really high ALT/AST liver test question

I had a routine ultrasound done at the request of my doctor who said I might have gallstones due to a couple incidents of "food poisoning"  and bad stomach aches over 5 years ago at 6 mos pregnant.  
A week later I ate abnormally bad for me, pizza and red meat, coffee etc.  
At 6pm my stomach started hurting.  It got worse, I was vomiting which seemed to relieve the pain.
I was writhing in pain(middle/upper stomach, dull unending pain, not to the right but centered) and no position relieved it at all.  I felt as though i might pass out during vomiting.  I fell asleep at 1am when the pain seemed to subside finally from crouching on the floor in a hunched over position.  I woke up feeling a little better at 4am and got in bed.  At 6am the pain came back worse and more pinpointed just below my sternum (not to the right). Vomiting again....At 9am called the doc who was not in but saw another one who could take me at 10am.
Laid on my stomach and at 9:45am the pain just stopped. I went in to see the doc and he said ulcer.  Later that day I noticed my urine was abnormally orange..
The next day at 9am I went in for the scheduled routine blood/urine test.  My urine was  still dark orange.  
The week after I went in for the results of the ultrasound and blood.  Doctor was just looking at the reports and said
"You have hepatitis!"  ALT = 1274, AST=492, bilirubin=3.2
My white blood cell count and cholesterol =normal. Alkaline phoshatase=114
I said look at the US... I think I had a gallstone attack.
"multiple gallstones, one as big as 2.6 cm. There is no gallbladder wall thickening or fluid. The CBD is dilated at 6mm. The possibility that there may be a distal CBD calculus in not excluded."
I got more blood tests(for hep etc)  that day and wont know results until tues.  My friend thought i looked jaundiced.   I feel fine now and felt fine before this.  My urine returned to normal after 1 day.  
Is it possible I passed a gallstone that had been stuck? Or pancreatitis?

[Kevin Pho, MD]

Those liver enzyme numbers are certainly high enough to consider hepatitis.  I agree with the blood tests that were done to exclude viral hepatitis.  If negative, and the cause remains unclear, I would then consider a liver biopsy to determine a more definitive cause of the rising liver enzymes.

If negative, you can consider gallstones or a blockage of the biliary duct.  I agree with the ultrasound, but an ERCP or MRCP would be a more comprehensive test to evaluate for the latter possibility.

Pancreatitis can be evaluated by measuring the pancreatic enzymes, like the amylase and lipase levels.   Inflammation of the pancreas can be caused by a blockage in the biliary duct.

These options can be discussed with your personal GI physician.

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.

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Twitter.com/kevinmd