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 common causes 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 infarction and 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.

A man with contracted fingers.

An Indian man from Malaysia presented with contracture of his hands. He is 55 years of age and has a history of chronic alcohol consumption. Examination revealed bilateral thickened structure at the palms.