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What is Considered High AST and ALT Levels?
Marked Elevation of Aminotransferases
When the alanine aminotransferase ( ALT ) is lift 10 or more meter the upper limit of quotation ( value grim than 40 U / l ) , it can be diagnosed the existence of acute liver wound , and in these case should be originate immediately the aetiological study . More than 90 % of character are due to intense viral hepatitis .
The diagnosis of an acute hepatitis due to Hepatitis A Virus or Hepatitis B Virus does not usually present difficulties , but the diagnosis of an acute hepatitis due to Hepatitis C Virus is more complex because the incontrovertibility of the anti - HCV or of the HCV RNA does not discriminate between acute or chronic infection . The diagnosing of acute infection will be base on the presence of a clinical introduction of acute liver equipment casualty , the exclusion of other acute viral hepatitis and the mien of HCV RNA with anti - VH C negative or seroconversion of anti - HCV in 1 -3 months .
When value of aspartate aminotransferase ( AST ) exceed 100 times the upper limit of reference , hepatic ischemia or hypoxia and toxic or pharmacological hepatitis are the responsible movement in more than 90 % of cases .
In a recent subject field , biliary obstructor was the cause of an elevation ≥ 10 times the transaminase values in 25 % of cases .
Mild or Moderate Elevation of Aminotransferases
The continuing hepatic lesion is commonly symptomless or paucisymptomatic ( causing few symptoms ) and sire an elevation of aminotransferases less than 10 time the upper limit of reference . Chronicity is defined by the persistence of the enzymatic elevation observed at least double during a minimum full stop of 6 calendar month .
Therefore , the initial step in the diagnostic rating of mild or moderate hypertransaminasemia is the repeating of the psychoanalysis , which will corroborate , if necessary , the existence of the abnormality and define it as inveterate , and then the etiological evaluation will commence . Some experts recommend , however , start the etiological study after confirming enzymatic elevation in a short period ( between 2 and 4 weeks ) . The diagnostic systematics to be watch is usually structure in a succession in which forward motion is made until the etiological diagnosing of hypertransaminasemia is obtained .
However , the order of the steps to keep up can be spay depending on the clinical context in which the finding of the analytical revision occurs and the data provided by the initial clinical account .
The initial clinical assessment should be aimed at identifying risk gene for viral continuing hepatitis ( old transfusion of blood mathematical product , parenteral drug abuse , risky intimate conduct , tattoos , piercing , etc ) , excessive inebriant phthisis , discourse with potentially hepatotoxic drugs , family chronicle of liver disease and associate diseases ( obesity , diabetes , hyperlipidemia , autoimmune diseases , etc . ) .
In USA , the most frequent continuing viral hepatitis is have by HCV . Its diagnosis is based on the detection of anti - HCV antibodies by means of ELISA , so that in a patient with hypertransaminasemia and risk factor for HCV contagion it is not necessary to use other confirmation techniques , however the viral RNA must be determined in serum by PCR in those cases in which it is assess to do discussion and when it is necessary to confirm the diagnosing of active infection . Chronic liver disease due to HBV is diagnose by the positiveness of HBsAg and full anti - HBc , with H BeAg , anti - HBe and viral DNA afterward being determined to investigate the front of retort .
inordinate alcohol consumption is commonly referred by the affected role , but on many occasions it is minimized or shroud . The AST / ALT ratio is a data to consider if this etiology is suspect since 90 % of the subjects with an AST / ALT ratio > 2 present histological data point of alcoholic liver disease .
In the symptomatic study of the affected role with hypertransaminasemia is especially relevant to follow a pre - established system that allows determining with sufficient precision the drive , avoid in turn , the performance of unneeded examinations .
