Which Enzyme Is the First Choice for Detection in Acute Viral Hepatitis?

In cases of acute viral hepatitis, liver function tests are essential for diagnosis. Among all the enzymes evaluated, the most direct indicators of liver damage are transaminases — specifically alanine aminotransferase (ALT) and aspartate aminotransferase (AST). During acute hepatitis, both ALT and AST levels can rise sharply and significantly. Typically, ALT levels are higher than AST levels, although in many patients, both enzymes may increase in parallel.

These transaminases are found within liver cells, but they are located in different cellular compartments. ALT is predominantly found in the cytoplasm of liver cells, while AST is mainly located in cellular organelles such as mitochondria and the nucleus. When a large number of liver cells become inflamed or die, both ALT and AST are released into the bloodstream, leading to elevated levels.

In acute hepatitis, it's common for both enzymes to rise together, with ALT often being the more prominent one. However, in chronic hepatitis, the pattern may differ. Chronic liver damage usually affects organelles and the nucleus more severely, causing AST levels to rise higher than ALT. This distinction can help doctors differentiate between acute and chronic forms of the disease.

Monitoring the ratio of ALT to AST can provide valuable insights into the nature and progression of liver damage. In acute cases, a higher ALT level reflects the extensive damage to the cytoplasm of liver cells. Meanwhile, a rising AST may indicate more severe cellular injury involving mitochondria and other organelles.

Understanding these enzyme patterns is crucial for accurate diagnosis and effective management of viral hepatitis. Early detection through liver enzyme analysis can lead to timely treatment and better outcomes for patients with acute viral hepatitis.