Trying to understand .

[XKE]

Hello,
Found out I had elevated enzymes on a blood test. Very healthy 36 year old, normal weight. The enzymes were rather high but, came back to normal after stopping wine and tylenol they are now ast/alt 27 and 22 respectively on a 0-40 scale, ggt 45 scale 0-60. I have read many of the prevous post regarding elevated enzymes, and it seems many people, myself included, are confused if they are now "OK". I spoke with my gyn. nurse who said" you are fine" if your liver was "messed" up other test would be out of range. Prior to this test, I had not had bloodwork done for years, I visit the gynecologist every year but she only does a pin *****. I just figured she would have noticed if something was out of sorts. I have great blood pressure, I now know great cholesterol. But, I have drak regularly for 10 years. Could my liver have been inflamed for years? If so would the enzymes have stayed higher longer? If my liver was enlarged would the doctor have felt it over the last few years? Do I need an ultrasound or can I monitor the enzymes.Most importantly, what blood test besides enzymes would be a first sign of something serious. I have just read too much now about liver diseas and it seems like a very silent disease.I would appreciate any insight. Thanks.

[Kevin Pho, MD]

Regular drinking can lead to fatty liver which can elevated the enzymes.  

Given the drinking history and the isolated elevated enzyme level I would obtain an abdominal ultrasound.  This probably would be the best test to rule out anything serious going on.  

Another initial test to consider would be blood tests looking for hepatitis.

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.
kevinmd_b

[Kalio1]

Keep in mind the gold standard to find out the status of your liver is a biopsy. Enzymes do not tell the whole story. Yours have normalized, which is good but should they continue to be elevated, speak to your doc about it. It is a good idea to be tested for fatty liver and hepatitis A, B and C to rule that out as a possibillity for the elevated enzymes. Many people with Hep C have no other symptoms at all besides raised enzymes.
I would also abstain and retest, if they stay low when you dont drink that shoud tell you something!

Do you have other symptoms or signs of liver problems? Fatigue? light colored stools, etc?

[XKE]

Hi Kalio1,
No, I have no sympotms at all. The blood test was done when I could not get a checkup with my usual gyn. for an annual exam, she was booked for 3 months. The doctor I went to was a "family" doctor, she took 3 viles of blood before even looking at me. She did not mention during the exam that my liver was enlarged. She had her nurse call regarding the enzymes and just said to wait and retest, I will now test for hep. I am just confused with the term alcoholic hepatitis, does any raise in enzymes that can be associated with alchol, being that the numbers go down upon abstaining, mean it is alcoholic hepatits. Or, is this a term used for a true episode that would require a hospital stay with other symptoms. I understand the biopsy is the true test but, if the enzymes stay normal it sounds like doctors are reluctant to do one. Also, what I have read is that fatty liver will go away when the offending factor, alcohol or diabetes or excess weight has been removed. So, if I get one now will it show no fatty infiltration. Thanks for reading my post.

[Kalio1]

A definitive judgement can not be made without a biopsy and examination by a pathologist. It is assumption based on blood factors and history. I'd go with the docs advise and get an abdominal ultrasound, get a guided one if possible. That will give you more info and they can see fatty liver and rule out any tumors or masses present with that. It doesnt hurt and it will probably make you feel more informed. Personally, I'd see a Heptologist and not a PCP for this, most PCPs just dont have the experience a Heptoogist will. Your doc probably thinks a biopsy at this point is unnecessary given you only had one symptom, raised enzymes but a Heptologist might handle it differently.
With a biopsy they can look at the tissue and that is how they determine alcoholic hep, based on the condition of the tissue.
Fatty liver can be caused by alcohol abuse and/or poor diet and being overweight and can be controlled and even reversed by making diet and lifestyle changes. Fatty liver causes raised enzymes. Your enzymes dont seem high enough to me for alcoholic hep, but I am just a lay person.
Good to hear you have no other symptoms, that is a good sign.
If it was me, I'd rule out the hep by testing for it just to be safe and also sure I didnt have it and take this as a wake up call regarding my diet/drinking habits. Be glad you found out and don't beat yourself up over the past. When you know better you do better. The effect of alcohol varies from person to person, some drink like fish and their livers are fine, others drink a lot less and develop problems, probably genetics play a big part in it. Im no doc just a patient with a liver disease, but that has been my observation.
The liver is a forgiving organ and can regenerate if you make the necessary changes in your life and reverse any possible damage you have incurred until now.
good luck to you.


PS. love those XKE's. I drive a vanden plas

[Kalio1]

A definitive judgement can not be made without a biopsy and examination by a pathologist. It is assumption based on blood factors and history. I'd go with the docs advise and get an abdominal ultrasound, get a guided one if possible. That will give you more info and they can see fatty liver and rule out any tumors or masses present with that. It doesnt hurt and it will probably make you feel more informed. Personally, I'd see a Heptologist and not a PCP for this, most PCPs just dont have the experience a Heptoogist will. Your doc probably thinks a biopsy at this point is unnecessary given you only had one symptom, raised enzymes but a Heptologist might handle it differently.
With a biopsy they can look at the tissue and that is how they determine alcoholic hep, based on the condition of the tissue.
Fatty liver can be caused by alcohol abuse and/or poor diet and being overweight and can be controlled and even reversed by making diet and lifestyle changes. Fatty liver causes raised enzymes. Your enzymes dont seem high enough to me for alcoholic hep, but I am just a lay person.
Good to hear you have no other symptoms, that is a good sign.
If it was me, I'd rule out the hep by testing for it just to be safe and also sure I didnt have it and take this as a wake up call regarding my diet/drinking habits. Be glad you found out and don't beat yourself up over the past. When you know better you do better. The effect of alcohol varies from person to person, some drink like fish and their livers are fine, others drink a lot less and develop problems, probably genetics play a big part in it. Im no doc just a patient with a liver disease, but that has been my observation.
The liver is a forgiving organ and can regenerate if you make the necessary changes in your life and reverse any possible damage you have incurred until now.
good luck to you.


PS. love those XKE's. I drive a vanden plas

[XKE]

Hi Kailo1,
thanks so much for your input, it was a good wake up call the blood work. I am a very healthy person I eat right, exercise. I just never had a reason to have bloodwork. I think many women fall into this, going to the gynecologist and not a primary care doctor. I guess it depends on insurance and what is required. I pretty much cut out wine all together and the tylenol. I will keep checking my enzymes once a month for the next year and then every 6 months. My doctor does not want to do the ultrasound right now I can get the bloodwork done at an independent lab and if it goes up I will demand an ultrasound. Thaks again and enjoy your jag this spring.