Upper right abdominal pain and high ALG and GGT

Dear Doctor,

I hope that you can help me.  I am a 30 year old man (about 10-20 lbs overweight).  I had an emergency appendectomy last month (the appendix had burst) and I developed septicemia which was treated with augmentin - I was hopsital for almost 2 weeks.  I was in a lot of pain to begin with (which is normal) but it then felt a lot better.

About 10 days after I came home I started to feel extreme pain in the upper right side of my abdomen (it is particualrly bad when I breathe deeply or eat food).  I also have a sharp pain on the right hand side of my body that is very tender to touch (I also sometimes have pain on the left side and in the lower abdomen where the surgery was done) and seem to have a constant elevated temparture though short of being fever.

To complicate things a bit I also have severe psorasis which has been treated (with some breaks in the treatment when it went into remission) for the last 6 years with methotrexate and azathioprine.

Anyway, this pain has been there for the last couple of weeks and does not seem to go and I am getting very worried about it.  I followed up with the surgeon who said that it is probably nothing, though he initially suspected gallstones.  I had an US done which showed everything to be normal -- however, the pain is getting worse not better.  My LFTs for the last three weeks were; GGT 245, ALT 67, ALP 183; GGT, 194, ALT 92, ALP 134; and GGT 112, ALT 49; and ALP 118.  I am worried that the drugs might have caused damage to the liver;

Since discovering these results I have not had any alcohol or eaten fatty food.  Usually I do drink most days (2-3 glasses of wine, no liqor).

I would be very grateful for your opinion on what steps I should take next/whether I should be worried.

Thanks so much.

[Kevin Pho, MD]

With the elevated liver enzymes, I agree with the ultrasound.

It's true that medications can often elevate the enzymes.  If they continue to rise, going over them with a GI physician can be done to see which one is the culprit.  

I would also obtain tests to look for viral hepatitis as well.  

If the tests remain negative, continual monitoring of the enzymes should be considered.  If they continue to rise, a liver biopsy would be a step to consider.

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 Pho, M.D.

KevinMD.com
Twitter.com/kevinmd

[Jameswb]

Thanks very much for your helpful comments, Doctor.  Will follow up with as you suggest.

James