RUQ Discomfort - High ALT

[astral]

I have had vague right upper quadrate discomfort for 6 to 8 months. The discomfort started out barely noticeable and then became more pronounced as time went on. Its is less noticeable in the morning and absent during exercise and moderate physical activity. The discomfort (not really a pain) radiates to my back sometimes - it feels like a pressure on my rib cage and back. I've noticed no connection to eating or bowel movements. I'm a 30 year old male with no other problems except borderline blood pressure.

I have been a moderate drinker for about 8 years - consistently drinking 18-24 beers per week, sometimes more, always on an empty stomach. I started to become concerned with the RUQ discomfort in Oct 03 and switched from regular drinking to social drinking. I drank during the holidays and at parties through new years day 04. A few days after new years I received blood work results from my doctor - ALT 86, AST normal, low good cholesterol and high bad cholesterol. A week later I had and ultrasound - the results were normal - gallbladder fine (I asked my doctor if they could have missed a fatty liver and he said only if it was a mild one). My doctor recommends a CT scan next.

My main concern is that the discomfort has not gotten any better since I had my last drink 17 days ago. Most of the info on the net indicates symptoms will clear up within days of the cessation of drinking. Intuitively that seems wrong, I would think the liver would take a longer time to gradually return to normal but I can not find any info to back that up. Also, for the last week I have been exercising daily - would this cause more strain on the liver?

Another concern I have is that I seems unlikely to me that a mild fatty liver - one that could not be detected on an ultrasound - could cause an enlarged liver.

Of course I'm convinced its secondary liver cancer - actually I know is probably not but I'm still frightened.

Any info would be appreciated!

[Kevin Pho, MD]

If the ultrasound is normal, it is unlikely that liver cancer is present.  A CT scan would also help elucidate whether a liver mass or cancer is present.  

Typically, with alcohol the AST is elevated over the ALT.  It is reversed in your case.  However, it is not out of the realm of possibility that alcohol itself is causing your discomfort as well as the elevation of the ALT.  I would agree with the suggestion of abstaining from alcohol and rechecking the liver function tests.  

It is unlikely that exercising is increasing the "stress" on the liver.

I agree with the CT scan being the next step.  I would also suggest obtaining hepatitis panels.  If those are negative, an upper GI series or upper endoscopy can be considered to evaluate for inflammation of the upper bowel tract or ulcers.  A HIDA scan with CCK stimulation can also be considered to evaluate the gall bladder function.

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.

Thanks,
Kevin, M.D.

[Caroline5]

You are drinking way too much. With RUQ pain and an elevated ALT, you should definitely be checked for hepatitis C. If it were just the alcohol you should have elevations in your AST also.

[astral]

Thank you for the information.

I agree that I drank too much. I consider myself an alcoholic. Hopefully with the help of my friends and family I will never drink again.

I have not engaged in any of the activities that could lead to hepatitis c infection - I would get the test to be certain but I don't think it should be a consideration..

I am also concerned with right side heart failure. I do not have fluid buildup in my legs or feet - I am trying to figure out if fluid buildup can begin in the liver before it starts in other parts of the body.

[Caroline5]

I don't know about right side heart problems. But fluid buildup does not begin in the liver. It can begin in the abdomen in liver disease and make you look pregnant. It comes in late stage liver disease. About the risk factors, approximately 20% of hep C patients have no known risk factors. Of course there are other liver diseases that can cause these elevations. You should get the test just to be sure.

[ycxox]

I recieved my lab result and on the AST its 38 and ALT its 45 is there something i should worry about

[fenny]

I have been having elevated AST & ALT levels since October and want to know if anyone has any opinions on what the diagnosis might be.  Here are my test results:

10-1-03    AST(66)  ALT(121)
10-15-03   AST(124) ALT(283)
10-27-03   AST(45)  ALT(123)
11-11-03   AST(112) ALT(235)
11-28-03   AST(61)  ALT(120)
12-15-03   AST(60)  ALT(164)
1-15-04    AST(80)  ALT(230)

These are the only results from my LFT that are elevated.  I have been tested for Hepatitis, aids, mono, ect & all results have come back negative.  I also had an ultrasound and they found nothing abnormal there.  I am a 34 year old male and have normal blood pressure and I am in good shape (not overweight).  I will be having a ultrasonic liver biopsy performed tomorrow.  The doctor doesn't know what is causing my AST & ALT to be elevated.  I am obviously pretty nervous about what the results may be.

The things that I can point to that might be contributers to my current condition are things that I did years ago.  In my 20's I used to be a heavy weekend drinker(20+ drinks) and also have used bodybuilding supplements (creatine, androstene, ephedra) in the past.  Current I have totally quit drinking, since October and as you can see from my test trend that has not changed my LFT elevation.

Any comments would be helpful.  Thanks.

[Lexie D]

Hi,

I noticed that a few people were really trying to tell you that you had to drink less. I know that this info. does not help an alcoholic in the recovery process. YOU have to be the one to decide to quit, for YOU. I am a recovering alcoholic, so I know what it is like.

Tha pain you have needs to be checked out (if it hasn't already, b/c i haven't been on this site lately), I believe it could be your gallbladder acting up. That might sound weird, but that is what was happening to me. Your symptoms are identical. Take care!

[Jigger26]

The same thing happened to me 2 years ago. I was a heavy drinker. My ALT was elevated at 80 and Ast was normal. It is usually reverse. Your pain is gastritis and probable esophgitis. Your liver is fine. Stop drinking or cut back. I stopped. Take prevacid and your pain should subside. The liver does not hurt except in extreme cases of enlargement---when the capsule is expandes. the liver is a tough organ, but you only have one, treat it better. I'm 34 and I was headed down a bad path!!  JEFF