### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Dear doctor(s): I have a patient recently found to have a high AST (15x more than baseline) and SGPt (20x more than baseline), His GTT and Alkaline Phosphatase also elevated. His ammonia level was 93 ( 47). He was noticed to be drowsy, sleepy, weak, which his family said he was not that way before. He is a 92 years veteran, who has cholecystectomy couple years ago and only one kidney (nephrectomy was during WWII) He was admitted to Norman Regional Hospital for 2 full days and returned with a diagnosis of hyperaminitis. After I checked on the book, I found out that was a non-specific hepatitis. But before he was transferred from our VA nursing home, hepatitis profile was done and sent out to private laboratory company, with positive HAV Antibody. Today, another test on IgM was negative. So, I think this hepatitis is not from Hepatitis A which caused positive HAV AB positive, or maybe the HAV infection has occurred about 2 months ago. Request to have instruction about how we should deal with this honorable veteran. Many thanks, jack kao, md, staff physician, Sulphur VA Center, Oklahoma

### output:

Hi thanks for asking question. Here according to history provided by you here all viral markers are negative. Hepatitis an is not cause here.it might be false positive report, or it is cured now. Here patient having high ammonia suggest progression toward chronic liver disease or chronic hepatitis or cirrhosis. The cause can be you are right is cryogenic hepatitis which can be idiopathic ... Rule out alcohol history as it can lead chronic hepatitis and cirrhosis. If possible after decrease in ammonia level liver biopsy can take.Meanwhile, instruct patient for less fat, less protein diet...fruits more. Papaiya seed with lemon juice good herbal remedy. Take care. Chat Doctor. 