Elevated AST/ALT and Lipase/Amyliase

Hello,

  I am a 33 year old man with a history of moderate drinking. I had an attack that went from the upper right part of my abdomen and radiated to my rear shoulder. Afterwards I have not had normal bowel movements and was crampy and gaseous and my stomach was on fire.  I went to the doctor and my blood-work was fine except my lipase was slightly elevated.
   My general thought it to be pancreatitis and put me on a liquid diet for four days and ordered an ultrasound that came back normal. During that time I took it upon myself to go to a specialist because my stomach still felt on fire. The specialist did an endoscopy where I tested negative for everything but had some erosive gastritis where he prescribed reglan, Prefaced, and Creon as a precaution.
      On the next day I received blood work on another follow up from my general. He told my that my Lipase and Amylase were slightly elevated but all of a sudden my liver AST and ALT we 2x the normal upper limit. He said he may have missed something like a stone or other blockage. I have a CT scan appt. on Tuesday to look at everything. From what I have been reading it sounds like blockage in my common bile duct but the ultrasound showed no signs of that. Since then I notice I get nauseous when I eat any fatty food but when I eat high carb low fat food I seem fine. I have no real pain just some mild heartburn and sometimes a dull pain just under my right rib kind of to the side. My stools seem to have normalized but sometimes I get a light brown stool but no diarrhea. I also have no fever or sign of Jaundice.
    At what point do I go to the ER? All of these tests and retests have taken a month and I am concerned that my condition is getting worse based on my lab results. Also is there anything else it could be? Btw... I stopped drinking altogether a month ago. Four blood test have been taken and only this last one showed the elevated liver enzymes.

Please Help

[Kevin Pho, MD]

I agree with the CT scan which can give a better evaluation of the pancreas.  

If there is concern about the biliary tree, an MRCP can be performed.  

Regarding the liver tests, blood tests to exclude viral hepatitis can be considered.  If the ALT/AST reach 3x the upper limit and continues to rise, a liver biopsy can be discussed.

Another consideration would be to perform a HIDA scan with CCK stimulation.  A low gallbladder ejection fraction may be responsible for the symptoms if the workup continues to be non-revealing.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com