Liver Enzymes/biopsy

  49 year old female went for routine check up and stated during medical history questioning that family had history of colon cancer.  Since she had not had sigmoidoscopy, GP advised her to see gastroenterologist for check up.  
  Blood workups  in March 98 revealed elevated levels of copper and GGT of 118. Tests for hepatitis A,B,C were negative.   Ultrasound was performed and suggested fatty liver deposits.   Follow up testing in August 98 again were negative for Hepatitis A,B & C however GGT was now 184.  Liver biopsy is scheduled for Sept 10.  
  Patient history: No alcohol use, no tobacco use, not obese, no blood transfusions, not diabetic, cholesterol/triglycerides with in normal limits, no meds other than Premarin. only complaint is fatigue.
  Any suggestions?  
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Dear Joe,
I assume that the transaminase levels were normal on the previous testings.  The elvated copper levels always makes one consider Wilson's disease although the absence of neurologic signs would make the diagnosis unlikely.  Elevated copper can be seen in patients with cholestasis.  Bile duct problems must be considered.  The normal ultrasound would argue against gall stones or tumors blocking the bile duct.  A condition such as primary biliary cirrhosis must be ruled out in view of the age and gender.
I would consider obtaining an antimitochondrial antibody as a blood test prior to the liver biopsy, which I believe is necessary.  IF the liver biopsy suggests a problem with the extrahepatic biliary tree, then an ERCP would be needed.
This information is presented for educational purposes only.  Always consult your personal physician for specific medical issues.
HFHSM.D.-rf
*keywords: liver tests, liver biopsy, primary biliary cirrhosis
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