Very high ALP,ALT,AST after gallbladder removal and duct stone removal

My wife had her gallbladder removed 9 days ago for stones. She did not recover from her pain and 4 days ago had the endoscopic procedure to remove a loose stone in her bile duct. After that we thought she was improving but went down hill again 2 days ago. Her pain is gone but now she is exhausted and nausous and wont eat. After the procedures her Billirubin and Amalayse levels are declining as expected but her AST has climbed to 565, up from 119 the day of endoscopic, and ALT has risen to 786 from 286 since the endoscopic. Bilirubin total is 3.4, down from 4.9. Amalayse is down to 85 from 506. (all these are 4 days apart) The Dr. suspects these numbers will trend down in time and are a result of the procedures. We live in a small town and I am wondering if we should go to a more specialized facility, or is waiting to see if these trend down going to damage anything that would be preventable with different care. Any input would be helpful. All my wife wants to do is sleep and occasionally throw up. Dan.

[Kevin Pho, MD]

It is likely an ERCP was performed to remove the stone from the bile duct.  An elevation of amylase is common after this procedure, occuring in about 70 percent of patients.  There is also the possibility of elevated liver enzymes due to the procedure as well.  The fact that it has decreased is reassuring.  

I would continue to recheck these enzymes serially to ensure the continue to fall.  If they start to rise again, despite a longer period of time post-procedure, you may then want to consider further testing and a referral to a more specialized facility.

Followup with your personal physician is essential.

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.

Thanks,
Kevin, M.D.

[krisg]

I takes a while to recover from post-procedure pancreatitis.  I, myself, took about 4 weeks before I started to feel half normal again.  I had pain on and off the whole time.  Again, as the doc has mentioned...if her symptoms seem to worsen, then its time to reevaluate her condition.  Try to see if she can get pain medication to take until she improves.  ERCP's can have lingering effects for weeks.  Hope your wife feels better soon
Kris

[dans]

Thanks for your input. It appears my wife has started the road to recovery as of yesterday. She is still in bed but is now not as nausious and is showing interest in food again. It is nice to hear from others that have gone through this and is reassuring that the recovery time frame can be longer than we were expecting. Thanks. Dans