Elevated Enzymes w/ Normal Ultrasound and Hep panel

[lisaz]

I am 37 year old female, in good health.  In Jan of 2005, after routine bloodwork, the Dr. found elevated GGT at 97.  All other enzymes were normal.  He recommeded retesting in 6 months. In Jan of 2006, the GGT was 145, all other enzymes were normal. The dr. recommended that I abstain from alcohol for a month and return for testing.  I abstained from all alcohol and returned in Feb of 2006.  Testing results revealed GGT at 143, and AST at 46, and ALT of 69.  I had surgery to remove a ovarian cyst in Jan 2006, (during the time I was abstaining from alcohol) and was given Vicodin as well as general anesthesia.  After the Feb 2006, elevations, the Dr. did a hepatitis panel which all were negative. He referred me for an Ultrasound, which also came back completely normal.  He now wants to monitor the enzymes for 3 months, and after that time if they are still elevated, he will refer me to a specialist for a possible liver biopsy. He does not feel it is alcohol related given the fact that the GGT did not go down. I am particularly concerned about the ALT/AST sudden rise.

My questions:

1)Is this approach safe, i.e, to wait 3 months before seeing a specialist?

2) Could the medications I was given for surgery and pain meds have caused the recent AST/ALT elevations?

3) What does the US reveal, i.e, can it tell if I have liver damage, cirhosis?

4) During the month of abstention from alcohol, I was taking Milk Thistle, Dandelion Root, and Borage Oil. Also added at Dr.
request a high potency vitamin during this time.  Could any of these have caused elevations in the AST/ALT.

[Kevin Pho, MD]

To answer your questions:
1) A reasonable initial workup has been done.  Rechecking the enzymes or seeing a specialist sooner each are reasonable approaches.

2) It is possible that medications may be responsible for raising the liver enzymes.  However, the enzymes should decrease once the medications are stopped.

3) The ultrasound will look for fatty liver, masses, and other structural abnormalities.  It can also suggest cirrhosis.

4) Yes, herbal medications certainly has the potential to raise the liver enzymes.

These questions should be discussed with your personal physician.

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.

Kevin, M.D.
kevinmd_b

[Kalio1]

Have you been tested for Hep C? I'd get tested and rule out any hepatitis. It is a simple blood test. I had back surgery and they repaired my back, but I got Hep C. I know they say it can't happen, but it happened to me. Previous to the surgery, I did not have it, a month later I did. You do the math.
I have no other risk factors other than my surgeries.
Meds and supplements can also raise enzymes, I'd stop them and retest in 6 weeks. You are right to be concerned.
The extensive waiting is "normal" I have found when dealing with liver probems, 3 months is pretty standard to wait to see a Heptologist but be proactive and keep pushing to get the care you deserve. Since your enzymes are probably considered "slighty" elevated, they act like it is no big deal. It is to YOU and it is worth following up on, they are about double normal, your numbers are similar to what mine were. I said to the doc" wow, they are twice norma" and his response was "they are a little elevated, I have seen them in the high 100's" like that made me feel better!
Good luck, stay strong, keep searching unti you find the answer.