high everything

[gracie03]

I'm a 37 year-old female.  5'4 & 145 lbs.  Took "Rebif" for my MS for a duration of about four months, but that was a year ago.  After repeated liver tests, I had slightly elevated AST & ALT (highest ever was 107 & 92), so my neurologist had me stop the injections.

Continued to have liver tests re-taken every 6-8 wks. following, and they were still slightly elevated, so stopped Lipitor (for cholesterol & tryglicerides) and Premain (hysterectomy abt. 6 yrs. ago for endrometriosis).

Stopped the Rebif last July and Premarin & Lipitor last Sept.  Since I've stopped taking everything (including Tylenol) they've still been rising.  Last blood test in Feb.

This week I had another round of tests and everything's suddenly REALLY out of whack.  Here we go.....
AST 229
ALT 187
GGT 215
LDH 324 (first time this had been elevated)
LDL 123
Tryglycerides 275 (actually normal for me)
Cholesterol 254 (slightly above normal)

In addition, for the last 8 yrs. I've had diarrhea sometimes.  Sometimes I get blood in the stool.

Abt. a month ago, had blood in the stool for @10 days.  Local dr. said from what he could see there in his office was inflammation, redness, etc.  But keep in mind I had a colonoscopy @5-6 yrs. ago for the very same reason and it was normal (but had no blood in the feces at that time).

Yesterday I started blood in the stool again.  This soon.

My Internist (which is where I should go next) is on vacation for the next couple wks.

Now my lifestyle (don't cringe) includes smoking 1-1/2 packs a day, and I drink also.  Frequently, but not much, and beer vs. hard alcohol.

No illegal drugs whatsoever.

Please keep in mind that because I've been on Lipitor for the last 10 yrs. that I've had my blood drawn every 3-4 mths. and there was never a liver problem before now.  

Why have the liver enzymes along with the LDH skyrocketed???

So, I'm shitting blood, my liver enzymes are out of control, I have MS, and I'm a little scared.  Give me a slap on the wrist if you must, but there are lots of people out there who drink and smoke much more than I do.

Any ideas of where the problem lies?  Have you ever encountered this problem before?

Many thanks in advance.

----Grace

[Kevin Pho, MD]

A visit to a GI specialist should certainly be considered.  Workup for various liver diseases can start with blood tests for hepatitis as well as liver ultrasound.

Blood in the stool can be indicative of late liver disease (i.e. cirrhosis leading to increased portal hypertension can lead to rectal bleeding).  A flexible sigmoidoscopy or colonoscopy should be considered to evaluate the source of the bleeding.

If the ultrasound and hepatitis tests are negative, a liver biopsy can be considered as a more definitive diagnostic step.

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.
Medical Weblog:
kevinmd_b

[gracie03]

I really should have mentioned when I got on my "rant" yesterday, that my Internist did all the Hepatitis blood tests with many other tests back in January, which came back all normal.

Also did an ultrasound of the liver, which also came back normal.  Normal size, normal blood flow into and out of the liver.

So, where do I go from here?

Many Thanks,
Gracie

[Christie2004]

Probably a liver biopsy would be the next step.  You could have an inflammation of your liver (steatohepatitis) from fatty liver.  Alcohol, even in "normal" amounts, can cause liver disease in some individuals.  Nicotine can likewise affect the liver.  Cirrhosis can't be reliably diagnosed from an ultrasound, and you don't have to be an alcoholic to have cirrhosis.  

You're right; some people probably smoke more and drink more than you do and nothing happens.  Those people are the exception, not the rule.  

Good luck to you.