In acute viral hepatitis, which transaminase is typically higher?

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Multiple Choice

In acute viral hepatitis, which transaminase is typically higher?

ALT higher than AST is the typical pattern in acute viral hepatitis. ALT is more liver-specific and is abundant in hepatocytes’ cytosol, so when hepatocytes are damaged by a viral infection, ALT leaks into the bloodstream in larger amounts than AST. AST is also present in other tissues (like muscle and heart) and in mitochondrial form, so its rise is less liver-predominant. This contrasts with alcoholic liver injury, where AST often exceeds ALT (AST:ALT > 2:1). Alkaline phosphatase elevation points more toward cholestasis or biliary involvement, not the primary hepatocellular injury seen in acute viral hepatitis.

ALT higher than AST is the typical pattern in acute viral hepatitis. ALT is more liver-specific and is abundant in hepatocytes’ cytosol, so when hepatocytes are damaged by a viral infection, ALT leaks into the bloodstream in larger amounts than AST. AST is also present in other tissues (like muscle and heart) and in mitochondrial form, so its rise is less liver-predominant. This contrasts with alcoholic liver injury, where AST often exceeds ALT (AST:ALT > 2:1). Alkaline phosphatase elevation points more toward cholestasis or biliary involvement, not the primary hepatocellular injury seen in acute viral hepatitis.

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