Liver Problems

[WorriedSick1981]

I recently went for bloodwork because I was concerened over a yellow tint that I had in my eyes.  I have been diagnosed with crohn's disease and gilbert's disease.  I have had Gilbert's for over 2 years and levels hovered at around 3.  This time though levels were close to 4.  However my direct Bilrubin was only .18 which is in the middle of the norm.  Typical of Gilbert's.  My AST was 22 which is in the Norm.  Alb was normal as was Alk Phos and Protein levels.  My pr time was 15 which is borderline elevated and my AST was at 90!!!!  I am currently taking medication for crohn's disease which include remicade, 6mp, and Asacol.  I also take Metamucil to increase my daily Fiber.  This is the first abnormal liver test that I have had since starting this medication.  I have been feeling run down lately and am wondering if some sort of flu or cold can raise my ALT slightly.  Normally I am in the 50's.  My doctor ordered test for Hep A,B, and C.  He also orderd a metabolite test to see how I am handling the 6mp.  The doctor just thinks it was just a bad reading and the level should go down by my next blood test, considering how my previous tests have been.  If everything else is negative he wants to just wait it out and retest in 1 month.  Does this sound suffecient?  i am worried sick because evrything you look at on the internet for increased enzymes has SEVERE causes.  Also since I have crohn's I would not be able to take an ANA test because I already have this antibody in my system.  Is this correct?

[Kevin Pho, MD]

The can be many reasons for the elevated liver enzymes.  This can include the medications you are already taking, as well as any alcohol use.  

Ordering the hepatitis screen is a reasonable thing to do.  I would also consider a liver ultrasound to evaluate the gallbladder as well as bile ducts.  The ultrasound can also evaluate for any antomical abnormality.  

Repeating the liver function test to see if the reading trends down is a good idea.  

With Crohn's disease, there is a possibility that the ANA test would be elevated.  

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.
http://www.straightfromthedoc.com

[kimbacat]

Hi,

it sounds like your doc is taking all the correct steps.  he's ruling out hepatitis, checking your drug metabolite levels from 6mp and doing the realistic wait, retest and make sure it wasn't just a "blip on the radar screen".

he's also correct in that ANA results in Crohn's patients aren't really very diagnostic since the Crohn's (and Remicade) itself can cause elevated ANA results.  

both the 6mp and Remicade can cause elevations in ALT and AST values.  if your results continue to be elevated and your doc thinks it is the 6mp, he might try adjusting your dose down a bit to see if that corrects the problem.  this is the MOST likely reason for elevated ALT and/or AST results in your situation.  that's why he is checking your metabolite levels and hepatotoxicity levels.  If he thinks it is due to Remicade, he might take a 'watch and wait' approach like I've done.  

after about 6-9 months or so of stable, mildly elevated results (ALT always under 100), I had a liver biopsy which ruled out all the nasty things it could be and left me with no explanation for the problem.  So, for over 3 yrs now, we (hepatologist, gi and I) have been monitoring my LFTs every 2 months and just "watching and waiting" for any spike in my results (which hasn't occurred).  since I'm also on methotrexate, I get periodic liver biopsies just to be sure.  I've been getting Remicade for over 5 years now and I get it every 4 weeks.

so, I really would try not to worry.  

take care