Liver Enzyme question

[Revil]

Hi-
A little background first. I am 39 years old, in excellent shape and rarely drink alcohol.
Last June I had  blood drawn for a life insurance policy with the following results:
AST:73
ALT:96

I called my Doctor who had me come in a month later and have blood drawn with the following results:

AST:76
ALT: 116

Let me preface this with the fact that 3 weeks prior to my being blood drawn I was hospitalized 5 days with an appendix abscess which I had drained and was subsequently put on 2 antibiotics for a few weeks.

Here is the timeline:
May31-June 5 hospitalized with appendix abscess
Around June 15th stopped taking both antibiotics
June 21st-Life insurance blood drawn
July 25th-Doctor has blood redrawn with results above
My problem is my Doctor never called me in July to tell me that my results were still askew so I had presumed they were normal. This February(about 7 months later) I called them about it and they told me, much to my shock, that the results in July were abnormal. I went right in that day and had my blood redrawn with the following results:
AST:37
ALT:38

I have 3 questions stemming from this:
1.Is it possible to have Cirrhosis and have your enzymes fluctuate like that or once they went up would they stay up? I have been checked for Hepatitis and it was negative
2.When I had an abdominal CT scan done and they found the abscess on my appendix, if there was cirrhosis would that have been detectable on the CT scan?
3.If I have another liver enzyme test done and it comes back normal, should I continue to be retested every few months because of an abnormality in the past? I realize the only for certain way to confirm cirrhosis is a biopsy, but do you see a reason for one?
       Thank you.

[Revil]

Just got my results back and all my enzymes are still normal. Am I correct to assume that since I have been tested for hepatitis and dont drink, am not overweight and am in good health that the chances of cirrhosis would be quite minimal?

[surgeon]

liver enzymes are not a good way to diagnose cirrhosis. Cirrhosis would possibly have shown on the CT scan; but it's a highly unlikely explanation. What's more likely is a non-specific effect of your recent infection and treatment; I'd agree that nothing ought to be done but repeat the tests after things settle down -- three weeks is very early in the healing process from a ruptured appendix.

[Kevin Pho, MD]

To answer your questions:
1) It is possible for cirrhosis to have fluctuating enzymes.  You may want to consider an ultrasound if this is suspected.  The definitive diagnosis of cirrhosis is done via a biopsy.

2) Typically an ultrasound would be better to define the texture of the liver.

3) If the enzymes are normal, I don't think that a liver biospy would be necessary.  An ultrasound would be the next step.  I would continue to serially check the enzymes every few months to ensure they stay normal.  Also note that transient alcohol use as well as medications can also raise liver enzymes.  

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.
Medical Weblog:
kevinmd_b