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What Causes Elevated AST Levels?
Question: I have a question. My husband (37) is a recovering alcoholic. He has not had a drink in over 6 years. He had a liver ultrasound 2 years ago which was normal. During his annual blood work, his AST is sometimes still elevated. It just came back as 50. He does not take NSAIDS. Dr. Is now worried, but I wanted to see another opinion. Should we worry?
Brief Answer:
Nothing to worry.
Detailed Answer:
Hello XXXX
How are you? Thanks for writing to HCM today. My name is Dr Suresh Raghavaiah. i am a liver transplant surgeon and I hope to answer your question today.
First of all let me congratulate your husband on not having a drink in over six years. it is truly commendable and I am sure this would not have been feasible without your support and the support of his family.
Mild perturbations in the AST level are normal even in a healthy person. Worrisome elevations will usually be elevated more than twice the normal levels and elevations of more than three times normal is definitely a cause for concern. But in your husbands case, especially since he has quit alcohol, a level of 50 is usually not a cause for concern.
If you are still worried I would advise you to check the levels again after a couple of weeks to see the trend. If the levels are still elevated, then I get it investigated. One more thing to do is to get a ultrasound scan of the liver done as alcoholics usually develop fatty liver which could explain these mild elevations. But once the patient gives up alcohol, the fatty liver usually regresses.
Hope this helps and hope your husband starts to feel better.
Please do not hesitate to write back for clarifications.
Have a great day.
Dr Suresh Raghavaiah
Nothing to worry.
Detailed Answer:
Hello XXXX
How are you? Thanks for writing to HCM today. My name is Dr Suresh Raghavaiah. i am a liver transplant surgeon and I hope to answer your question today.
First of all let me congratulate your husband on not having a drink in over six years. it is truly commendable and I am sure this would not have been feasible without your support and the support of his family.
Mild perturbations in the AST level are normal even in a healthy person. Worrisome elevations will usually be elevated more than twice the normal levels and elevations of more than three times normal is definitely a cause for concern. But in your husbands case, especially since he has quit alcohol, a level of 50 is usually not a cause for concern.
If you are still worried I would advise you to check the levels again after a couple of weeks to see the trend. If the levels are still elevated, then I get it investigated. One more thing to do is to get a ultrasound scan of the liver done as alcoholics usually develop fatty liver which could explain these mild elevations. But once the patient gives up alcohol, the fatty liver usually regresses.
Hope this helps and hope your husband starts to feel better.
Please do not hesitate to write back for clarifications.
Have a great day.
Dr Suresh Raghavaiah
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thanks. That makes me feel much better. He did a liver ultrasound about 2years ago. He was having some digestive issues and feeling of pressure under his rib cage so they did the ultrasound. His gastro dr. said his liver looked normal and the pressure (which is still there) is likely muscle related. Do you think a 2 year old ultrasound would suffice for assuming liver is ok?
Brief Answer:
Repeat USG necessary
Detailed Answer:
Hello again XXXX
I am glad that the two year old USG report came back normal. Patients who eat high caloric food can also develop fatty liver. And since your husband has given up alcohol, I am sure his nutrition would have improved. Under normal circumstances, a repeat scan would not have been necessary, but given that the enzyme levels are mildly raised, I would feel better if he repeated the scan.
Hope this helps.
Dr Suresh Raghavaiah
Repeat USG necessary
Detailed Answer:
Hello again XXXX
I am glad that the two year old USG report came back normal. Patients who eat high caloric food can also develop fatty liver. And since your husband has given up alcohol, I am sure his nutrition would have improved. Under normal circumstances, a repeat scan would not have been necessary, but given that the enzyme levels are mildly raised, I would feel better if he repeated the scan.
Hope this helps.
Dr Suresh Raghavaiah
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Ok. I talked to his dr and she said they would retest in3 months and scan then if needed. What would the scan be looking for? Sorry for all my questions.
Brief Answer:
Echogenecity of the liver
Detailed Answer:
Hello XXXX
Sorry for the delay in replying. But the scan should be looking for evidence of fatty liver disease. This is usually seen as a altered echotexture on the USG scan and the sonologist will be able to diagnose the condition. In addition any other cause for an elevated liver enzymes will also get ruled out.
Please get back to me with the report.
Have a great day
Dr Suresh Raghavaiah
Echogenecity of the liver
Detailed Answer:
Hello XXXX
Sorry for the delay in replying. But the scan should be looking for evidence of fatty liver disease. This is usually seen as a altered echotexture on the USG scan and the sonologist will be able to diagnose the condition. In addition any other cause for an elevated liver enzymes will also get ruled out.
Please get back to me with the report.
Have a great day
Dr Suresh Raghavaiah
Above answer was peer-reviewed by :
Dr. Prasad
Ok. I think we will do the ultrasound at the 3 month check if it is still high. One more question, does cirrhosis show up in ultrasound? That is always my fear. I thought that was something they ruled out last time, but am not sure. They just said the scan was normal. Thanks again!
Brief Answer:
Yes
Detailed Answer:
Hello,
Cirrhosis of the liver does show up on USG in late stages. But I don think you have anything to worry about because cirrhosis takes a long time to set in and given the fact that your husband has given up alcohol, I would not expect to see cirrhotic changes. The scan is to check for fatty liver. Also since the previous scan was normal, I would not expect it to show cirrhotic changes this early.
Please do let me know what the scan shows.
Have a great day
Dr Suresh Raghavaiah
Yes
Detailed Answer:
Hello,
Cirrhosis of the liver does show up on USG in late stages. But I don think you have anything to worry about because cirrhosis takes a long time to set in and given the fact that your husband has given up alcohol, I would not expect to see cirrhotic changes. The scan is to check for fatty liver. Also since the previous scan was normal, I would not expect it to show cirrhotic changes this early.
Please do let me know what the scan shows.
Have a great day
Dr Suresh Raghavaiah
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Above answer was peer-reviewed by :
Dr. Raju A.T
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