Diagnosaurus
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
Last updated: September 17, 2024
Citation
Zeiger, Roni F.. "AST/ALT Increased." Diagnosaurus, 4th ed., McGraw-Hill Education, 2024. Emergency Central, emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114726/all/AST_ALT_increased.
Zeiger RFR. AST/ALT increased. Diagnosaurus. McGraw-Hill Education; 2024. https://emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114726/all/AST_ALT_increased. Accessed November 4, 2025.
Zeiger, R. F. (2024). AST/ALT increased. In Diagnosaurus (4th ed.). McGraw-Hill Education. https://emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114726/all/AST_ALT_increased
Zeiger RFR. AST/ALT Increased [Internet]. In: Diagnosaurus. McGraw-Hill Education; 2024. [cited 2025 November 04]. 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
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T1 - AST/ALT increased
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PB - McGraw-Hill Education
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DB - Emergency Central
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