American Association of Critical-Care Nurses (AACN) Certification Practice Test

In alcoholic liver disease, what is the AST:ALT ratio typically observed?

1. 1:1

2. 2:1

3. 3:1

4. 4:1

The correct answer is: 2:1

In alcoholic liver disease, the typical AST:ALT ratio observed is primarily due to the mechanisms involved in the metabolism of alcohol and its effect on liver enzyme levels. This ratio is characteristically greater than 1, often around 2:1. The reason behind this increased ratio is that as liver cells are damaged due to alcohol, the enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are released into the bloodstream. However, AST is found in higher concentrations in the liver and in other tissues such as the heart. In contrast, ALT is more specific to the liver. In cases of alcoholic liver disease, AST tends to rise more significantly than ALT. This can be attributed to the fact that alcohol-induced liver injury also leads to increased release of AST from mitochondria within liver cells, rather than just from the cytoplasm as with ALT. Consequently, a classic finding in patients with alcoholic liver disease is this elevated AST:ALT ratio, typically around 2:1, indicating a preference for AST elevation in comparison to ALT. Understanding this ratio can be vital for healthcare professionals in recognizing and diagnosing alcoholic liver disease, allowing for timely intervention and management of this condition.