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Gastroenterology (Expert Forum)
What Additional Tests Should Be Considered
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.
What Additional Tests Should Be Considered
by Jaric, Jul 13, 2004 12:00AM
Diagnosed 2004 Chronic, Active Hepatitis B, AST 177/ALT 416 continue rising.
-- Question what other tests should be considered as the cause for the continued rise, or is this typical with chronic Hep B until medication has longer to work?
My son, age 25 (1979), adopted as Korean orphan (1986) & tested positive for Hepatitis B antigen. His stools were pure white from 1986 - 1988, his pediatrician indicated probable cause was poor diet, malnutrition. At 5 years, was 34" height, and 30 lbs, very weak as he'd had no supervision or medical/dental care and from ~age 2-4, survived on the street Assumption was inherited Hep B. ALT/AST Enzymes normal.
1987 1st seizure in US; MRI and EEG indicated traumtic head injury after birth probably age 2 -3. Seizures controlled at 200 mg x 4 daily with Tegretol. Until 2003 liver enzymes normal; periodic EEGs continued to show grossly abnormal electrical signal, trial reduction in meds presented with seizures (1997) --therapeutic dosage continued -- monitoring of enzymes normal until 11/2003.
He has marked language-communication, learning, memory disabilities. He has never used drugs, alcohol, takes no other meds, vitamins or supplements and has a reasonably good diet. Periodic episodes of very high cholesterol but in the normal range, BP normal, Bilirubin - normal. Average height (5'7" and weight, 145lbs).
I've been concerned and reported very dark urine (rust colored)over the past 10 years, he's been advised to drink more water.
SGOT/AST SGPT/ALT
Nov 2003 48 147
Feb 2004 97 272
Other interim tests – still high
May 87 209
June 2004 177 416
---------------
May 2004 Sonogram of liver non-remarkable
June 2004 Iron is also high but no hemochromatosis
May – 2004 – accelerated transition off Tegretol (200 mg x 4 daily to Trileptol without marked incidents
No AIDS
No Hepatitis D, C, or A
June 2004 – Liver Biopsy: Inflammation Grade 2; Scarring – 0; forgot to request analysis of drug level toxicity (Tegretol) or Hepatitis as the cause. Assumption is Hepatitis.
Initiated Hepsera 10mg x 1 day
July 2004 Immunization – Hepatitis A
Specialist is monitoring enzyme levels every other week out of concern that the elevation continues. Urine is still very dark, no other jaundiced symptoms.
What other tests, if any, should be considered? No original family health history is available. If so, what's next? He is presenting with marked and growing fatigue; and mini-episodes of mild seizures -- brief and frequent staring spells with memory loss/disoriented x 10-15 per day. We're assuming its the change in anti-convulsive meds and perhaps, lower effectiveness in Trileptol vs. Tegretol.
Coordination between neurologist and liver specialist continues. Is a liver biopsy indicative of all areas of the liver or the just the cells biopsied? Would an MRI of the liver or other organs be useful?
Thank you in advance for your consideration and feedback.
-- Question what other tests should be considered as the cause for the continued rise, or is this typical with chronic Hep B until medication has longer to work?
My son, age 25 (1979), adopted as Korean orphan (1986) & tested positive for Hepatitis B antigen. His stools were pure white from 1986 - 1988, his pediatrician indicated probable cause was poor diet, malnutrition. At 5 years, was 34" height, and 30 lbs, very weak as he'd had no supervision or medical/dental care and from ~age 2-4, survived on the street Assumption was inherited Hep B. ALT/AST Enzymes normal.
1987 1st seizure in US; MRI and EEG indicated traumtic head injury after birth probably age 2 -3. Seizures controlled at 200 mg x 4 daily with Tegretol. Until 2003 liver enzymes normal; periodic EEGs continued to show grossly abnormal electrical signal, trial reduction in meds presented with seizures (1997) --therapeutic dosage continued -- monitoring of enzymes normal until 11/2003.
He has marked language-communication, learning, memory disabilities. He has never used drugs, alcohol, takes no other meds, vitamins or supplements and has a reasonably good diet. Periodic episodes of very high cholesterol but in the normal range, BP normal, Bilirubin - normal. Average height (5'7" and weight, 145lbs).
I've been concerned and reported very dark urine (rust colored)over the past 10 years, he's been advised to drink more water.
SGOT/AST SGPT/ALT
Nov 2003 48 147
Feb 2004 97 272
Other interim tests – still high
May 87 209
June 2004 177 416
---------------
May 2004 Sonogram of liver non-remarkable
June 2004 Iron is also high but no hemochromatosis
May – 2004 – accelerated transition off Tegretol (200 mg x 4 daily to Trileptol without marked incidents
No AIDS
No Hepatitis D, C, or A
June 2004 – Liver Biopsy: Inflammation Grade 2; Scarring – 0; forgot to request analysis of drug level toxicity (Tegretol) or Hepatitis as the cause. Assumption is Hepatitis.
Initiated Hepsera 10mg x 1 day
July 2004 Immunization – Hepatitis A
Specialist is monitoring enzyme levels every other week out of concern that the elevation continues. Urine is still very dark, no other jaundiced symptoms.
What other tests, if any, should be considered? No original family health history is available. If so, what's next? He is presenting with marked and growing fatigue; and mini-episodes of mild seizures -- brief and frequent staring spells with memory loss/disoriented x 10-15 per day. We're assuming its the change in anti-convulsive meds and perhaps, lower effectiveness in Trileptol vs. Tegretol.
Coordination between neurologist and liver specialist continues. Is a liver biopsy indicative of all areas of the liver or the just the cells biopsied? Would an MRI of the liver or other organs be useful?
Thank you in advance for your consideration and feedback.
Doctor's Answer
by Kevin Pho, MD, Jul 14, 2004 12:00AM
, Jul 14, 2004 12:00AM
The liver biopsy is indcative of the just the cells biopsied. There is always the possibility that the biopsy may have missed any active areas of disease.
Other considerations would be evaluating the biliary tree. This can be done via an MRCP or ERCP. Any obstruction can lead to a rise of the liver function tests.
You can try to MRI the liver, but it is doubtful that it would be any more useful than a CT scan or ultrasound - each of which I'm sure has already been done given the fact you are under the care of a liver specialist.
If these have already been considered or if the tests are negative, it may be due to the hepatitis - or the lack of response to the treatment.
You may also want to consider another opinion if the situation is not improving.
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.
Medical Weblog:
kevinmd_b
Other considerations would be evaluating the biliary tree. This can be done via an MRCP or ERCP. Any obstruction can lead to a rise of the liver function tests.
You can try to MRI the liver, but it is doubtful that it would be any more useful than a CT scan or ultrasound - each of which I'm sure has already been done given the fact you are under the care of a liver specialist.
If these have already been considered or if the tests are negative, it may be due to the hepatitis - or the lack of response to the treatment.
You may also want to consider another opinion if the situation is not improving.
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.
Medical Weblog:
kevinmd_b
