Slight, chronic liver enzyme elevation

[LufkinDeb]

I am a 47 year old caucasian female, recovering alcoholic (sober since Oct. 2003.  In about November 2004, I had about 10 days of severe diarrhea following a trip to Europe.  I thought nothing of it until the following months when the blood work from my routine physical came back with my ALT at around 60.  ASt and GGT may also have been slightly high but I don't have those values.  The doctor wnated to repeat the tests in 3 months.  Long story short, the tests were repeated in May 2005 and were about the same.  I was referred to a gastroenterologist who ran many more tests.  A CT showed no enlargement of the liver or tumors.  I don't have all the results of the tests but do know that the ANA titer came back elevated.  HBV, HCV were negative. The GI doc told me that I could go ahead and have a liver biopsy or wait and have the enzymes repeated.  I waited.  In Sept. 2005, everything came back in range.  In Jan. 2006, I had a routine blood panel done as part of a health program at my employer because I was feeling extremely fatigued for a few weeks no matter how much sleep I got.  The blood results included:  ALT 51, Globulin 2.1, GGT 53, WBC 3.99, monocytes 15.0, and basophils 1.3.  Everything else was within normal range.  My TSH (I had thought maybe it was my thyroid) was 2.34 and HgB was 14.2.  I should also mention that I go for 3-4 months without a peiod (perimenopausal I assumed)and I have terrible itching on my legs that when I scratch results in small welts.  They go away fairly quickly though.   Should I now have the liver biopsy?  Does autoimmune hepatitis sound plausible?  The fatigue is my boggest issue as it is hard to get teh energy to do anything.  I have a lot of stress in the past 2 months (17 year old son had acute post streptococcal glomerularnephritis and had to do a drug/alcohol intervention on my 21 year old daughter).

[Kevin Pho, MD]

I can't make any personal recommendations without examination.

That being said, you have had a pretty good initial evaluation - which included imaging as well as blood tests for ANA and hepatitis.  A negative ANA titer would make autoimmune hepatitis less likely.  

The liver biopsy would give a more definitive diagnosis.  Most physicians would hold off on this test until the ALT rises to about 3 times the upper limit of normal.  An ALT of 51 is a bit low to consider a biopsy.  

However, I would discuss this option with your personal GI physician - or consider a second opinion.  

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.
kevinmd_b

[B_Johnson]

Well the fatigue is understandable rasing two teenagers.  Diet and exercise (even small amounts) can help increase your energy during the day.

I would not worry too much about the small increase in your ALT.  This could represent old resolving alcoholic hepatitis from your drinking history.  There are also a lot of medications (including alot of antibiotics) that can falsely increase ALT.  There are also some meds that have mildly hepatotoxic metabolites that can increase LFTs, Tylenol being a common one. Realize that ALT in severe liver disease can be as high as 50X normal.

All of your other labs look normal.  Your age suggests that you might be going thru perimenopause, and therefore it is common to have irregular periods until eventually they stop.  I wouldnt worry too much about this either.

[stac2424]

A related discussion, A LOT OF STOMACH BLOAT was started.