<s>[INST] Hi, I have elevated liver enzymes, ALT = 196 and AST 181. The nurse (almost a doctor) I go to thinks I should have a liver biopsy. When it first went up I was on a medication that was known to elevate the liver enzymes but I got off of the 7 years ago. It never did go down. What is your opinion? thank you! Melanie [/INST] Hello, How old are you?? Since when you're on drugs?? Yes you may be suffering from chronic elevated liver enzymes may be due to fatty liver disease or non alcoholic fatty liver disease or infection or trauma etc.Until examination is done it is difficult to say what it is. Need to be evaluated for liver enzymes or ultrasound abdomen,viral markers and if necessary liver biopsy.Then only we have to come to conclusion.Also stop intake of liver toxic drugs , alcohol, smoking and pain killer medication.Eat green leafy vegetables, do regular exercise if symptoms not improved please consult your physician he will examine and treat you accordingly. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Penchila Prasad Kandikattu , Internal Medicine Specialist </s>