High AST/ALT Levels

[gd2lvwll]

I am a 36-year-old female, 5’8” 145lbs.  I was recently ill with vomiting and diarrhea 1/30/05.  The following day I had a sever pain around my ribs.  The pain was like being squeezed, I couldn’t walk, breath and broke out into a sweat.  I was taken to the hospital.  The pain subsided on it’s own after approx. two agonizing hours.  I was given fluid and told that my liver enzymes where high.  They took more blood to check for hepatitis and asked that I follow up with my Doctor.  To date:  Hepatitis and thyroid have come back negative.  I have also had a normal CT Scan.  Two years ago I had my gallbladder removed, so I know it is not that.  I have not experience sever pain since them but do have a discomfort/pain on my right side – seems to always be there and several times a day goes from discomfort to pain.  I am also fatigue and having difficulty functioning on a normal schedule.  I have had nausea and diarrhea a couple of times since the onset and have lost 10 lbs.  I went to see a Doctor today that told me he believes it is viral and that there is nothing to do but wait.  He said that he wouldn’t consider more test until August.  He did give me medicine for acid reflux and said to give it a try.  This is hard to swallow when I have a job and a family and can’t function and don’t want to live with pain for months. It has only been a little over two weeks; maybe I am being an unrealistic about all of this.   Here are my levels:
First Test – AST=236 ALT=131 (all else is normal)
Second Test AST=73 ALT=225 (again all else is normal)
I do not drink, nor take any medication.

These are my questions:

1. Should I just wait and suffer?
2. Is there cause for concern with these levels?
3. Are there any other possibilities besides viral?
4. Could a 6-month wait be danagerous?

Thanks,
Kim

[Kevin Pho, MD]

To answer your questions:
1) I would consider further testing before resorting to watching and waiting.
2) If the ALT continues to rise, then that is more concerning.
3) Sphincter of Oddi dysfunction, hemochromatosis, hepatitis, a liver mass, autoimmune hepatitis are all possible amongst other diseases.
4) I would consider repeating the liver function tests sooner than 6 months.

Other tests to consider would be an ultrasound (which can pick up some things a CT can't), ERCP or MRCP, or a liver biopsy.

These options can 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.
Medical Weblog:
kevinmd_b

[LvdByGod!]

i have liver disease and i surely would be very concerned about those alt/ast levels and the pain etc...there are many other liver problems that could be possible...NASH is also a possibility and like the dr said there are others...

if you can't get anywhere with your dr i would immediatly get another that will get to the bottom of it...asap!!!

asceties is a possibility from severe liver damage...that could also explain your pain...i pray you find a good dr.

[HubatHome]

Hi, I normally dont post here but your story is so similar to mine its unreal ..I had the exact same thing happen to me last year - all of it - but I also experienced tetany in my arms and legs too.  I have had chronic right side pain as well and my liver enzymes tend to go up in down depending on illness, surgery and menstrual cycle.  Finally after being told Im crazy and after every cat scan and mri and endoscopic procedure and 2 surgeries for adhesions and a gall bladder removal with no relief, 2 different drs suggested porphyria...seemed like a stretch until i looked at my medical history and now im waiting for test results.  Oh, i was also tested for all types of hepatitis and had 2 endoscopic ultrasounds.  Good luck but you might want to take a look at porphyria its rare but not uncommon.  Good Luck.

Lisa