AST/ALT increased

Etiology

• Acute viral hepatitis (ALT > AST)
• Toxic hepatitis, eg, acetaminophen
• Alcoholic hepatitis (AST < ALT)
• Cirrhosis (AST > ALT)
• Vascular: right-sided congestive heart failure, shock liver, Budd-Chiari syndrome
• Biliary tract obstruction (followed by increased alkaline phosphatase and bilirubin)
• Nonalcoholic fatty liver disease (formerly NASH)
• Metabolic, eg, hemochromatosis, Wilson’s disease
• Liver abscess
• Hepatocellular or metastatic cancer
• Drugs, eg, INH, statins
• Heart or skeletal muscle injury
• Celiac sprue (ALT)

AST/ALT > 500-1000

• Acetaminophen, Amanita mushroom, other toxins
• Viral, especially hepatitis A
• Shock liver (ischemia)
• Budd-Chiari syndrome
• Right-sided heart failure

See related DDx

• Acute hepatitis
• Cholestasis
• Alkaline phosphatase increased
• Amylase increased
• Jaundice (icterus)