Elevated Liver Enzymes and concerned, again.

[Rubble]

I am late 30's male who is slightly overweight (5 feet 8 inches and 190lbs). I have a history of concerns about my liver after being diagnosed via ultrasound with fatty liver 2.5 yrs ago (although subsequent CT scan saw no fatty liver and ultrasound 3 months later also saw no fatty liver.  I had elevated ALT levels (as high as 73) over 3 months in 2006 while taking antibiotics for lyme treatment, but all other liver enzymes were within normal range. I have been an excessive drinker (socially) my adult life which leads to my concerns, although recently I have cut back and only drink on the weekends (12-15 beers per weekend). I take milk thistle daily since 2.5 years ago "fatty" ultrasound.

Recently I have had intermittent upper right quadrant pain for a few months and recently after some extended alcohol intake the pain was worse, so I had ultrasound and blood work.  Ultrasound revealed possible gallbladder polyp or non-shadowing stone measuring 6mm (liver was of normal hepatic echogenicity and all other organs normal). Blood work revealed ALT 59 (Quest says not high as has to be above 60) while AST 32, Bilirubin .9, Albumin 5.1, Alk Phosph 86, Protein 8.2, Lipase Serum 9 (all within "normal" Quest Diagnostics range).

My Questions:
1. do i have gallstone?
2. can a gallstone cause elevated ALT even if all other liver enzymes are normal?
3. would you consider 59 an elevated ALT level and could this be caused by heavy night out 1 week prior?
4. if my ALT has always been above my AST (and now almost 2x above), is this an indication that I might not have liver damage from alcohol (I have read that AST>ALT and most likely 2x is the common sign for alcohol liver disease)?
5. what other test can be done to determine gallstone (CT scan, etc?) and are they more reliable than ultrasound?
6. would long-term antibiotics use cause elevated ALT specifically?
7. why do some blood work labs have different "normal ranges" for ALT, AST, etc?

thanks in advance.    

[Kevin Pho, MD]

To answer your questions:

1) A gallstone would have been picked up on the ultrasound or CT scan.  A negative test would make a gallstone less likely.

2) Yes, a gallstone can raise the ALT level.

3) Yes, an ALT of 59 is elevated and can be caused by alcohol.  Repeating the test to see if it normalizes is recommended.

4) Typically, the AST is greater than the ALT in alcohol.  But this is not always the case.

5) Normally the CT scan and/or ultrasound is good enough.  You can also consider a HIDA scan or an MRCP to evaluate for stones in the biliary tree.

6) Most antibiotics can raise the liver function tests.  I would discuss these with your personal physician.

7) Labs use different standards and may have mildly varying reference ranges.

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.
www.kevinmd.com

[Rubble]

I want to also add that I did have normal Liver Function Tests in July 2006 (ALT 32, AST 24) and also again in April 2007 (ALT 28, AST 23).  Thanks and I await your response.