Elevated ALT/post ultrasound

My husband is 55yrs old, 186lbs, rare social drinker who does not
take any routine meds. Through a blood donation he was informed that his ALT was 253 in Feb.(He donates every 3 months and no previous problem) He saw his MD who repeated the lab and it was
206last week. He had an ultrasound of liver/GB on Monday and it
showed stones with biliary dilitation and blockage. He is referred to a gastroenterologist - earliest appt is in 2 weeks.
I am waiting a call back from MD as I have questions but:
1)does this sound more like a GB or liver issue? (he has no symptoms - no pain, distention, jaundice, no fever) He is a smoker for 40yrs. 2)What other labs should I inquire about - is
there a cancer marker test? You mentioned AMA to a prior question. Is a liver biopsy the next protocol? then what. Thanks.

[Kevin Pho, MD]

It is possible that the stones is raising the liver enzymes.  It would be helpful to know if the other liver enzymes and bilirubin as elevated as well.  If it has been determined that the gallbladder is the cause, a surgery consult should be obtained to see if it needs to be removed.

From the information you provided, I cannot say for sure if this is gallbladder or liver.  

Other labs to consider would be the rest of the liver function tests, including AST, GGT, total and direct bilirubin.  There is a cancer marker test for liver cancer (known as the AFP), but this is not a screening test.  

AMA is a test looking for primary biliary cirrhosis.  This can be considered of all the other tests are negative.  With the ultrasound findings, I would look at resolving that first, and then proceeding to other tests (i.e. a biopsy) if the treatment does not help the test findings.

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.

Thanks,
Kevin, M.D.