Elevated ALT and AST in an asymptomatic person, what the primary care doctor should do?
• Abnormal liver function test with raised alanine aminotransferase (ALT) and raised aspartate aminotransferase (AST)are commonly seen in primary care setting.
• Chronic alcohol consumption, drugs, non-alcoholic steatohepatitis (NASH) and chronic viral hepatitis are commoncauses associated with raised ALT and AST.
• In chronic viral hepatitis, the elevation of liver enzyme may not correlate well with the degree of liver damage.
• Non-hepatic causes of raised ALT and AST include polymyositis, acute muscles injury, acute myocardial infarctionand hypothyroidism.• In the primary care setting, the doctor should obtain a complete history regarding the risk factors for viral hepatitis,substance abuse and request investigations accordingly.
• Suspected chronic viral hepatitis and liver cirrhosis are best referred to hepatologist for further management
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