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Systemic Lupus and Liver Disorder
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Systemic Lupus and Liver Disorder

  Dear Dr.
  I am a 49 yr. old female with SLE diagnosed in 1995.  I have CNS, heart, lung, kidney and pancreas involvement.  I have cerebral vasculitis as well as peripheral vasculitis, high blood pressure, diabetes (untreated).  I am a smoker but never consume alcohol. A previous ct scan indicated a fatty liver and several small hepatic cysts.  I also have a peripelvic cyst in the left kidney that the result of a recent ultrasound indicated it was somewhat larger than a previous test in Oct. 98.  I am on the following meds at this time:  17mg Triamcinolone, 30 mg Prevacid,200 mg Colace, 2 tsp. Carafate, 75 mg. Plavix and 3000 mg Tylenol and Atacand for high blood pressure.  I was taken off 250 mg of Serzone just a few days ago.  About three months ago, I noticed my urine becoming a very bright yellow.  I slowly developed swelling in my abdomen, legs, ankles and hands.  I have nausea mostly at night and my right upper quandrant was tender when being examined.  I have become extremely fatigued and I am sleeping 18-20 hours a day and feeling unrested.  Over the past several months, I noticed an area just below my adam's apple that appeared to be swollen.  The swelling seems to be going up the side of my neck now. I wake up itching at night.  The doctor order some blood work and the results are as follows: SED RATE: 40, TSH, T3 and T4 are normal; ALT 53, ALK PHOS 135 AST 23 GGT 687.  My previous GGT's for the period of 3/96-3/99 are 214,119,97,304,249,675 and 687. HELP! What's going on?
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Dear Joan.
There are mulyiple medical issues that could be affecting your liver tests.  Fatty liver could produce the elevations that you describe.  Alterations in your metabolism due to either the corticosteroids or the diabetes ( which itself may result from the steroids) could cause fatty liver.  
The symptoms that you describe (swelling, fatigue) may be the result of liver injury (drug-related, secondary to your autoimmune disease) or could be a sequela of your SLE.  A detailed history and physicial examination with review of your records is necessary to evaluate the different possibilities.
This information is presented for educational purposes.  ASk specific questions to your personal physician.
We would be happy to see you in the Division of Gastroenterology of Henry Ford Health System in Dwetroit.  You can arrange an appointment with Dr. Fogel, one of our experts in gastrointestinal amd liver disease, by calling our Physician Referral Line at (800)653-6568.
*keywords: lupus, fatty liver

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