There are number of blood tests that reflect the condition of liver. Serum alanine aminotransferase (ALT) is one of the important and sensitive indicator of injury to liver cells although raised values can be caused by diseases unrelated to the liver. There is a tendency amongst clinicians to consider a raised serum alanine aminotransferase synonymous with a viral hepatitis, acute or chronic but there are a large number of unusually or frequently overlooked causes of raised serum alanine aminotransferase in addition to viral hepatitis. It is very important to consider these uncommon causes while investigating a patient for raised serum ALT because early detection may not only helpful in diagnosis but management of such cases as well. This study will not only help in earlier diagnosis of unusual causes of raised serum Alanine aminotransferase but also in management of such cases.