Digestive Disorders / Gastroenterology Expert Forum
Elevated Liver Enzymes
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Elevated Liver Enzymes

Hi - I'm a 28 year old male with elevated liver enzymes (as of 2003-07-23: ALT=118, BILIRUBI=1.1, ALKALINE=137). In January of 2002 I had surgery to remove a tumor located at the beginning of my large intestine (cecum area) - the final diagnosis was Stage II Colon Cancer (my surgery was not succeeded by chemotherapy and I have had no cancer related complications since). Prior to my surgery, on 2003-01-14, my liver tests were normal; ALT=17, AST=18, BILIRUBI=0.6, and ALKALINE=96. Just subsequent to my surgery (which took place on 2002-01-21), while recovering in the hospital, it was discovered that I had an allergic reaction to the antibiotic I was on (I believe it was Kefsol) which resulted in a significant drop in my platelet count (to 3,000) and hermatocrit - I was taken off that particular antiobiotic and received numerous blood and platelet transfusions.  Please note: some tests were excluded on certain dates (not sure of the rationale). On 2002-01-24, two days before I was discharged, my liver tests were as follows: ALT=14, AST=21, BILIRUBI=0.6, and ALKALINE=54 (still normal). On 2002-02-12, after being at home for a while recuperating (and takin iron supplements), my liver tests were: ALT=125, AST=61, BILIRUBI=.7, CARCINOE=1.8, and ALKALINE=146 (the first signs of elevation). On 2002-02-26: ALT=101, AST=48, BILIRUBI=0.6, and ALKALINE=101. On 2002-03-14: ALT=91, AST=37, BILIRUBI=0.6, CARCINOE=2.2, and ALKALINE=128. At the beginning of May, I began drinking alcohol again (I had abstained since the surgery) - mostly weekend drinking - usually between 5-15 drinks throughout the course of an entire weekend (i.e. two nights, Friday and Saturday - sometimes I have "heavy" nights - i.e. more than 10 drinks).  This has continued to the present with a brief period of abstination (see below). On 2002-06-13: ALT=39, BILIRUBI=0.8, CARCINOE=2.6, and ALKALINE=95 (I slight drop from before). On 2002-10-21:ALT=72, AST=40, BILIRUBI=1.0, and ALKALINE=122.  At this point, I decided to abstain from drinking for a month, and on 2003-11-21, my tests were: ALT=63, AST=36, BILIRUBI=1.2, and ALKALINE=122. I then saw a liver specialist in 2002-12 who ordered an ultrasound of my liver - the results were completely normal..And so, a liver biopsy was not pursued. It should also be noted that I have had routine CT scans of my liver (every 4-6 months) which have also been normal (though I do have a slightly enlarged spleen). On 2002-04-08: ALT=118, AST=57, BILIRUBI=1.0, CARCINOE=2.4, and ALKALINE=112.My most recent results, as I mentioned above, are: ALT=118, AST=53, BILIRUBI=1.1, and ALKALINE=137.No one was ever able to determine what caused the initial elevation - do you have any ideas? After seeing a complete graph of my tests, I've concluded that alcohol is playing a role and plan on abstaining indefinitely.  How alarming is my condition? Could I have caused permanent damage via my drinking? Any thoughts, in general, are appreciated.  Thanks so much.







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Typically with drinking the AST would be elevated over the ALT, but this is not a universal rule of thumb.  There are many reasons why the ALT is elevated.  The CT scans to evaluate any metastases to the liver and the ultrasound were good first steps.

I would also consider a hepatitis screen as well as thoroughly going over any medications that you may be taking (since there are many medications that can raise the enzyme levels).  

Other more specializeed tests to consider would be iron studies and a ceruloplasmin level to evaluate for hemochromatosis and Wilson's disease respectively.

As for the liver biopsy, it is recommended for those who have persistantly greater than twofold elevated levels (i.e. ALT greater than 100).  If it is persistantly less than that, then observation is acceptable.  

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.

Thanks,
Kevin, M.D.
3 Comments
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Avatar_n_tn
Hello - I will be on vacation until August 9th. I look forward to answering your question when I return.

Thanks,
Kevin, M.D.
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Avatar_n_tn
my ALT 291; AST 179
Al Kalin Phosphatase 131
I don't drink at all. I am overweight and have eaten lost of fatty foods...which i never thought about til i came across your forum here..

I went to my ob/gyn bc I am having sever pain when I urinate
feels like I never finished Like something trying to come out but can't. I frequently have to go
I have been getting up at night The first week was friday July 25 it was so painful i scheduled to see my doctor the following Thursday 31 of july. I had fever and chills and severe pain.
He took lab test of my blood and called me today and said
my liver enzyme levels were too high.

I never had this pain ever before .. Its was all the sudden
and has been nonstop since July 25. I'm drinking lots of cranberry juice bc friends said it might help. It has. Its reduce the frequency of having to urinate but the pain is still there Now I only get up twice at 1 or 2 am in the morning then again around 5-6 AM as oppossed to the 7 times at night when it first began on July 25. I'm really scared. I've never been sick before.I scheduled with a gastroenterologist Aug 18
I really hope its like a gallbladder problem
that can just get fixed.. bc it only happens when i have to urinate.. Please tell me your knowledge regarding liver problems


Thank you.
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Avatar_n_tn
Kevin - thanks for the response - very much appreciated.

I had all the standard hepatitis tests (A,B,C) and they came back negative.  Also, I'm presently not taking any medications.

Therefore, I'll bring up your mentioning of Wilson's disease and hemochromatosis to my doctor.

Thanks,
Brendan
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