Re: elevated liver enzymes

Posted By HFHSM.d.-rf on June 09, 1998 at 05:53:56:

In Reply to: elevated liver enzymes posted by mike  on June 06, 1998 at 21:19:20:






28-m presents with elevated liver enzymes which include:
ast, alt, and ggt.  Pt denies excessive alcohol intake (<3/month)
and is unaware of any toxic exposure.  No familial liver dz noted.
no palpable tenderness or enlargement is noted. Bilirubin levels
are normal.  No other s/s noted.
lab results are as follows:
enzyme    lab range   3/3/98    3/10/98     3/31/98     5/7/98
ast        12-29       31          33         39           39
alt        9-41        n/a         78         78           107
ggt        11-55       n/a         59         84            104
Appreciate some advice on how to procede with the management
of this case.
____
Dear Mike,
The liver test elevations remain relatively mild.  I would continue to monitor the transamianses monthly.  As initial investigation, I would check viral hepatitis markers ( A, B and C), serum ceruloplasmin, possibly 24 hour urine copper, and liver ultrasound.  If liver tests remain elevated and the initial tests are normal, I would order serum Fe and TIBC, and autoimmune markers ( ANA, antismooth muscle antibdoy etc).  If the liver tests remain elevated after six months and the patient is not suspected to have hepatic steatosis or steatonecrosis, I would do a liver biopsy.
This information is provided for educational purposes only.  Always consult your physician for specific medical questions.
HFHSM.D.-rf
*keywords: hepatitis, automimmune liver disease, viral hepatitis
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