Liver Function Tests

  On Feb 20th I went to the doctor with a bad case of Bronchitis.  
  He ran blood tests and they came back with my liver functions
  elevated. Then on the 23rd, he ran more tests, some were higher
  and some lower. He ordered a liver biopsy,ultra sound and cat
  scan which all came back normal. The liver biopsy showed there
  was a minimal focal lymphocytic inflammation of some of the
  portal triads without associated piecemeal necrosis. Liposuscin
  pigment was detected. Everything else was normal. Then on 28 May
  I went to a doctor about foot surgery. He ordered blood tests
  before the scheduled surgery and they came back with my liver
  functions elevated and I had to cancel my surgery and return to
  my family doctor. Here are the results of my tests.
  LDH-- 2/20- 373   2/23- 171  5/28- 645
  SGOT-  "    107     "   62     "    79
  SGPT-  "    131     "   168    "   127
  GGT    "    142     "   198
  Chol.  "    245     "   271    "    245
  Alkaline    131     "   165    "    162
  Phosphatase
  Glucose "   152     "   100    "     74
  Blood count--   28 May- MCV 108
                          MCM  35
                          RBC 3.87
  My doctor sent me to a gastroenterologists and he said that we
  should just wait for a year until it manifested itself. I did
  that 7 years ago and after suffering with extreme pain in my
  breasts for 2 years I had to have a mastectomy. I had Fibrocystic
  breasts disease and surgery was my only cure. I don't feel I should
  have to wait for something to happen that could be good or bad.
  My symptoms are weight gain, about 25 lbs in 6mos, swollen lower
  stomach(about the size of a 9 month pregnant woman). I'm tired
  all the time and am up and down all night. I am up and down all
  night with cramps in my legs and they ache alot. Any help you could
  give me on this would be much appreciated. Thank you, Judith
_____________
Dear Judith,
Your letter raises an interesting issue.  Can the liver biopsy miss an abnormality.  Your liver tests indicate that there isa evidence for liver cell leakage or destruction.  You write that you have gained weight and have a swollen stomach.  If there is free fluid in your abdomen, then you have ascites, a condition that is often associated with liver scarring. This would be surprising to me because you re[port that the abdominal ultrasound and cat scan were normal, an apparent contradiction if you have ascites.
You do not report whether you hade blood and urine tests to identify possible causes for your increased liver tests e.g. Hepatitis B and C markers, autoimmune antibodies etc.
Usually, the liver biopsy is considered the definitive test to diagnose liver disease.  For most liver diseases, there is uniform involvement of the liver so that the piece of tissue that is examined is representative of the pathology elesewhere in the liver.  There are however, instances in which there is sampling error i.e. the liver biopsy does not indicate the severity of damage.  Sampling error is most common when the liver biopsy is very small, although even adequate size biopsies can soetimes miss the pathology.  The other option to consider is that the biopsy may have been misinterpreted.
If you are concerned regarding your health, I suggest that you take all the data including the liver biopsy slides and arrange a second opinion consultation with a hepatologist.  If the second consultant agrees with the first, you will at least have peace of mind that serious conditions are not being missed.
This information is presented for educationalpurposes only.  Always consult your personal physician for specific medical questions.
HFHSM.D.-rf
*keywords: hepatitis, cirrhosis, liver biopsy
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