Hi, about 6-7 years ago I started having dull achey right upper abd pain and thought my eyes looked a bit yellow, I went to the doctor and my liver function tests were on the high end of normal and my bilirubin was normal, I was also tested more than once for Hep A,B, and C which were all negative and Hep B showed status of immunity from childhood vaccines. I also had a HIDA gallbladder scan which was normal. None of the doctors wanted to follow the issue because everything was normal so I too forgot about it too for a while.
About 4 months ago the pain has returned - a dull achey right upper and pain, additionally I've had a sharp pain in my right shoulder and I've felt very fatigued. In addition I've noticed that the veins in my abdomen have become more apparent (not necessarily bulging, just visible) and the same thing on my chest. (there is no chance of pregnancy by the way). I'm worried that there was something wrong with my liver that wasn't caught, and the symptoms I have now are possible signs of cirrhosis. What else could cause hepatitis/cirrhosis besides hepatitis A, B,C? Do I have signs of cirrhosis.
Your concerns are well placed since you have a dull ache in upper right abdomen that is referred to your shoulder. I’ll go over the various causes of raised liver function tests with you.
Many a times AST (SGOT) and ALT OR SGPT (both are collectively called transaminases) rise without any cause. Because AST is found in many other organs besides the liver, including the kidneys, the muscles, and the heart, having a high level of AST does not always (but often does) indicate that there is a liver problem. For example, even vigorous exercise may elevate AST levels in the body. However to reach at that conclusion the medical causes of these raised transaminases have to be ruled out. Causes of liver transaminase elevations include viral hepatitis, alcohol use, medication use, steatosis or steatohepatitis, and cirrhosis. Steatosis and cirrhosis are ruled out by the ultrasound. Other common health conditions, such as diabetes, heart disease, pancreatitis, hemolytic anemia and thyroid disease, can also cause liver transaminase elevations. Most liver diseases are characterized by greater ALT elevations than AST elevations except cirrhosis and alcohol abuse. ALT also rises in bile duct obstruction due to stone or tumor. In all liver related cases AST and ALT are pretty high, often double or more than double the normal value.
Raised alkaline phosphatase (The normal range is 44 to 147 IU/L (international units per liter).is often found in a growing child and at puberty. There are several bone disorders too that can raise this enzyme like rickets, osteomalacia, Paget’s disease of the bone, tumors, metastasis and recent fracture. An elevation in AP is often seen in cholestatic liver disease, pregnancy, bone disease, and occasionally with inflammatory bowel disease. In an otherwise healthy individual a raised AP could be due to false positive test and the test should be repeated. If it is still high then other mentioned causes should be ruled out.
High concentrations of GGT are found in the liver, bile ducts, and the kidney. Hence kidney and urinary problems could be causing the high GGT level. Greater-than-normal levels of GGT may indicate: congestive heart failure, cholestasis (congestion of the bile ducts), cirrhosis, hepatitis, liver ischemia (blood flow deficiency), liver necrosis, liver tumor, high alcohol intake, use of hepatotoxic drugs (drugs toxic to liver).
Also, a right upper abdomen pain that is referred to the shoulder can be due to liver and gall bladder problems, heavy meals or acidity that cause distension of the duodenum or any cause for distension of the small intestine.
The symptoms could be signs of mild cirrhosis or stricture or stone in common bile duct or liver fibrosis. It could also be fatty liver. In your case alcohol and drug related causes are ruled out.
The work up for diagnosis should include recent levels of SGOT, SGPT, alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT, GGTP), prothrombin time (PT) and international normalized ratio (INR), ESR, hemogram, and pancreatic enzymes. Magnetic resonance cholangiopancreatography (MRCP) or abdominal computed tomography (CT) or endoscopic retrograde cholangiopancreatography (ERCP) may be needed for definitive diagnosis. Please consult your doctor regarding this. Take care!
I sincerely hope you will find this information useful in your journey towards better health.
I went and got labwork drawn which was as follows:
CBC with differential was completely normal.
Comprehensive metabolic panel was all normal except:
Low AST of 8 (reference range of 10-30)
High Protein of 8.2 (reference range 6.1-8.1)
High Albumin of 5.4 (reference range of 3.6-5.1)
My ALT, globulin, albumin/globulin ratio, bilirubin total and direct, and alk phos were all normal. So were all the kidney function tests, as well as TSH.
Also RA factor and ANA were negative.
And C-reactive protein was not elevated.
Does this rule out/make hepatitis or cirrhosis less likely? Should I still follow up with a physician to get a CT or Ultrasound or other tests to completely rule out liver disease?
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