Elevated LFTs

HISTORY: 56-year-old female with history of breast cancer, NED x 4 years, with mild constant sense of fullness under right ribs. Nonsmoker. Alcohol use has always been about 1 drink a month. No palmar erythema, no spider nevi, no jaundice. Stools always hemoccult-negative, soft, normal color, but minimal volume. No GU problems. Weight correct for age until chemo/steroids. Diet primarily fish/chicken/vegetarian/no sugars/no processed foods since bc dx. No other chronic health problems of any kind.

1999 - tested for hepatitis because of mildly increased LFTs (negative)

2001 - feeling of choking at night (acid reflux)

2002 - bc dx, chemo, rads, hormonal therapy. LFTs continue up & fluctuating. Upper endo showed sliding hiatal hernia, reflux, no H. pylori, no polyps, no ulcers. Colonoscopy showed no problems. Abd U/S and repeats showed biliary sludge, 2 stable hemangiomas in liver. Acid reflux treated with PPI briefly periodically.

2003 - extensive lab tests -- even tested for Wilson's disease by ophthalmologist. GGT elevated, ALT/AST continue mildly elevated, alk-phos sometimes elevated moderately

2004 - feeling of fullness under right ribs started. ALT/AST continue mildly elevated, alk-phos sometimes elevated moderately. Chest/abd/pelvic CT showed possible renal cyst on the OTHER side, everything else normal. 5 prime nucleotidase normal. Saw gastrodoc; recommended high vegetable/fruit diet I already have been doing all along, and nothing else.

2005 - feeling of fullness under right ribs more constant. ALT/AST continue mildly elevated, alk-phos sometimes elevated moderately.

2006 - mild feeling of fullness under right ribs continues. Hurts to lie on ribs on right side from front to back, with lower ribs more tender.  ALT/AST continue mildly elevated, alk-phos rising but still moderate and continuously elevated. Bone scan clear, CA 27.29 low, CA-125 good. Liver edge and spleen not palpable by doc.

QUESTION: Considering cancer history and all else, what test would be considered next? I wonder if there is blockage of biliary system, possibly by cancer, but don't know what test would cover the most problems? Also, I live in Alaska so am seen in Seattle and have to schedule tests as much as possible in advance of seeing the gastrodoc because I can't afford to stay there very long. Thank you. - AlaskaAngel

[Kevin Pho, MD]

Further testing would be dependent on how elevated the liver enzymes are elevated.  If they are above 3x the upper limit of normal, a liver biopsy can be considered.

The ultrasound and CT scan are pretty comprehensive tests to image the liver and gallbladder.

If there is concern about the biliary ducts, an MRCP or ERCP can be considered for imaging.  

These options can be discussed with your gastroenterologist.

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_

[AlaskaAngel]

PS. WBC is still below normal 4 years out from chemo. - AlaskaAngel

[Kalio1]

Have you ever had a liver biopsy? I'd stay away from alcohol if you drink and be tested for viral hepatitis C ad B which can be easily missed by doctors, be tested specifically for them. dont go by ast/alt

[AlaskaAngel]

Thanks, Kalio - Fortunately I am a cheap drunk -- I never have been able drink more than half a beer or glass of wine without being tipsy, so that helped me avoid alcohol from the beginning. - AlaskaAngel