Elevated liver function tests, but improving. Need biopsy?

[JoshMonster]

I have an interesting situation.. I'm scheduled for a liver biopsy in 3 months, and I'm wondering if its better to wait a few months.. heres why..

I'm a 27 year old male, 6'1, 215lbs. Ex-smoker, computer programmer...

In january last year, I have elevated liver function tests, not sure which ones.. just 'slightly elevated'. We waited a while and in May, my liver function tests were normal expect

SGOT (53) (norm is 0-40 I think)
and my SGPT was (155) also norm is about 5-40 I think..

I went to see the liver specialist, we talked and are thinking.. maybe NASH, maybe fatty liver.. So I lost weight, went down to 185lbs. (30 lbs lost), by doing weight watchers.. Now I did my tests again in December, I've got normal SGOT, but my SGPT is still above normal (88), but almost half of what it was 6 months ago.. I think that's a good sign, but I'm not sure.

I'm wondering if its better to lose 10-15 more pounds and wait 6 more months to do a biopsy.. I'd rather not have the risks of a liver biopsy if I don't have too...

perhaps we should do a catscan or ultrasound first maybe?  Biopsy seems like it should be a last step.. so I'm wondering if I'm just being silly and improvements don't mean much and I should get the test anyways...

any suggestions? (my doc is hard to get a hold of, so I'm writing here in the mean time.. :)

Thanks!

[rthornton]

A positive reading for anti-smooth muscle antibody may indeed indicate autoimmune disease...you need to do the biopsy to verify this.  Talk to your doc about that test and have him/her explain it.  I have positive anti-nuclear antibody...and that led to my biopsy.  Although, some people are positive for these without autoimmune disease...it is one of the things pointing in that direction.  So the biopsy is of utmost importance!  Really, as I said before, it is not so bad!!!

Rebecca

[rthornton]

My enzymes were only slightly elevated, too.  This still may mean liver inflammation and damage.  I tested negative for viral hepatitis and and don't have fatty liver. SO I had a liver biopsy...NO BIG DEAL...JUST DO IT :-).  The level of enzyme doesn't necessarily indicate the severity of inflammation...so let them check it out!!

Now I know what is wrong...I have Chronic Active Hepatitis caused by an autoimmune disorder, not a virus.  My immune system is way too efficient and is attacking my liver!  This is not very common, so you probably don't have it, but it is worth doing the biopsy to find out what is going on.  This gives the doc information that can't be obtained by blood tests alone.  There are also a couple of other autoimmune diseases that effect the liver (mine is "Autoimmune Hepatitis"...immune system attacks protein in the liver, another one (PBC) effects the bile ducts in the liver, etc.)  These are more common in women, but some men have them too. (I am a 36 year old female...most common sex and age group for autoimmune disorders...but they can strike at anytime and any sex)

Good luck!

Rebecca

[fyreflye]

I want to say go read my post to Danny22 on 1/28/02, but I'll just give it here in a nutshell.

My liver enzymes were ALT 62, AST 45. I was worried because I have gallstones. Anyway, a friend's insurance agent told her that eating meat can increase enzyme counts. I didn't believe it at first because my Doc said that's only seen in obese people. He gave me a lab slip anyway. I waited 10 days...no meat, no alcohol and got re-tested.

Today, my results came back. They are: ALT 18, AST 18, Alkaline Phos. 70 (under 115 is normal), Amalayse 72, Lipase 36 (These are pancreas tests). All NORMAL!

The Alkaline Phos. is the biggie because that determines if there is a serious disease like cancer, inflammation, heart problems, etc.

So, do what I did and get re-tested! Quick! Pleae post your results and I'll check back. Hope it helps!

[Pixie1969]

Here is my email addy:  pixie_dust1969***@**** .  Tell her to email me whenever she wants, I will be more than happy to help her out however I can.  If she's got PCOS it can be pretty overwhelming because it can not only lead to some very serious health issues later on, but it is also the leading cause of infertility in women.  There is a sort of male equivalent to this called Syndrome X.  Here is a great website to start with for PCOS:  http://www.pcosupport.org/ .  This one is my favorite - I have learned volumes here:  http://forums.obgyn.net/pcos/ .  There are also so many others.  Please have her send me an email if she has any questions at all or needs a buddy to help deal with it.

I went through that with a doc a year and a half ago; for a week straight I kept calling and I never got a call back.  So I found another doc (I had only just started with this doc didn't have much time invested with him yet).  If you can't get a response from him, make an appt and express to him that you made repeated phone calls and never heard back from him.  It may not be him at all; could be his staff not giving him the messages.  That's what happened in my case.  

Well, keep on the track you're on - I think you're doing just fine.  I was glad to see that post from Furgie - he gave very good advice!  

Stay well!

[JoshMonster]

Hey, that is great news! I think it does make sense then to wait and maybe do an ultrasound.. now If I can only get a hold of my doc to tell him.. :)

[JoshMonster]

I think she might have that.. I don't notice her having depression really, or thining hair, or body hair in general, but then again, I just never noticed.. I'll have to ask her..

but certainly, any information, and maybe even I could send your email to her for questions she might have. She was recently diagnosed, so its all quite sudden. I heard there was a male equivalent to this, but I'm not sure what it is.. since I'm her brother, I should find out! :)

Strangely enough, I've called my doc every day since jan 1 and haven't been able to get a hold of him.. hopefully I will before I have to just up and cancel the biopsy.. <sigh>..

[furgie]

Hi.  I suppose this is specifically for Joshmonster and Joe L.  I too am 29 and 6' and weigh about 250.  I used to play Varsity university hockey and now I am not as active.  We are getting older!  Anyways, I too have an elevated ALT at about 100.  I have been to a few specialists (only because they are my friends), and they informed me that there is ABSOLUTELY nothing to be concerned about other then the fact that we must all lose weight!  They are saying this after my Hep stuff came back negative and my ultrasound showed a moderately fatty liver.  That's it.  Don't worry too much.  A biopsy is only in question when your enzymes keep going up for no reason (gaining weight IS a reason).  I hope this helps.  My friends were overly cautious about me and put me through the whole mess.  Enjoy life and lose weight.

[Pixie1969]

Yes, as a matter of fact I am 32 and Insulin Resistant - I have Polycystic Ovarian Syndrome (PCOS).  Very irregular periods - kinda sucks to go through pregnancy scares time and again because my period's decided to go on hiatus!  Is that what your sister has?  Other symptoms besides the insulin resistance, weight, and irregular periods are excess body hair, thinning hair on the top of her head, acne, depression, etc... just a lovely thing to deal with..  If she hasn't had a diagnosis of PCOS and any of those symptoms sound familiar to her, let me know - I will give you some great websites for her to check out to see if she might have it.  I certainly hope she doesn't, but if she does it is treatable and is not the end of the world.  If left untreated it can lead to other health issues though.

I don't think waiting a couple of months about the biopsy is too big a deal.  Just watch the numbers and work with your doctor to see what the best course of action is.  What about the ultrasound?  That will tell you if it's fatty liver.  

Wish you continued success with your weightloss (and the not-smoking!).  And I KNEW vacuuming was evil ... hahhahah

[JoshMonster]

thanks for the reassurance.. sometimes knowing to much spooks ya, yaknow? I'm still hesitant about the biopsy.. I guess I'd like to see if I can lose some more weight and get it down to normal and keep it there.. I've gained about 10 of my 40 lbs lost over the holidays.. but I'm about to start pushing it back down.. but I did get a weight set, and so that will throw off my weight losss if I'm trying to gain muscle mass and lose weight.. weird...

Pixie: Do you have that insulin resistance thing? You would be pre-diabetic around 25-30.. something like that? Irregular periods is one of the symptoms I know.. but thats it.. It comes with a host of others..

My sister was just diagonsed with that.. so she (being 29) is racing to lose weight safely...

All of my problems started 1 year ago when I felt misserable because of an ache right about where the appendix is.. no ruptered apendix, but about 1 month of feeling bad.. then it got better for a month, then I picked up a huge poland spring bottle and ripped some muscle there.. that took about 6 months to heal (no surgery), but It's still a weak area.. can't vacum for more than 10 minutes..   but on a whole, I feel fine.. so I'm thinking of waiting a few months for this biopsy... but certainly your comparison to the dentist helps as I hate the dentists too.. hehe.. :)

[Buggirl]

What exactly is Chronic Active Autoimmune Hepatitis?
There is a chance my husband has it.His enzimes were high like around 700 but now down to around 300.He was on Tetracycline for a long time then Minacycline for acne.When they found out his enzimes were high he was prescribed something else.(for the acne)The Dr. is doing another test in a month to see if it was due to the Minacycline.Hopefully that is what it is.We are really scared about this autoimmune thing because the Dr.says that is a serious thing.Any thoughts or answers to this would be greatly appreciated.Thanks

[Texguy]

Hi, I was taken to ER a few weeks ago because I had a severe pain below the sternum.  They did EKG etc to make sure it wasn't the heart.  The DR said that it was possible I had a gall bladder attack (I had mine removed 6yrs ago) which is very rare but can happen.  Has anyone ever heard of this?  My liver enzymes were slightly elevated.  I've gone to my Primary Doctor and he agrees, but has tested the blood again to see if they are still elevated.  I'm awaiting the results.  Does anyone have any suggestions?  I'm a 39YO male, 165lbs, non smoker and have a drink once or twice a month at the most.  Thanks for your response.

[mack]

I had a liver bioposy. I did not know what to expect.  The doctor gave a numbing shot to the area of my side. I jumped but the medicine kicked in and I did not feel anything after a minute.  The doctor took out a very fine needle. I heard him click it a couple of times and it was so easy. I layed in bed for 1 hour on my side and then went home and spent a day in bed.

I personally think that going to the dentist is 100% worse. The operation was nothing. Just wanted you to know.

[Pixie1969]

I was and still am overweight (I have an insulin based metabolic disorder and am pre-diabetic).  My doctor told me though that fatty liver can even happen to skinny people so who knows?  I didn't know much about the risk of the biopsy, just that there was a slight risk of bleeding.  But I didn't care; I was so uncomfortable and at the end of my rope with feeling so terrible all the time - I just wanted it over and done with, and to be on the road to recovery.  

My gallbladder came out just because it wasn't emptying and was causing me all sorts of pain.  Once it was out I was surprised how much my numbers came down.  Now I'm taking insulin sensitizing medication and hopefully that will help with the weight issue.  I'm just hoping the medication doesn't cause any liver problems, but I get blood tests regularly to keep track of that.  That's so great that you were able to lose the weight with Weight Watchers!  I was never able to reach my goal weight with them; I think I tried really hard 5 different times to do well but I would hit a certain weight and that would be it.  Now I know it's because I was eating too many carbs and I had health issues that weren't allowing the weight loss.  And the smoking thing - wow is THAT an accomplishment!  You should be very proud!

Keep up the good work.  Good luck with the liver stuff!

[JoshMonster]

Interesting! Thanks for the link! I think perhaps it is a good idea to get the ultra scan test...

So, how much did you weigh? (or were you overweight). I think my SGPT tests go up and down just like my weight.. I wonder if that indicates simple fatty liver, and if so, if I drop enough weight to keep the values normal... hmmm... So how was your liver biopsy? Risky?

Did they take out your gall bladder because of simple fatty liver?

Its amazing how much weight has a factor in everything..

Just dropping 10% of your weight (if your overweight) can do great things for your body.. I like to eat like a horse, so finding a deit plan to work with was tricky, but Doing the Weight watchers online system was grreat! No meetings! Just go to their site and do everything by computer.. heleped a lot!

I lost 2 lbs a wek without exersising.. then I got down to a reasonable weight (upper range for my height... ), but maybe I need to go a bit lower..

And as you can guess... yes, its time to quit smoking.. I smoked for 10 years and had to quit... It took me awhile, but I eventually did it.. and the further you get from the 'stop smoking date' the easier it is...

I used to think.. 'Man, I'll never enjoy driving again without a smoke..' stuf like that.. its all BS.. you enjoy those things again.. with a fuzzy memory of smoking... hehe.. makes me look fondly on college days when I could eat anything and smoke all the time.. :)

[Joe L]

Well, I'm not sure what mine where. I just remembered
the tests and then I forgot about it.

Then just recently am having some minor pain and started think
about those tests. I'm going to go in for new tests just
am postponing the trip for some reason. Stupid to wait I know but
that is just me at the moment. Who knows I get freaked out easily.

I'm 6'2, 250Ibs and 28. I've been active in sports and stuff
so I'm not flabby but could stand to drop about 60lbs. I do smoke and I throw down an party once or twice a month but I don't drink
daily.

We're you having any pain?
Did your Doctor send you to a specialist right off the bat?

The biopsy dosen't sound fun and you have gotten your levels to drop so I think [I AM NOT A DOCTOR :)] that you should see if your levels continue to drop from your changes in diet and stuff. Sounds like you have worked hard.

[Pixie1969]

Hi guys,

My liver enzymes were/are slightly elevated as well.  They dropped alot right after my gallbladder removal in October and in fact, I just had blood drawn today to see how they are now.  I would DEFINITELY suggest having an ultrasound done first simply because it will tell the doc alot about the liver and it's non-invasive.  Maybe after that get a CT scan as that can diagnose fatty liver too.  I have fatty liver due to NASH as well, it showed up on the ultrasound and on the CT scan, and they took a biopsy when they were removing my gallbladder.  NASH stands for Non-alcoholic steatohepatitis.  This link might explain it better:  http://www.gastro.com/liverpg/fattyliv.htm

Even if you have the ultrasound and the CT scan, you will probably still need to have a biopsy.  Also, my numbers changed frequently too.  Sometimes they'd be really close to normal, other times they wouldn't.

Good luck.  Hope this helps a little!

[JoshMonster]

I'm not actually too concerned at the momemnt.. My elevations aren't in the thousands like they might be for hepatitis. I was tested and came up positive for anti-smooth muscle antibody (not sure what that does), but not the other anti-something that would indicate auto-immune hepatitis..

my main concern right now is taking a test that comes with risks (1 in 10,000 die from a biopsy, 1 in 5,000 need a transfusion), etc.. I think I'd just like to exahust other options while I'm still young, strong and healthy before we go skewring me. :)

My doc thinks maybe something called NASH.. but not sure.. could be anything really.. but If i go back to normal, I'm not going to worry about it.. It might be related to weight.. in which case I'll certainly always try to remain around the 170 - 180 marker. :)

What about you? what were your results?

[Joe L]

The thing that interests me is that we similar age height and weights.

[Joe L]

Josh Monster - Sorry that I don't have any experience in this area. Not enought to give you suggestions on what you could do.
My note is mainly to ask you a question.

About a year ago I had my blood tested as we all do periodically.
Everything was cool except for one of my Liver functions which was elevated slightly and I can't remember which function it was.

My question to you is, what concerns do you face with these elevated Liver functions? I understand you do not know the
cause for elevation of the levels at this point....but what fears do you have?