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High liver enzymes on a blood test

Also called: Elevated liver enzymes, high ALT, high AST, abnormal liver tests, transaminitis

Liver blood tests (like ALT and AST) that come back higher than normal. Most mild rises come from fatty liver, alcohol, or medicines, and many go back to normal.

TypeA blood test result
Most common causeFatty liver
Next stepRepeat tests and look for the cause

Overview

Liver enzymes leak into the blood when liver cells are irritated or damaged.

Common causes are fatty liver, alcohol, some medicines and supplements (including acetaminophen), hepatitis B or C, and, less often, autoimmune or inherited liver diseases.

Symptoms

Common signs:

  • Told I have fatty liver or high liver tests

Less common

  • Often no symptoms
  • Tiredness

When to get medical care

Call 911Confusion, vomiting blood, or black stools.
Get care todayYellow skin or eyes, dark urine, or pain under the right ribs.
See a doctor soonLiver tests stay high on repeat testing.

Causes

Fatty liver, alcohol, medicines, hepatitis viruses, and other liver diseases.

Does it spread or run in families?

  • It isn't contagious. You can't catch it from someone else.

Who is more likely to get it

  • Obesity and diabetes
  • Heavy drinking
  • Certain medicines or supplements

Possible complications

Diagnosis

Your doctor looks for the cause.

Questions you may be asked

  • Alcohol use
  • All medicines, vitamins, and herbal supplements
  • Risk factors for hepatitis

The exam

A check for an enlarged liver and signs of liver disease.

Tests

Tests, if needed:

  • Repeat liver tests:
  • Hepatitis tests:
  • Liver ultrasound: Looks for fat or other problems.

Treatment

Treatment depends on the cause.

Self-care

  • Limit or stop alcohol
  • Lose weight if you have extra: even 5 to 10 percent helps fatty liver
  • Review supplements: some can harm the liver
  • Don't take more acetaminophen than the label says

Get vaccinated for hepatitis A and B if advised.

Prevention

To protect your liver:

  • Limit alcohol
  • Keep a healthy weight
  • Get hepatitis vaccines

Which doctor treats this

  • Start with your primary care provider (family doctor or internist).
  • They may send you to a gastroenterologist (stomach and gut doctor).

Living with it

Support groups and helplines

Pregnancy and breastfeeding

  • If you're pregnant or planning to be, tell your prenatal provider about this condition.
  • Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
  • Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
  • Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

Outlook

Mild rises often go back to normal once the cause is treated.

Getting ready for your visit

Bring a list of your symptoms and medicines.

What to bring

  • All medicines and supplements

Questions to ask

  • What's causing this?
  • Do I need an ultrasound?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on High liver enzymes on a blood test

Sources

Last updated 2026-11-12.