elavated ast and ggt

[Dan1000]

I had elevated liver enzymes 3 years ago due to heavy drinking for approximately 1-2years (1-2 bottles of wine a night). I stopped drinking completely for about six months, within 3 months my results were normal. My ultrasound came back normal and my liver specialist thought it highly unlikely that I had any cirrhosis. After I had stopped for 6 months my liver specialist told me that I could probably resume social drinking at below the recommended units. I drank again for a year and half, occasionally, but had a slightly evelated result after getting drunk before my wedding. I was told by one doctor not to drink anything and that I was ok to drink by another. I then only drank on special occasions maybe once a month. In the summer I was due to have LFTs for life insurance but told the company I drank 5 units a week and they rejected me. Since then I decided I would go back to the doctor and be tested. I was tested about two weeks ago by my new doctor (who hadn't seen my history) and recieved my results. My results were all normal except for AST 43 and GGT 79. I have a very slight pain occasionally under my ribcage on the liver side but I can't stop thinking about it so I am very concious of it. I would like to be able to drink one beer a week but I am terrified I have done myself some real damage.  Are the results indicators that I may have cirrhosis?

[Kevin Pho, MD]

Cirrhosis is really only diagnosed via a liver biopsy.  The liver function tests are not a good indicator for cirrhosis.  It is possible that the slightly elevated levels are due to the alcohol.  Repeating the ultrasound can also give some clues whether cirrhosis is present or not.  

If there continues to be concern about the LFTs, you may want to consider abstaining from alcohol, as well as obtaining hepatitis panels - which can also increase the enzymes.

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

[Dan1000]

my original ultrasound I forgot to say showed my liver to be slightly enlarged.

[bdusk]

Dear Dan,

I am not a doctor but my father was a heavy drinker (as you are)and he developed cirrosis (sp?) of the liver.  He refused to give up drinking and is now dead.  What are you thinking, still wanting one beer a week?  You've already damaged your liver according to your post.  It is enlarged and you've had abnormal test results.  Do you really want someone to give you permission to drink?  It's apparent that you have two choices here:  give alcohol up -- completely -- and allow your liver to heal/regenerate and you'll live a long, fairly healthy life or choose to pursue your habit and keep chipping away at an organ you MUST have in order to sustain your life.  If you choose to commit suicide, you die as a consequence.

I don't mean to sound so grouchy, but this is serious and although I have no idea who you are, I care.  I imagine your loved ones want to keep you around, and presuming by your self-admitted fear, you want to stay around as well.  Think about it.

[Dan1000]

Thanks for your concern bdusk, I am very sorry to hear about your father. I appreciate your concern. I don't currently have an enlarged liver (this resolved itself after 3 months of abstence 3 years ago) and I haven't drank daily for three years.  Where I live drinking is very much the culture (Scotland) and it is difficult to not drink socially at all (acoholism is supposed to effect your friends and work life - here abstence does the same).  I now drive as much as possible to social occasions because I know I won't drink and drive I also never drink at home. I am 30years old and did drink maybe once a month. I stopped completely 4 weeks ago and am trying not to drink anything. I don't get cravings for alcohol but I wish I didn't have to explain myself everytime someone offered me a drink. The problem is I have three friends who are doctors that think that drinking the way I am doing is probably fine and that I should just be having my results monitored. You are probably right that I should give up but it is very difficult when I am the only person I know that shouldn't/doesn't drink and I don't get a lot of support from my friends.

[bdusk]

Here's the thing about friends:  If they don't support you in your decisions, then they're not very good friends, are they?  That said, though, perhaps I jumped the gun a bit in your situation.  NOT that I think you should be out drinking, but I understand the social pressure only too well.  But remember always that the people who really love you, will love you without a drink in your hand.  If they don't, then you need to seriously re-evaluate that/those relationship(s).  

Here in America, you can order non-alcoholic beverages (mixed-drinks), which is what I always do.  No one is the wiser and I'm never asked, "Is that REAL alcohol in there?"  But you know, if you are asked, you don't have to explain anything.  A simple smile and an "I've given it up," will do.  

Here's something of note:  I've been researching the liver alot lately, because my son recently developed some complications himself (not alcohol related).  I found some info that said if you have liver damage due to cirrhosis, even if you stop drinking completely, your liver is damaged for life and should be monitored.  It doesn't heal at all.

I don't mean to scare you to death, but some fear is good, if it gets you to change your habits.  But only you and your doctors can truly evaluate whether or not social drinking is "safe" in your individual case.  I may easily be a bit too judgmental in this department because I've had it hit so close too home.  I wish you all the best.

[sherryd55]

I am something of a liver problem specialist since contracting Hepatitis C about 15 years ago, and researching it as much as I can. Additionally, my beloved husband had a drinking problem--mostly beer! and died at a very young age of 39 years old, in part because of complications of cirrhosis (it affected his heart, and made the heartbeat irregular). What my liver specialist has told me (and I have read about) is that the liver can recover if the damage has not progressed to cirrhosis.  One of the things that happens with cirrhosis is scarring or the tissue of the liver, that does not go away even if someone stops drinking completely.  The liver also can become hard, dark, and shrunken, even though it may be enlarged in the first stages.

I know that hepatitis liver disease is somewhat different from alchoholic liver disease, but some things are similar.  The other thing I found out researching alchoholic liver disease is that many other organs and body systems can be affected, such as the heart, brain, nerves.  Usually alchoholic liver disease takes a long time, with many ugly effects, before it kills someone.  You can develop numbness in your feet and hands, memory problems, and if you are starting to get cirrhosis, your muscles may start wasting.  My husband worked every day in physical work--construction, but still his legs shriveled to little sticks, and his arms were way less muscular. He developed numbness in his fingers and toes, which eventually worked its way up his legs. He also was very fatigued all the time, and having difficulty working a full day, even at a young age.  He also had pain all over his body, with joints and muscles hurting, which probably was related to the liver problem.  He bled easily, getting nosebleeds all the time, and bruising easily.

The end stage of cirrhosis is horrific, with the possibility of terrible memory loss,  swelling of the stomach with fluid because the liver can't process  properly, bleeding of the veins going into the liver that can't be stopped, and a host of other attractive conditions.

Why take the chance of drinking at all?  Without having a liver biopsy you cannot be sure that you do not already have the beginning stages of cirrhosis, with "bridging" starting--that's where the internal structures of the liver start to get scarred.  Blood tests do not show this sort of damage.  You can have good blood tests and still have scarring.  I know, because that is my situation--and I quit drinking completely 7 years ago.  

I'm sorry about preaching, but believe me, you don't want to take the chance of developing cirrhosis.  The medical examiner who autopsied my husband told me that it was an easy death, to die of heart failure, compared to dying slowly of cirrhosis, which he had at 39, by drinking beer!