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Gastroenterology (Expert Forum)
Urgent Liver Enzymes over 800, not going down, need all possible DX to address with gastroenterologist
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Urgent Liver Enzymes over 800, not going down, need all possible DX to address with gastroenterologist
by momo4boys, Jun 26, 2007 12:00AM
Writing about my mom. A 73 y/o healthy female, just takes water pills fo high blood pressure. no cholesterol meds. nondrinker. Had a lack of appetite for few weeks (about 6 weeks ago) and just felt listless, figured a virus. About 2 weeks ago, skin & eye whites turned yellow, still really itchy, appetite returned somewhat.
On 6/17 at urgent care blood test results: potassium 3.0, chloride 3.0, RDW blood 14.6, ALT 846, AST 781, Alkalinephosphatase 136, billirubin 22.2.
Next day, saw her regular doc on 6/18 more blood work results: hep a - normal, hep b - normal, iron 303, tibc 336, iron sat 90, alt 795, ast 706, alkaline phosphatase 132, billirubin 23.9, billirubin direct 13.5, albumin 3.1, globulin 4.2. She also had a CATSCAN all organs look fine(negative), NO MASSES. Doc referred her to a gastroenterologist, doc "thinks" she was exposed to hep b.
Today,june 25th, more blood work results: ALT 811, AST 714, alkal..121, bilirubin 24.4, bilirubin direct 15. We are looking for all possible causes for her condition. Thoughts? they have not done a liver biopsy yet. would cirrosis appear on the catscan? and how long can a liver endure such elevated enzyme levels, and still function?
A friend brought up hemochromatosis? but doc didnt reorder the iron testing on the 3rd round of blood work. Thoughts? We are so concerned that her liver is being destroyed. anything we can suggest to the gastro would be greatfully appreciated!
On 6/17 at urgent care blood test results: potassium 3.0, chloride 3.0, RDW blood 14.6, ALT 846, AST 781, Alkalinephosphatase 136, billirubin 22.2.
Next day, saw her regular doc on 6/18 more blood work results: hep a - normal, hep b - normal, iron 303, tibc 336, iron sat 90, alt 795, ast 706, alkaline phosphatase 132, billirubin 23.9, billirubin direct 13.5, albumin 3.1, globulin 4.2. She also had a CATSCAN all organs look fine(negative), NO MASSES. Doc referred her to a gastroenterologist, doc "thinks" she was exposed to hep b.
Today,june 25th, more blood work results: ALT 811, AST 714, alkal..121, bilirubin 24.4, bilirubin direct 15. We are looking for all possible causes for her condition. Thoughts? they have not done a liver biopsy yet. would cirrosis appear on the catscan? and how long can a liver endure such elevated enzyme levels, and still function?
A friend brought up hemochromatosis? but doc didnt reorder the iron testing on the 3rd round of blood work. Thoughts? We are so concerned that her liver is being destroyed. anything we can suggest to the gastro would be greatfully appreciated!
Doctor's Answer
by Kevin Pho, MD, Jun 26, 2007 12:00AM
, Jun 26, 2007 12:00AM
There are a variety of causes for liver enzymes that high. Hepatitis is one cause. Others can include Tylenol toxicity, congestive heart failure, other liver infections, gallbladder disease or infection.
I agree with the GI referral. Cirrhosis can be suggested on the CT scan, however with liver enzymes that high, an acute process is more likely.
If the liver is normal, the biliary ducts can be evaluated with an MRCP. If the tests continue to be negative, a liver biopsy may need to be considered.
These options can be discussed with your GI physician, or in conjunction with a second 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_
I agree with the GI referral. Cirrhosis can be suggested on the CT scan, however with liver enzymes that high, an acute process is more likely.
If the liver is normal, the biliary ducts can be evaluated with an MRCP. If the tests continue to be negative, a liver biopsy may need to be considered.
These options can be discussed with your GI physician, or in conjunction with a second 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_
I am just concerned that the place my mom gets care, may not be the most PRO ACTIVE place.