Questions regarding AST tests liver/gallbladder

Hi,
I have a question on which I am hoping to get some input.
I first become aware of the issue when I woke up with moderately bad (say 6/10) dull/deep pain in my right side.  Developed high fever and chills for 2-3 days, mildy dark urine, diarrhea, weakness, lessened appetite.  Was not able to go to doctor right away until main major symptoms had disappeared, though mild pain in the area continued.  Had comp blood panel taken with normal/very mildly elevated liver enzymes (AST around 40- which is something I've heard before).  Abdominal X-ray negative - taken because kidney stones suspected (white blood cells in urine though no stones found-antibiotics given).  Worse after eating fatty/certain foods.  Stressful. Lost weight. (5"10 140-45).  Had ultrasound revealed 4mm polyp in neck of gallbladder.  Wait and see was plan from doctors since polyp less than 10mm.  Continued mild pain, some bloating in right side.  But felt like it was minor problem that was no major issue. (Thought right side pain the new normal.)
Months later developed severe gas and diarrhea for weeks. It did go away.  Had HIDA Scan with CCK (80% explosion rate - so fine and no pain during test) and CT Scan of colon- Crohn's/similar suspected.  CT scan normal.  As pain was mild and not constant, and tests negative, thought everything was ok.  Gained back weight and more.  (though still not obese - 5"10 170. Normal for me is 150-55.)
Months later (a continuing theme, sorry) at routine checkup comp blood panel revealed AST in mid 50s. Follow up test 4 weeks later showed AST again in mid 50s. (no blood tests were done since original problems) Hepatitis and HIV tests negative. Another ultrasound of abdomen - normal.  Gallbladder showed no polyp this time, though gallbladder was said to be "folded."   Mild pain on right side continues.
Right now to have follow up tests to see liver enzyme functions and on road to liver biopsy.  Perhaps as a function of stress, am semi-fatigued and low libido.  I am not alcoholic, though used to drink socially, and stopped completely (along with use of Tylenol) when began to have problems, though when doctor gave approval now again maybe have 3-4 drinks per month and one or two Benadryl when allergies act up. I am white male of mostly ashkenazi jewish background in mid twenties.  Some family history of intestinal problems, no liver problems in family that am aware of.  
Would be interested in hearing any expert advice as to what questions to ask or possible helpful input.  

[lizziecee]

Hi - sorry you are having problems. I am not an expert and I don't know anything about gall bladder problems, but a quite a bit about Crohn's, having had it since I was 24 yrs, now 62.
Crohn's is very prevalent in the Jewish Ashkenazi population - ask any gastro - as every gastro I have seen has always asked me if I have any Jewish blood. Not to my knowledge, but my maternal grandfather may have been. My grandmother was estranged from him in her 40's and we really know little about his background. The synagogue in the town where he lived in Yorkshire, England, was burnt down down during WWII and we can find no records. However, having recently had breast cancer, which is also very prevalent in Ashkenazi Jews, I do believe that genetically I may be part Jewish. Crohn's particularly seems to affect young people in their late teens and early twenties, for some unknown reason, although children as young as 6 yrs are being dx with it where I live in South West England.

I went to a Crohn's Assocn meeting last evening where my gastro spoke to the members on a number of subjects, one being the latest research into mutated genes that have been identified in Crohn's patients. One is NOD2 (CARD15) the first susceptability gene for Crohn's.; another is ATG16L1, and also interleukin-23 (IL-23).  can't remember the others, but he did say that in 5-10 years scientists will be able to test various genes and offer a tailored approach to treatment, as Crohn's is not "one" disease, but multi-factorial. At the moment treatment it is by guess and by God, which he is not happy with. He did say a while ago my problems are "empirical"; had to look that up in a dictionary - which my bright husband said just means there is no precedent for my problems, and they are flying by the seat of their pants.  I am currently on the chemo drug methotrexate, which is keeping the disease, and symptoms in remission.

In my own experience, a CT scan will not diagnose Crohn's - I've never had a CT scan or ultrasound for Crohn's, but have had otherwise for breast cancer and bone density loss caused by years of steroids.  I was treated for some 10 years at one of the best teaching university hospitals in London, and if those tests would have been helpful in a dx I am sure they would have been done.   As far as I am aware, the only conclusive way to dx it is through an endoscopy of the small intestine and/or colonoscopy of the large colon, with biopsies. I was dx via laparotomy in 1970, as endoscopy/colonoscopy was not done then. This would be viewed as barbaric today. A bit like using leeches for bloodletting! Overkill.

My only symptoms were severe weight loss and diarrhea. I had no pain whatsoever for the 9 months whilst I had in and out patient
investigations, so I did not "present" properly. But, no Crohn's patients have exactly the same symptoms. It was only when I got pain,around the terminal ileum which is next to the appendix, in hospital for 3 weeks, that the gastro and surgeon decided to do the laparotomy, that
the dx could be made. They don't need to cut you open these days to diagnose it thankfully.  Your problem could of course, be Ulcerative Colitis (which is only found in the large colon). This is not an auto-immune disease as Crohn's is, but the initial symptoms can be similar. Again - only a biopsy will prove conclusive.  

I saw my gastro privately this morning for a 3 monthly check-up (mandatory when on chemo) and he has prescribed another Calprotectin stool test. It is non-invasive, cheap for the lab to do, and takes about 5 days for the result. My last one was a little high at 200 (whatever that means) so he wants it done this week, before going to a liver biopsy (mtx is highly toxic to the liver, but my lft's are just on normal thankfully). We have discussed liver biopsy on a number of occasions over the past 4 years that I have been seeing him, and after he talked to an hepatologist, said the risks are too high, as my lft levels are fine. If my calprotectin level is elevated from the last test, he is going to review the liver biopsy.

I obviously haven't a clue what your problem is - it could be many different diseases, just thought I would let you have my own observations in the hope they may help. You did ask for any input, and I hope other gastro patients may also respond with their thoughts and experience.

If you are interested in doing some research - just google "Crohn's- Ashkenazi Jews" and you may find something. Googling Crohn's just blows the mind, as there is so much new research/new treatments going on at various levels - leukapharesis, biologic therapies, stem cell transplants and, seriously, eating live pig whipworm eggs." I think I draw the line at that last one!

I do hope you get your problem properly diagnosed. Don't give up -my first husband told me it was "all in my head" and I did have a stressful job at the time with lots of overseas travelling,  but the problem was in my butt!.

good luck,
Liz.