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Elevated Enzymes Concern - pls help
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Elevated Enzymes Concern - pls help

Hello -

I had a physical a couple of years ago and my liver enzymes were elevated. The Dr. did not seem concerned at all and said I should completely abstain from any type of alcohol for 30 days and re-test.(I am not a heavy drinker, but do enjoy on average a drink a day (beer or wine) with dinner...and sometimes 2 on a weekend night). I did not have a drop for 30 days and my enzymes returned to very close to normal and the Dr. let the matter drop......I have still always been a bit concerned.

Monday, I had another physical and everything turned out very well except for my enzyme levels; again!! I have not been drinking heavily and have not drank heavily since my college years about 8 years ago - like most college students!!

Anyway, here are my statistics:

ALT........100
GGT............95
Biliruben..........1.9

All other ezymes and parts of blood test were completely normal. Of course, I've been doing extensive research on the web and am scared to death....the problem is my physician does not seem concerned at all.........it was me that was more concerned and asked to see a specialist. He thinks that would be a good idea just to put my fears to rest, but I'm truly scared that there could be something wrong -

I am 29 years old
5'9"
185 lbs

I feel great and excercise, etc........no symptoms whatsoever except for the elevated count. I'm seeing a specialist this month but would love to hear anyone's thoughts.

Thanks so much!!

Ksilv
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There can be many reasons for an elevated enzyme count - this can include fatty liver, Gilbert's disease (a benign condition of bilirubin metabolism), gallbladder disease, hepatitis etc.

An ALT of 100 deserves further workup.  I would start with an ultrasound and blood tests for hepatitis.  

If these tests are negative, repeating the enzymes periodically is recommended.  If they continue to rise, a liver biopsy can be considered.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b
29 Comments
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Avatar_m_tn
Have you beeen checked for Hep C? I'd be screened for Hep , a b and c. Many people have hep c and do not know it, nor do they have past IV drug use experience. They have no idea how the contracted it. If it was me, I'd do that first to rule that out and also have the doc che check you for a condition called "fatty liver"
those conditions can cause raised enzymes and no other symptoms like you are experiencing. Id rule those out first. Might be a good idea to seek a second opinion from a Heptologist or a Gastroentrologist. I also wouldnt ignore it even if the doc says it is no big deal, keep trying to get a diagnosis until you get an answer. Id stay completely away from alcohol until you know what is going on.
good luck
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Avatar_n_tn
Thank you so much for you reply, this board is so helpful. I was tested for Hep the first time this happened (2 yrs ago) and everything was clean....since the enzymes came down the second time I tested I think the Dr. decided to let it drop.

I'm concerned that I have either a very sensitive liver or a problem going on that I want to address asap - 29 seems a bit young for these issues, especially given that I've never had an actual problem with alcohol. I love the glass of wine with dinner and a beer with buddies, but if it will severely hurt me I have no issues with cutting it out of my life completely.

My doc did mention that GGT sometimes is elevated with alcohol use - although I have no clue why ALT (which I know is liver related) and biliruben would also be elevated. Are there any common(or rare) issues that you know of that would result in the elevated ALT, GGT, and biliruben and everything else being normal....also in your opinion are these numbers severely high or moderately high? Again:
ALT - 100
GGT - 95
BI - 1.9

Thanks so much for your comments, I just found out I am going to see a liver specialist on June 14th, I just wish I could get in sooner; my doc assures me this is not an emergency but I get scared on this stuff very easily!!

Enjoy your weekend!!
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Avatar_n_tn
Thank you so much for you reply, this board is so helpful. I was tested for Hep the first time this happened (2 yrs ago) and everything was clean....since the enzymes came down the second time I tested I think the Dr. decided to let it drop.

I'm concerned that I have either a very sensitive liver or a problem going on that I want to address asap - 29 seems a bit young for these issues, especially given that I've never had an actual problem with alcohol. I love the glass of wine with dinner and a beer with buddies, but if it will severely hurt me I have no issues with cutting it out of my life completely.

My doc did mention that GGT sometimes is elevated with alcohol use - although I have no clue why ALT (which I know is liver related) and biliruben would also be elevated. Are there any common(or rare) issues that you know of that would result in the elevated ALT, GGT, and biliruben and everything else being normal....also in your opinion are these numbers severely high or moderately high? Again:
ALT - 100
GGT - 95
BI - 1.9

Thanks so much for your comments, I just found out I am going to see a liver specialist on June 14th, I just wish I could get in sooner; my doc assures me this is not an emergency but I get scared on this stuff very easily!!

Enjoy your weekend!!
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Avatar_m_tn
There are too many things that can raise enzymes, you cant get a definate answer on the net. seeing a liver doc is the answer to find out definitively what is going on, most regular docs just dont have the experience in specific things like this, try to get a referral. I just mentioned two common things that reaise LFTs aside from alcohol. I am certainly no doctor, just a patient who has a liver problem and knows how scary it is to hear your liver is under stress. Great news if you were tested for heps and all were negative. You can get to the bottom of this and correct it, try not to overworry it, hard as that is. You can start today improving your nutrition and cutting the booze, both excellent things for your liver and toos to bring down those LFTs. Keep in mind, if it IS from drinking then you can correct the problem easily by stopping the booze. If you find you cant stop, then face it and get some help because you are awful young to be having a drinking related health problem. I used to drink until the day I found out my enzymes were up and it freaked me out and I havent had a drink since, so if you are like that it shouldnt be too bad. Down the road when you have this solved, drinking in MODERATION (less than 2 a day) should be ok.
I just really think you should see a liver specialist,it will ease your fears a lot I think and you will get to the bottom of it.usually takes a month or two to get in so be patient. Id cut out the alcohol while you wait to see the doc, eat a good diet, exercise and test again in say 8 weeks. Be a good idea to get an ultrasound of your liver, they can check for fatty liver ( which thin people can also get) and masses and tumors so that can be ruled out. I  believe aloohol makes fatty liver worse
I dont know how much you drink but if it is strictly from drinking too much then stopping drinking and retesting it should have been normal. Are you taking any meds? They too can raise enzymes so double check the meds you take, if any are not liver friendly, have the doc adjust them. Are you on an AD? Some of them can affect enzymes too. Also supplements or other Over the counter products people take can also raise your ezymes. Dont freak out yet, but that is a pretty high GGT and elevated GGT can be related to heavy alcohol use.
Good news is, you are young and can change your habits and reverse damage you could have caused until now and your body is young and resilient.
hang in there, good luck
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Avatar_n_tn
Hi there,

Raised serum ALT along with GGT, usually point to alcohol ingestion.

ALT levels are usually raised if any hepatoxic agent is present in the body like regular alcohol ingestion, Hep & other Viruses, some drugs etc.

Are you on any regular medication for some other ailment?

If I were in your place would request my doc to do a complete lab work & imaging to exclude all possible causes.

Take care.

PS: I apologize about my poor english.
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Avatar_n_tn
Thank you all for the comments and thoughts....I really appreciate all the responses. I have an appointment set with a liver specialist on June 14 (that's the soonest they could get me in and they say I do not have an "emergency"??? oh well....)

Is there any other symptoms I should watch for until then? I feel perfectly normal and am exercising, etc.....and I do have a good diet. I guess I'll just wait and see; and stop drinking alcohol for now - I'm going to Vegas with friends next week so that will be very tough!!! Club soda with a lime please!!
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Avatar_m_tn
Yes, the wait is LONG but you are smart to do that.
To them it isnt an emergency and that right there should ease your fears. Worry if they rush you in LOL
Have a good time, I was pleasanty suprised how easy it was to keep enjoying life as usual without alcohol compared to how I thought it would be before I did it. Nothing like a test reading that high to take the joy out of drinking. Have fun in Vegas!
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Avatar_n_tn
Thank everyone for all of your comments. I'm interested to hear if anyone has had similar results or heard of the ALT>AST, elevated GGT, ALP normal, and biliruben at 1.9 (Elevated ALT, GGT, and Biliruben). I've seen a ton of posts that say AST>ALT suggests alcohol but what about specifically ALT>AST, elevated GGT, and elevated biliruben - everything else normal. I know that it is not possible to get an answer or even hope for a sure answer until I see the specialist in June - is this more suggestive of fatty liver or possible something gastro problems? Thanks.
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Avatar_n_tn
To me it looks as Chronic liver damage due to some hepatotoxic agent, along with bilary obstruction.

U/S, CCK test would be very helpful.

Regards!
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Avatar_n_tn
As one who has just gone thru a major liver panel work-up  and ultrasound, you can't diagnose this person as having chronic liver problems based on the info he provided. JMO.

Hudson
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Avatar_n_tn
Thank you for the comments!! Hudson if you don't mind me asking, what were your levels and how was the outcome.....I hope everything worked out alright for you and that you are doing well. From the research I've done (albeit only on the web, which paints quite a picture of doom!!) - I can see where he would make those comments. Obviously, I'm hoping that the fact that I am young and in good health otherwise, my only vice being moderate alcohol use, that this will not be a very serious issue.

This board is so helpful to hear from others that have had similar occurances, so again I can't tell you how much I appreciate the comments!!

Kenny
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Avatar_n_tn
I don
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Avatar_n_tn
Hi again, my situation was an odd one, as I had no symptoms of liver disease. During removal of an ovary my gyne thought my liver "looked odd".   She stated it was way out of her realm of knowledge but insisted I see a gasto specialist. Well, I did and boy did I get a work-up. $2200 worth of blood work including tumor markers and an ultrasound. All came back fine. Bottom line was my gastro guy told me livers can look pretty "funky" and function just fine. He told me to go home and live my life.

I have a friend who is a nurse and works for another gastro guy. She told me the same thing and also said that more than
the actual panel numbers doctors look for stability. There is a lot more to diagnosing these things than meets the eye and each case is different. I wouldn't jump to any conclusions at your young age. Maybe get another opinion, or even a third opinion. Do you happen to live in Chicago? If so, I'd be happy to e-mail you the name of my gastro doc.

Hudson
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Avatar_n_tn
p.s. what were your enymes levels 2 years ago as compared to now?

Hudson
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Avatar_n_tn
ksilv,

alt/ast reference range is usually around 0-40 depending on testing facility.  your 100/95 is about 2x, so that should probably warrant some additional testing such as full bloodwork and possibly ultrasound.

just as a precaution, you probably want to get tested again for hep b and hep c for peace of mind.

it's really hard to say what may be causing your elevated liver enzymes and bilirubin.  fatty liver can certainly be one reason, and is generally reversible.  and you do not have to be overweight to have fatty liver.  another possibility are pain medications or other prescription medications, or even exercise supplements.  be sure to bring in with you to your gastro any supplements or vitamins you have been taking.  while waiting for your appointment, try to eat better and get more rest.  try to lay off the booze and any medications.

hudson,

good to see another chicago native on this board!  i hear you on the cost of the lab work... good grief!

leeac
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Avatar_n_tn
Hi Leeac, I agree with your post. Before jumping to conclusions, I would think an ultrasound and further bloodwork would be the way to go.

Where in Chicagoland are you? I'm in the burbs...in St. Charles.

Hudson
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Avatar_n_tn
Thanks for all the comments from Chicagoland - definitely one of my favorite cities. I live in Columbus, OH right now but am originally from Boston.....thanks again for your comments. Guess the bottom line is to just live life "smart" until my appointment on the 14th (June) with the Gastro doc....I am on a waiting list so hopefully I can get in sooner...it just sucks b/c it's on my mind everyday. My wife keeps saying "don't worry, your doc says it's not an emergency and you don't have any symptoms" - but she's not the one with high LFT's!!!! It's on my mind everyday, but I'll hope for the best.

Thanks!!
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Avatar_n_tn
Hey there, you won't believe this, but I am originally from Ohio and lived in Columbus for 8 years.

I was just like you, very worried about my "liver issue". But, your wife is right. It is not an emergency and I'm betting things are not serious. Try to relax as best you can.

I hope you post after your GI apppointment. Take care,

Hudson
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Avatar_n_tn
I certainly will, as I really appreciate the comments of people who understand the impact of health related issues. I am from Boston but moved to Columbus 3 years ago for my job. We lived in Dublin for 3 years and just bought a house in Arlington in January......it is certainly growing on us although we really miss the Ocean.....at least you have Lake Michigan - a little more like the ocean than the Scioto River!!!!

Take care and Best Wishes,

Kenny
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Hi Kenny, small world then, as we lived in Dublin for all 8 years. I still miss it. We came to Chicagoland for my husband's job. We are about 40 miles west of the city, so we don't see much of Lake Michigan. lol.

Hudson

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Avatar_n_tn
I'm from the northwest burbs but now living downtown...
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Avatar_f_tn
Elevated liver enzymes can mean many things, from a 'fatty liver' to more serious conditions.  Do not let anyone put you off with the 'alcohol' business.  I have high enzymes because I have Primary Biliary Cirrhosis and Auto-Immune Hepatitis, and I was only a social drinker.  The minute people hear any kind of cirrhosis they think I must be an alcoholic, but it's a misnomer because PBC is an auto-immune disease.  You are doing the best thing possible, seeing a specialist.  Any liver disease caught early is a non-emergency situation, there are so many advances and so many new drugs to help with most liver conditions that hitting the panic button is a waste of time. Good luck and keep us posted.

Patsy
DX 12/05 PBC/AIH
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Avatar_n_tn
Everyone has had very helpful comments, thank you.......I'm going to completely abstain from any alcohol for 5 weeks, test again, and then go see a gastro specialist. I have read every post on here and still cannot find any hint of what my combination of enzymes could point to -

ALT 100
GGT 95
Bilirubin 1.9

All of the posts say ALT and AST ONLY or AST above ALT. All my enzymes/tests were completely normal with the exception of the above three. I have come to the conclusion that since I have been a "regular" drinker for the last decade or so (averaging about 2 drinks/day......but having many times where I'd go days or weeks without anything, I'm more of a social or "with dinner" drinker)......that alcohol has to have something to do with it.

I know that ALT and GGT could suggest alcohol, but usually AST is elevated above the ALT, right?? My AST was normal? And what does any of this have to do with the elevated biliruben level? I'm just going nuts thinking about it every day and I can't see anyone until June 14th, again "not an emergency" according to my doc, I'm the one that forced him to let me see a specialist!!! Any and all further insights GREATLY appreciated.

Kenny
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Hello everyone I am new to the forum and I was wondering if you guy and gals can help me because all the doctors are giving me the run arounds my bilirubin and sgot and sgpt are all high.  my face has gotten darker and my lips also. my eyes are light yellow and I itch all day and all nite with stinging sensation.
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A higher AST to ALT ratio usually indicates that you are in the realm of Alcohol Hepatitis where your entire system is starting to rebel against Alcohol. AST alsop resides in the bones and other parts of your body, when it is activated hugher than ALT, it usually means other areas of your immune system are reacting to alcohol. At this point, somebody is usually getting quite ill. This is usually the result of daily alcoholic drinking (5 drinks or more a day) However, alcohol even in moderation can cause elevated ALT without a raised AST, but that does not mean that you are on the path to doom. If AST is higher than ALT and they are both quite raised you should be concerned. Obviously, you should follow up with your doctor and run this thing down so you can rest easy. Good luck.
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Hello - very helpful comment thank you......My AST is within normal range and the ALT, GGT, and Bilirubin are moderately elevated. I'm not a heavy drinker at all (although I was back in my college days).....and maybe I'm paying the price now. On average, I drink 1-2 drinks a night with dinner (beer or wine). Does isolated ALT elevation without any AST or ALP elevation point to anything? I've heard that GGT can be related to alcohol as well, but no clue about Bilirubin.  I am seeing a specialist on June 14 and the wait is killing me. I went to Vegas with friends last week and did not touch a drop because I am so scared......my doc thinks Im being way too cautious, but it's not him with the elevated function tests!!

Thanks,

Kenny
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Avatar_n_tn
It is hard to diagnose specifically what an elevated ALT, GGT or Bili reading could mean. GGT is a very sensitive enzyme which indicates that something is amiss. GGT is very sensitive to alcohol. If you have an elevated GGT reading after alcohol abstinence for 4 weeks, then it would be due to something else, but is very specific to the liver but not what the cause could be. An elevated GGT with and elevated Alkaline Phosphatase level would indicate a cholestatic problem which could be impaired bile flow, gallstones, bile duct issue etc. This would also cause your bilirubin to probably elevate. You might notice lighter colored stools if this is the cause. But it is hard to diagnose a high ALT sand GGT in combination. They both point to a liver origin, but liver enzymes can be elevated by a galbladder issue. Also, any regular prescription medicine, aspirin, tylenol etc could cause elevated enzymes. My brother just went on cholesterol lowering meds after being on them for about 1 month and his ALT went up. Do let us know if you get a specific diagnosis. Would really like to know. Find out what it is, but don't worry too much.
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Similar situation except GGT rising each year for over 5 years. AST AND ALT always in normal range. Gastroenterologist was not alarmed, said it is a sensitive test. But my concerns about the increased number encouraged him to run a ultra sound. No fatty liver, just looked normal.  I have just received my latest (annual) test results again an increase in GGT only. It went to 160 from 124. Everything else in normal range. No alcohol is involved. I have had the hep tests which were negative, a couple of years ago. I will see the doctor once again soon and maybe have the hep tests again. Don't know what else to look for. Don't have any pain but lots of heartburn. Prilosec works great for me on a daily basis. No other meds involved.  Any thoughts?
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Just received results from blood work and wanted opinions.  My AST was 47 and my ALT was 92.  Everything else I was told looked wonderful (HGB was 15.2, platlett 247 and my cholestrol was great).  I do not drink alcohol at all so it can't be that.  Does medication have anything to do with the ALT levels?  I have read different things on the web but thought that people who have gone through this experience are better at explaining things.  Not sure what could be wrong.

thanks for any comments
Raine
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