The greatest activities of serum AST and ALT are seen in which condition?

• A. Acute viral hepatitis
• B. Primary biliary cirrhosis
• C. Metastatic hepatic carcinoma
• D. Alcoholic cirrhosis

Answer: (A)

A high level of serum AST and ALT appears when liver cells are damaged, and ALT is the enzyme more specific to the liver. In acute viral hepatitis, there is rapid and extensive hepatocellular injury from the viral infection, causing a large release of these enzymes into the bloodstream. This results in markedly elevated ALT (often higher than AST) and AST, producing the greatest overall increases among the conditions listed.

In alcoholic cirrhosis, the pattern usually shows a higher AST than ALT, but the absolute elevations are typically more modest. In primary biliary cirrhosis, enzyme elevations occur but tend to be less extreme and more cholestatic in pattern. Metastatic hepatic carcinoma can elevate aminotransferases, but the elevations are not as consistently dramatic as those seen with acute viral hepatitis.