Bile Duct obstructed

47 Year old male
Spinal Cord Injury in 1980
Gall Bladder removed in 1986

Recently, developed fever, chills, urine turned amber - then became jaundice.
Bilirubin was elevated - Doctor performed ERCP.

After 1 week repeated blood tests. Listed are out of range results:
Total Bilirubin  - 1.9
Direct Bilirubin - 0.7
AST [SGOT]       - 93
ALT [SGPT]       - 199
ALKALINE PHOSPHATASE - 190

TRIGLYCERIDES    264
CHOLESTEROL      314
HDL              35
CHDL\HDL RATIO   9.0
LDL              226
VLDL             53
LDL\HDL RATIO    6.46

MCHC             28.7
RDW              16.4

Am still slightly jaundice. nauseous, dizzy, weak.
QUESTIONS:
-Are enzymes at normal range considering ERCP performed 1 week earlier?
-Are Cholesterol readings inaccurate[affected] by liver being damaged? (I always had good cholesterol readings (last time 11 months).
-Is ERCP procedure risky (to pancreas or puncturing anything)?

Thank You

[Kevin Pho, MD]

To answer your questions:
1) The liver enzymes are elevated despite a recent ERCP.  Repeating the tests to ensure they aren't rising should be considered.  An ultrasound and/or a liver biopsy can be considered for further evaluation.

2) Although possible, I am not aware of liver disease leading to a significant shift in the cholesterol level - however, I would repeat the tests to ensure this isn't the case.

3) Pancreatitis, infection, perforation and bleeding are all complications of an ERCP.  The complication rate is related to the skill and experience of the endoscopist.

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

[Kalio1]

I'd test for A, B and C if it was me to rule them out in trying to figure out what is going on with your liver.
Hope you start feeling better soon.

[jcupo58]

A,B & C tested. Negative.

[surgeon]

bilirubin of 1.9 is elevated, but not much: it takes a higher number than that (usualy 3 or higher) to actually appear jaundiced. What was it at the start of your illness? Did they do sphincterotomy (enlarging the opening of the bile duct) when they did the ERCP?

ERCP, as any test, is not 100% safe: perforation and pancreatitis can occur, but not very commonly, especially perforation. Without knowing more about your situation, it's very hard to evaluate: the numbers you give, which I infer are after the worst was over, are generally not very high and could be due to any number of things.