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    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

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    Last updated: December 1, 2014

    Citation

    Zeiger, Roni F.. "AST/ALT Increased." Diagnosaurus, 4th ed., McGraw-Hill Education, 2014. Emergency Central, emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114726/all/AST_ALT_increased.
    Zeiger RF. AST/ALT increased. Diagnosaurus. 4th ed. McGraw-Hill Education; 2014. https://emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114726/all/AST_ALT_increased. Accessed April 20, 2019.
    Zeiger, R. F. (2014). AST/ALT increased. In Diagnosaurus. Available from https://emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114726/all/AST_ALT_increased
    Zeiger RF. AST/ALT Increased [Internet]. In: Diagnosaurus. McGraw-Hill Education; 2014. [cited 2019 April 20]. Available from: https://emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114726/all/AST_ALT_increased.
    * Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - AST/ALT increased ID - 114726 A1 - Zeiger,Roni F, Y1 - 2014/12/01/ BT - Diagnosaurus UR - https://emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114726/all/AST_ALT_increased PB - McGraw-Hill Education ET - 4 DB - Emergency Central DP - Unbound Medicine ER -