Elevated AST, ALT, ferritin, and alkaline phosphatase

Six weeks ago I had my first episode of severe stomach pain (upper center abdomen) with by nausea and vomiting, which lasted 22 hours; I tried heat, ice, Pepto-Bismol, Maalox, Tylenol, peppermint tea and whining; nothing relieved the pain. After two more episodes in the next two weeks, I saw my doctor who suspected an ulcer, prescribed Prilosec, and ordered blood tests.

Helicobacter pylori was negative but platelets were elevated (456) as was fasting glucose (115); the surprise was AST at 384. She sent me for another set of tests two days later: ALT 363; alkaline phosphatase 191; bilirubin normal. A specialist ran yet another set of tests: platelets 438; AST 329; ALT 382; ferritin 387; AMA negative; all hepatitis viruses negative. (AST and ALT were previously tested in June 2008; both were in the low normal range.)

I then had a CT scan and a referral to a gastroenterologist (another blood test: TSH .10 and tissue transglutaminase .21); I'm booked for an MRI in five days. The pain/nausea episodes have lessened but I have no appetite and have lost 10 lbs in 4 weeks.

Physically, I'm a 64, overweight (250 lbs, 5'3"), non-smoking, wine-drinking (now non-drinking) female with degenerative arthritis in my spine and an artificial knee; my cholesterol usually is normal, as is my blood glucose—although both were slightly elevated in this last series of tests. I took prescribed ibuprofen (1200-1600 mg/day) for over 5 years; I'm now taking only Celebrex.

At this point, the specialists have tentatively ruled out ulcers, hepatitis, cirrhosis, GERD, celiac disease, and a host of others they haven't specifically mentioned to me. Apparently the CT scan showed some thickening in the bile duct as well as a small shadow in the pancreas. I'm forming some ideas of my own but before I become alarmed I'd value another opinion.

[Kevin Pho, MD]

I agree with the MRI, as this can evaluate the biliary tree as well as the pancreas.  Any mass or tumor there can lead to blockages, and thus, elevated the liver function tests.

If negative, the next test to consider would be a liver biopsy, especially with values that high.

Another consideration would be the long-term use of both ibuprofen and Celebrex, which have both been associated with drug-induced hepatitis.

These options can be discussed with your GI physician.

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 Pho, M.D.

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