Elevated liver enzymes.

[lb688]

32 year old Male. Heavy drinker. Routine blood work after starting Lisinopril 20mg. Labs came back ALT 210, AST 199. All other labs came back WNL other than WBC @ 3.9 (minimum lower limit 4.1) and Hemoglobin 16.7 (upper limit 16.5). Also hematocrit 49.3 (high is 48). I suppose my question is, everywhere I've read online state if ALT is greater than AST it is indicative of being viral as in hep c. With that said, the same ratio typical with alcoholic liver disease is usually 2-1 ratio. My question is, do you still see those numbers that close together in alcohol related disease or does it appear to be more viral? Or cant you tell by the lab values alone? Also, what is the difference in values normally seen in hep c patients? Oh, and also, MCV is 109.8 with a UL of 99.0 Thank you for your time.

[fntn]

The typical fibrosis will not show up in the standard imaging. They would need to do a biopsy to know for sure where you stand. But you are too young yet for advanced stage fibrosis caused by heavy drinking. It usually takes decades for that to happen.

With some life style adjustments and dietary/exercise thrown in, you should be as good as new.

[lb688]

"There is coarsening of the echo texture of the liver with increased
acoustic attenuation as seen in findings of hepatic steatosis. No
discrete mass lesion is identified. Portal vein Doppler signal
demonstrates flow in the appropriate direction at 24 cm/sec."

So diagnosis is hepatic steatosis. (negative for hep panel) Not sure if any of this signals signs of fibrosis or if that would've shown up on the US (dr is on vacation).  But none the less the doc that did call with the results state fatty liver and said what has been done can be reversible thankfully.

[lb688]

Thanks again for helping me at ease a little bit more.  I will keep you informed!

[fntn]

Your Ast should typically be a little less than your Alt levels. But this will vary of course. Ast enzymes are also produced in your muscle tissues as well as in other organs. So it may fluctuation a bit just due to exercise, for example. Your ratio looks OK to me, nothing of concern. The levels are mildly elevated though which might be due to your ACE meds.

Let us know how your appt goes with your doctor.

[lb688]

Sorry if this is a duplicate message...not sure if the first one went through.  But thank you for your response.  
I guess the ration thing is where I'm confused.  I've read 0.9 ratio is the mean for certain alcohol related liver problems as well as 2 to 1 for more severe liver disease from alcohol. I have also read that if it's fatty liver disease that the levels are usually much lower than mine.  
Lastly, I'm very close to 1 to 1, but when they say viral hepatitis is less than 1 to 1, technically I am that too.  Is there a bigger disparity between the two in viral?  None the less, I am awaiting test results for the hep serum.  As with most I'm just a wee bit nervous so I figured I'd try to clarify.  Thanks again.

[fntn]

Alcohol by itself can affect the vitamin balances within your body. Plus, many heavy drinker tend to neglect their diets, which can cause vitamin deficiencies. So both of these factors will tend to cause the MCV levels to be elevated in heavy drinkers.

Your Lisinopril is known to be mildly hepatotoxic. So you can expect to have transient serum aminotransferase elevations. So it's not clear whether your elevated levels are due to your medication, or to your fatty/alcohol liver disease. I mention fatty because this is the typical affect that chronic alcohol consumption has on the liver. So your De Ritis ratio, Ast/Alt, is 0.95. And this is basically normal, especially given that both your enzyme levels are elevated. And yes, a ratio greater than 2 would indicate alcoholic liver disease (alcoholic hepatitis, in particular), and a ratio below 1 would be inline with viral hepatitis.

You should touch base with your doctor and discuss whether or not a Lisinopril dosage adjustment is needed. Take care.