Liver & Gastrointestinal Disorders

    
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Posted by HFHSM.D.-rf on March 21, 1998 at 17:31:17:

In Reply to: Liver & Gastrointestinal Disorders posted by Marlene on March 07, 1998 at 18:15:00:

: Over the last six months I have been discovering that every time I do my
  Specific Gravity test I consistently have a abnormal reading always 1.000.
  Also, when doing an ordinary urinalysis using a reagent strip it shows that
  I have Urobilinogen in increased amounts.  Upon microscopic analysis, after
  centrifuging my urine and properly mounting on a slide, it showed an extreme
  amount of Tyrosine and Leucine Crystals.  Now, after donating blood to the
  Red Cross they sent me a letter stating that although I tested negative for
  any type of Hepatitis, my ALT level was above the cutoff of 120.  My ALT level
  was 144.  So now I am not allowed to donate blood ever again in my life.  I
  have diarrhea every day, not loose bowels, diarrhea.  Abdominal pain.  
  Sometimes severe in the upper right quadrant.  Pain is debilitating when it
  occurs.  Pain medications don't give any relief.  I had a cholecystectomy
  five years ago.  Colitis runs on my mother's side, Hypothyroidism father's.
  I often am nauseated.  Never constipated.  Extreme fatigue has affected
  my life for about six years.  Is this, in your opinion, Liver or
  Gastrointestinal related, or neither?  Thank you very, very much.  
  By the By, I am 27 years old and female.
______________________________________
Dear Marlene,
The concurrent symptoms of diarrhea and abdominal pain always raises the possibility of inflammatory bowel disease.  If there is a family history of colitis (either Crohn's Disease or ulcerative colitis) the need to exclude ulcerative colitis or Crohn's disease is of even greater importance.  Also in your history, you mention that you had a cholecytectomy at a relatively young age.  The reason for this procedure is important information, that will affect the evaluation undertaken by your physician.
The presence of ALT elevations in the absence of hepatitis virus infection raises the possiblity of several diagnostic entities.  Patients with inflammatory bowel disease and elevated transaminases (AKT or AST) can have chronic active hepatitis ( an autoimmune disease of unknown etiology) or steatoheatitis ( a condition in which fat is deposited in the liver). One must also consider other causes of liver disease that are not related to inflammatory bowel disease. Alcohol use can be associated with liver damage.  Viral hepatitis must be excluded.  It is necessary to confirm that both Hepatisis B and C virus were checked.  Hepatitis A  must also be excluded.  This infection is not spread via blood and therefore is not sought by the Red Cross.  In young people it is also necessary to exclude Wilson's Disease, a condition of copper overload.  Additionally, your physician should rule out any hepatotoxic drugs that you might be taking.  Finally, it is important to know that you do not have diabetes mellitus (sugar diabetes) because this condition can cause fatty liver.
I suggest that you be checked by your physician or that you see a gastroenterologist/hepatologist.  You will need additional liver tests, blood tests for autoimmune markers, an a urine test to quanify the amount of copper excreted in 24 hours, an ultrasound of the liver and possibly a liver biopsy.  Yoyu will also need an evaluation for the cause of your diarrhea that may include colonoscopy and small intestine X-ray.
This information is presented for informational purposes only and should not be considered a formal medical evaluation.  Always check with your personal physician when you have a question pertaining to your health.
If you wish to be seen at our institution please call 1-800-653-6568, our Physician Referral Line, and request an appointment with Dr, Fogel, one of our experts in the treatment of intestinal and liver diseases.  We would look forward to meeting you personally and working with you to resolve your medical problems.
Best of Luck.
HFHSM.d.-rf
*keywords: hepatitis, inflammatory bowel disease
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