements (iron and vitamin A) can cause liver toxicity, make sure to avoid them if you have elevated liver enzymes. Likewise, consult your doctor regarding taking prescribed medications and be sure not to take them beyond the recommended dosage. For example, acetaminophen (a drug for fever and pain) can induce acute liver damage if taken in large amounts. 

Other Frequently Asked Questions 

Which is worse: high AST or ALT?

Liver enzymes AST and ALT are often compared to better understand liver health. Getting high lab values for both AST and ALT indicates the severity of the liver problem. Generally, if AST is significantly elevated than an already high ALT, it could suggest cirrhosis, which can lead to liver failure. 

How quickly can ALT levels drop?

On average, ALT decreases significantly after treatment and lifestyle changes in about four weeks. This depends on how consistent you are with the necessary adjustments. For example, if you have given up alcohol, your ALT could start to drop in a week and continue to do so with continuous abstinence. 

Can ALT levels go down on their own?

Unless you change your diet, start exercising, and eliminate unhealthy habits like heavy drinking and smoking, serum ALT levels will not decrease. Additionally, if the elevation of the liver enzyme is due to a severe liver disorder, failing to address and avail of proper treatment will only contribute to high ALT remaining unchanged. 

Bottom Line 

When your ALT levels are elevated, it’s certainly high time to check your liver. Doing so allows you to seek proper treatment and employ the necessary lifestyle adjustments, such as changing your diet, getting tested for a particular disorder, and being physically active. If symptoms of liver damage are observed, consult your doctor immediately. 

High and low levels, and what do results mean

An AST blood test measures levels of aspartate aminotransferase (AST) and helps determine liver function. Too much of this enzyme can indicate a problem, such as liver damage.

Aspartate aminotransferase (AST) is an enzyme mostly found in the liver. AST is also present in other parts of the body, including the:

• kidneys
• heart
• muscles

Another name for the AST enzyme is serum glutamic-oxaloacetic transaminase (SGOT).

Most people have low levels of the AST enzyme. Damage to liver cells can cause the release of extra AST into the blood though, leading to higher levels of the enzyme.

After taking a blood test, doctors will classify AST ranges as normal, high, or low. Laboratories may use different testing methods for analyzing samples, so normal ranges can vary between each laboratory.

There is not an exact range for AST levels, as levels can vary among people and still be normal. AST levels can vary depending on factors such as:

• age
• sex
• weight
• race

The measurements for AST levels are typically in units per liter (U/L) or international units per liter (IU/L). On a test result, the laboratory will usually list their specific reference range.

People will need to look at this reference range and discuss with their doctor what their test results mean for them. To understand the results of an AST blood test, a doctor will also look at other enzymes that can indicate a liver problem.

The following table indicates general AST blood test ranges. However, reference ranges can vary slightly among different laboratories.

Results from an AST blood test can help indicate liver health.

If AST levels are high, it may also be a sign of:

• chronic hepatitis
• damage from alcohol
• cholestasis, a decrease in bile flow
• heart, kidney, bone, or muscle damage
• liver cancers
• liver scarring, known as liver cirrhosis

Very high AST levels are usually a sign of progressing liver damage, often due to acute hepatitis.

Low AST levels may indicate:

• vitamin B6 deficiency
• kidney disease
• liver disease
• cirrhosis
• cancer
• autoimmune conditions
• genetic conditions

A doctor may also test levels of alanine aminotransferase (ALT), another liver enzyme. ALT levels occur in higher concentrations in the liver.

If ALT levels are normal but AST levels are high, it could indicate a health problem outside of the liver, or it may be a sign of alcohol-induced liver damage.

Having high levels of AST and no other signs of a problem is not necessarily a cause for concern. People with normal liver function can have high AST levels, which may be due to:

• age
• sex
• race
• certain medications

A person should always discuss any medications or health products they take with a doctor.

Doctors primarily use the AST blood test to check for and assess liver problems, usually alongside other liver tests. The AST protein mainly occurs in the liver and heart. With liver damage, AST can leak from the liver into the bloodstream. When this happens, AST levels in the blood will be higher than normal.

AST also occurs in the brain, heart, kidneys, and muscles. If there is damage in any of these areas, AST levels may also increase.

To rule out issues affecting areas outside the liver, doctors may order a check of the second liver enzyme, ALT, at the same time. If both levels are high, it may indicate a problem with a person’s liver. If only AST levels are high, this may indicate a problem with another organ or system.

People may have an AST test for screening, diagnosis, or monitoring purposes. A doctor may recommend this test if a person:

• has risk factors for liver disease, such as family history, obesity, or diabetes
• has symptoms of a liver problem, such as jaundice, fatigue, or unexplained weight loss
• is undergoing treatment for a liver condition, as an AST blood test can help show how well treatment is working

Alanine aminotransferase (ALT) is an enzyme that mostly occurs in the liver. If there is damage to liver cells, ALT levels in the bloodstream can increase. An ALT test can help indicate liver health, along with other liver enzyme tests.

Healthcare professionals may use both ALT and AST tests to check for the presence of liver enzymes in the blood, as this can give them a clearer idea of overall liver function and health.

Learn more about the ALT test here.

The AST blood test is straightforward and similar to any other blood test. A healthcare professional may take the following steps:

• sit the person down and tie a stretchy band around the upper arm to increase blood flow to that area
• clean the site of the blood draw with an antiseptic wipe
• insert a needle into a vein in the arm to take a blood sample, which may cause people to feel a mild prick or pain
• remove the needle once they have drawn enough blood
• send the blood sample to a laboratory for testing

An AST blood test will usually only take a few minutes in total.

In some cases, people may be able to take an AST test at home. Using an at-home test kit, people will take a blood sample from their fingertip and send the sample to a laboratory. People may receive AST blood test results through the mail, an app, or an online system.

Learn how long it might take to receive blood test results here.

Preparation

People may need to fast for several hours if they are having a combination of liver enzyme tests.

If people are only having an AST blood test, they may not need to fast or prepare in any way.

People will need to let their doctor know if they are taking any medications or supplements, as some may interfere with liver enzyme levels.

As a healthcare professional will be taking blood from the arm, it may be helpful to wear short sleeves during the test.

As with any blood test, an AST blood test has very few risks. It is rare to experience any severe side effects, but people may have some mild bruising or discomfort in the area at the site of the blood draw.

A healthcare professional will place a Band-Aid or bandage on the arm to stop any bleeding.

People may want to have something to eat after the test, particularly if they were fasting beforehand. It is safe for people to drive and continue their usual activities after an AST blood test, unless they experience any unusual symptoms.

A doctor may order tests along with an AST blood test or follow-up tests. This is to help ensure proper diagnosis and determine the best course of treatment. These tests may include:

• ALT test: A doctor may order an ALT test alongside an AST test.
• Platelet count: Low platelet levels may indicate HELLP syndrome during pregnancy.
• Coagulation panel: This measures the functioning of clotting-related proteins that the liver produces.
• Complete metabolic panel: This assesses how well the kidneys and liver are working and shows levels of electrolytes.
• Bilirubin test: A bilirubin test checks levels of a byproduct created when the liver breaks down red blood cells.
• Glucose test: High or low blood glucose levels may indicate a liver problem.
• Viral testing: This can help doctors check for hepatitis.
• Imaging: A doctor may order images of the liver via ultrasound.

The extent of follow-up testing will depend on a person’s results. A doctor may also take additional blood tests, imaging tests, or a biopsy to identify or rule out any potential conditions relating to abnormal AST levels.

Learn about different types of blood tests here.

An AST blood test, or SGOT test, checks how much AST, a liver enzyme, is present in the blood. High levels of AST in the bloodstream could be a sign of liver damage, or cell damage in another organ such as the heart or kidneys.

Doctors may also take additional tests to check other liver enzymes, such as ALT, to get more information on the health of the liver.

When the liver goes wrong: a gastroenterologist named 4 common reasons why ALT and AST are elevated in the blood

• Health

However, the growth of these main “liver” markers in the blood test does not always indicate problems.

April 25, 2022

Source:

Getty Images

A biochemical blood test is considered one of the main ways to find out if the liver copes with the load of “wrong” nutrition, alcohol, and medication. This will be told by such indicators in the analysis as ALT (alanine aminotransferase) and AST (aspartate aminotransferase) – these liver enzymes are among the first to respond to malfunctions of the organ.

– If there is an increase in both ALT and AST, this means that the liver cells are destroyed and the enzymes from them enter the blood. (…) An increase in AST and ALT means that an inflammatory process is taking place in the liver and its cells are being destroyed. If the indicators are above the norm, you need to contact a gastroenterologist, – gastroenterologist Maria Lopatina wrote in her telegram channel, adding that the upper limits of the norm may differ in different laboratories and one must focus on those established where the analysis was taken.

The doctor named the 4 most common causes of increased liver values.

Chronic viral hepatitis

With an increase in ALT and AST in the blood, viral hepatitis B and C are always excluded first. This is very important, as they can be asymptomatic, while destroying the liver. Mandatory tests: HBsAg – hepatitis B and Anti-HCV – hepatitis C.

Non-alcoholic fatty liver disease

When fatty liver cells destroy them, ALT and AST in the blood rise and steatohepatitis develops.

Fatty liver disease is suspected if:

• Waist circumference ≥94/≥80 cm in men/women;

• Blood pressure 130/85 mmHg And more, or the person is taking antihypertensive drugs;

• Fasting glucose level of 5.6 mmol/l or more, or the person is taking hypoglycemic drugs;

• Serum triglycerides more than 1.7 mmol/l;

• High-density lipoprotein (HDL) level less than 1.0/1.3 mmol/l in men/women.

Drug-induced liver injury

All drugs that we take by mouth pass through the liver. The more drugs we take, the more likely it is to be damaged. This group includes both herbal preparations and dietary supplements. Liver damage can occur immediately or after several weeks.

Alcohol

According to Russian clinical guidelines, a safe dose for the liver in women is 20 grams of ethanol per day, for men – 40 grams. Regular excess of this dose leads to the development of alcoholic hepatitis and an increase in ALT and AST.

Determining the ethanol content in 100 ml of a drink is very simple: the percentage of alcohol in the drink must be multiplied by 0.8. Thus, 100 ml of 40% vodka contains 40×0.8=32 grams of ethanol, and 100 ml of 12% wine contains 12×0.8=9.6 grams of ethanol.

The doctor specifies that there are other reasons for the increase in ALT and AST in the blood, but these four are the most common.

Read also

When an increase in the indicator is not a cause for alarm

It happens that an increase in the level of “liver” indicators may not be associated with a problem in the work of our main “filter”. According to gastroenterologist Maria Lopatina, this may be the case if only the AST index is elevated.

– AST is found not only in the liver, but also in the heart, muscles, kidneys, brain and pancreas. If AST levels are elevated and ALT is normal, causes that are not related to damage to liver cells should be ruled out. For example, active training for all muscle groups, the doctor clarifies.

But if the liver values ​​are below normal in the blood test, in most cases this is not a cause for serious concern. According to the gastroenterologist, a decrease in their level can occur during pregnancy, starvation and a reduced content of vitamin B6.

What other indicators of a blood test can be used to understand that something is wrong with the liver, read HERE.

Signs of liver problems that can be seen in the mirror

According to doctors, the liver does not hurt in the usual sense of the word, especially at first – specific symptoms of the disease appear when things have gone too far. As the head of the MIBS outpatient department, gastroenterologist Iyri Alaya said, liver diseases are often accompanied by various digestive disorders:

• Increased flatulence;

• Feeling of fullness in the stomach;

• Rapid satiety after eating;

• Loss of appetite;

• Dryness and bitterness in the mouth;

• Attacks of nausea and vomiting;

• Constipation or diarrhoea.

And the most famous sign of liver problems is yellowness of the skin, mucous membranes and sclera, which indicates an increase in the level of bilirubin (bile pigment) in the blood.

Text author: Anastasia Romanova

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Aspartate aminotransferase (AST)

Aspartate aminotransferase (AST) is an enzyme found in all cells of the body, but mainly in the cells of the heart and liver and to a lesser extent in the kidneys and muscles. Normally, AST activity in the blood is very low. When liver or muscle tissue is damaged, it is released into the blood. Thus, AST is an indicator of liver damage.

Synonyms Russian

Serum glutamine-oxaloacetate transaminase, serum glutamate-oxaloacetate transaminase (SGOT), aspartate transaminase, AST/ALT ratio.

Synonyms English

Aspartate aminotransferase.

Test method

UV kinetic test.

Units

U/L (unit per litre).

What biomaterial can be used for research?

Venous, capillary blood.

How to properly prepare for an examination?

• Do not eat for 12 hours before the test.
• Avoid physical and emotional stress for 30 minutes prior to examination.
• Do not smoke for 30 minutes before the test.

Study Overview

Aspartate aminotransferase (AST) is an enzyme found in all cells of the body, but primarily in the heart and liver, and to a lesser extent in the kidneys and muscles. In healthy patients, AST activity in the blood is low and the AST norm has low values. When the liver or muscles are damaged, AST is released, and the level of AST in the blood rises. In this regard, the activity of this enzyme is an indicator of liver damage. An analysis for AST is part of the so-called liver tests – studies that diagnose disorders in the liver.

The liver is a vital organ located in the upper right side of the abdomen. It is involved in many important bodily functions – helping with nutrient processing, bile production, the synthesis of many important proteins such as blood clotting factors, and breaking down potentially toxic compounds into harmless substances.

A number of diseases lead to damage to liver cells, which increases the activity of AST.

The most common test for AST is to check if the liver is damaged due to hepatitis, toxic drugs, cirrhosis. However, AST does not always reflect only liver damage; the activity of this enzyme can also increase in diseases of other organs, in particular, in myocardial infarction.

What is research used for?

• To detect liver damage. Typically, an AST test is ordered along with an alanine aminotransferase (ALT) test or as part of a general liver function test. AST and ALT are considered the two most important indicators of liver damage, although ALT is more specific than AST. In some cases, AST is directly compared with ALT and their ratio (AST/ALT) is calculated. It can be used to find out the causes of liver damage.
• Blood AST is often compared with other tests, such as alkaline phosphatase (AP), total protein, and bilirubin, to determine a specific form of liver disease.
• To monitor the effectiveness of the treatment of liver diseases.
• To monitor the health of patients taking drugs that are potentially toxic to the liver. If AST activity rises, the patient may be switched to other medications.

When is the test ordered?

• For symptoms of liver disorder:
  • weakness, fatigue,
  • loss of appetite,
  • nausea, vomiting,
  • abdominal pain and bloating,
  • yellowing of the skin and whites of the eyes,
  • dark urine, light stool,
  • itching.

• If there are factors that increase the risk of liver disease:
  • previous hepatitis or recent exposure to hepatitis infection,
  • excessive alcohol consumption,
  • hereditary predisposition to liver diseases,
  • taking drugs that can damage the liver,
  • overweight or diabetic.
  • On a regular basis throughout the treatment process to determine its effectiveness.

What do the results mean?

Reference values ​​(AST norm for men, women and children):

Normally, the activity of AST in the blood is low.

Excessively high AST activity (more than 10 times normal) is usually caused by viral infections. It can also increase significantly as a result of taking drugs or other substances that are toxic to the liver, as well as due to diseases that slow blood flow to the liver (ischemia).

In chronic hepatitis, AST activity usually exceeds the norm by no more than 4 times. It fluctuates between normal and somewhat elevated, so often an analysis is prescribed to determine the degree of the disease. Diseases such as obstruction of the biliary tract, cirrhosis, and some types of liver cancer contribute to a moderate increase in AST. After a heart attack and with muscle damage, AST activity can also increase, usually much more than ALT.

In most liver diseases, ALT activity in the blood is higher than AST activity, so the AST/ALT ratio will be low. However, there are a few exceptions: alcoholic hepatitis, cirrhosis, and muscle damage.

Important notes

• AST activity may decrease during pregnancy.