High AST/ALT

[vallenti]

About 3 months ago I started getting terrible abdominal pain and heartburn. I went to my college clinic and they gave me some meds, which I did not get to use and sent me back to my dorm. When I returned I threw-up a lot of blood. I called the doctor back and she told me to go to the ER. I went to the ER and they told me that I had High ALT/AST levels. They thought I had mono but then said the tests were negative.  They did a CT, Ultrasound of my liver, and sent me home with my dad. The next day I went to see my family doctor, at this point I was in so much pain in the abdominal area, I had not had anything to eat in about 5 days and very littler water. After seeing me the family doctor sent me to the hospital. I was given a morphine pump to control my pain. About 4 days went by with every test the doctor could do all came back negative. The pain lessened and I was able to eat a little, he sent me home saying that I probably had a really bad case of Mono even thought the mono test came back negative.

After being home for a day, not being able to eat or drink water again, I went back to the Hospital and my doctor called a doctor at another hospital and they told him to send me there as well as to do a liver biopsy. I then went to this large teaching hospital and they preformed every test possible, Hep A,B,C, auto immune, Acute Hep all coming back negative. I also did another ultrasound, x-ray, and CT. I stayed in the hospital for 1 week, at one time my AST/ALT were both well over 2,000. My biliruben was 21.  We started having talks with the doctors about transplant options, then my numbers started to go down.  I can now eat and drink and have put back on 20 of the 30 pounds I lost.  It has been about 4 weeks since my stay this hospital, my ALT/AST were steadily dropping until 2 days ago were they seemed to have gone up. My AST was 490 and my ALT was 190. They had gone up about 90 points since by last lab draw, which was 2 weeks before. They requested my second liver biopsy which I completed on Friday.  I am awaiting tests results.    

I am a college student, who rarely drinks,(I have had nothing to drink in the past 3 months.

Should I get a second opinion.  Can you advise me on questions I should be asking?   Thanks

Please help  

[Kevin Pho, MD]

Yes, a second opinion - including one with a liver specialist - is recommended.  

AST/ALT above 2,000 is severely high.  Normally things like hepatitis and acute liver intoxication (i.e. Tylenol overdose) brings it that high.  

The imaging studies, including the CT and ultrasound, are negative.  An MRCP should be done to evaluate for biliary obstruction (evidenced with an elevated bilirubin).  The liver biopsy would also be essential to give a more definitive diagnosis.  

I would consider a referral to a major academic medical center for another opinion.

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_

[vallenti]

With regards to my bilirubin it has pretty much returned to normal, 1.3.

I have been tested for all types of hepatitis, and all were negative. I am currently getting care from liver specialist at a major academic medical center in Michigan.

Would you suggest maybe going to Mayo Clinic? What other hospitals and/or doctors would you recommend?

[Lenore0903]

My daughter 17 has been very sick and was finally diagnosed with Epstein-Barr Virus via Bloodwork after 4 weeks of being ill.
Her ALT is 819 & AST 252 & ALK PHOS 278, Which worries me.

Her ENT did comment they were high, and said just to retest in 6 weeks to see if they return to normal, no Tylenol, Sports. I will follow up with our Family PHD also.

Is this good advice, is there anything else I should do?
Are these levels considered "normal" for an EBV infection?

Thank you

[vallenti]

I would for sure go see a liver specialist.

[agoode]

Brry,
My son seems to have exactly the same symptoms as you.  His problem started by waking up in the middle of the night throwing up.   Did yours resolve itself?  They are holding off on the biopsy to see if his levels go down more.  He also had elevated numbers on his kidney functions. He was transfered to the University of Michigan Hospital yesterday and his levels are slowly going down.

[NZLapisblue]

I had elevated enzymes for 9 years that I know of before last February having a liver ultra sound and discovering that I have cirrhosis of the liver caused from non alcoholic fatty liver disease, my liver is small shrivelled and fibrous and only 20% of my liver is okay, the damage is irriversable. I also have portal hypertension, barretts osephegus and my spleen is enlarged. Since diagnosed  I have lost 19kg in weight, I am 76kg, 55 years old female. My liver tests are now in normal range. What I would like to know is how do I retain that 20%, is it only through diet and exercise? can I do any strenuous exercise with the portal hypertension or would I be putting myself at risk, at the moment I go to the pools 3 times a week and walk for 45 minutes and the days in between I walk for half an hour a day. I get hot flushes, itchy midrift,nausea,  fatigue and have always had insommnia. I go for a 2nd ultra sound next week and am hoping that I have retained the 20% of my liver that is still working. Any advice would be gratefully received. My diet consists of mainly fruit, vegetables, small amount of protein and carbs daily. Cheers, Chris

[vallenti]

agoode,


Berry06161987 was my dad who posted for me. What did they tell you at U of M. That is where I am being treated, they still don't know what is wrong. I started to take a steroid, which has lowered my AST/ALT. But my ALT is still not back to normal. What did they say your son had?