Overview
AST and ALT are enzymes that are commonly used in conjunction to identify active hepatocellular injury.
AST is found in the liver, cardiac muscle, skeletal muscle, kidneys, brain, pancreas, lungs, leukocytes and erythrocytes.
ALT is found mainly in the liver, and is more specific for hepatocellular injury.
Elevated Aminotransferases
Causes of Elevated Transaminases
Hepatocellular Injury
- Viral hepatitis - A, B, C, E, HSV, EBV, CMV, VZV
- Alcoholic liver disease - alcoholic hepatitis, steatohepatosis, cirrhosis
- Non-alcoholic hepatosteatosis (fatty liver disease)
- Drug or toxin-induced liver disease - paracetamol, NSAIDs, statins, ciprofloxacin, azole antifungals, methotrexate, amiodarone, isoniazid, phenytoin, sulfonylureas, rifampicin, anabolic steroids, cocaine, ecstasy, PCP, glues, solvents, certain herbal remedies
- Vascular disease - ischaemic hepatitis, portal venous thrombosis, congestive cardiac failure
- Infiltrative disease - sarcoidosis, amyloidosis, tuberculosis, Hodgin lymphoma, liver metastases
- Autoimmune liver diseases - autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis
- Haemochromatosis
- Wilson's disease
- Alpha-1 antitrypsin deficiency
- Hepatocellular carcinoma
Non-Hepatic
- Myopathy - vigorous exercise, myositis
- Hypothyroidism
- Coeliac disease
Interpretation
- Mild derangement (<5x normal)Non-alcoholic steatohepatosis, chronic viral hepatitis, liver metastases, drugs
- Moderate derangement (5-20x normal)Chronic viral hepatitis, alcoholic hepatitis, autoimmune hepatitis
- Severe derangement (>20x normal)Acute viral hepatitis, drug-induced hepatitis, ischaemic hepatitis
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