What are normal drops in LFT results are dmage to liver / possible Hep-A?

[SteveRH]

Due to being sick and not being able to identify it an ongoing unidentified ailment, plus with the stress of having to find a new job I went onto an Anti-depressant called Cymbalta in November 2006.

During Xmas I drank very heavily.

Early January I started seeing blood in my spit and after blood tests found I had elevated LFT's.  Later tests that month showed I had HAD Hep-A although I have no evidence of when.

I had an Auto-Immune test and everything came back normal except a postive result for Smooth Muscle Antibodies which the doctor suggested was a sign of Hep A.

I stopped drinking and stopped the Cymbalta.

The results that were not normal were: ALT , AST and GGT.

I have had 4 tests over the period.

I am told that the normal results are a maximum of ALT = 60, AST = 45, GGT = 35

07/01/09 : ALT 174, AST 110, GGT 81
07/01/18 : ALT 180, AST 126, GGT 76 - this was when I stopped drinking and meds
07/01/22 : ALT 134, AST 103, GGT 57 - a drop on all that was encouraging

I then waited for 5 weeks during which the blood in my spit disappeared.
07/02/29 : ALT 126, AST 78, GGT 51

So, a further drop but I am most discouraged at ALT only dropping marginally.

I will go back to the doctor for consultation but any advice to stop my current state of worry would be appreciated.

I am most interested to know what would be the normal period for LFT results like these to drop to normal.  Am I expecting too much in 1 month?

I should add I am overweight, but my cholesterol is in acceptable levels.

Regards,

[SteveRH]

An update is I had the ultrasound today and everything to do with the liver, kidneys, gallbladder was normal.

Doctor believes the most logical explanation is I am recovering from Hepatits A (which I know doubt did not help with the heavy Xmas drinking and AD.

I go on some tablets tomorrow to help the Liver Function but I think everything is  clear

Thanks for all the replies

[SteveRH]

Well a small setback as my GP has up and left her practice.  I asked where she went and I was told it was some Health Org. and it seems she doesn't see previous patients.

Anyway, I am going to see a doctor at the clinic at the lab who is experienced in gastro and liver.  I've met him before but I was trying to maintain one doctor throughout after I was out of the country in January.

I just hope I do not have to go back to the start of a new doctors 'one step at a time' in dealing with these types of issues approach

[Kalio1]

I don't know if you have been checked for fatty liver or not but fatty liver is quite common and can cause enzymes to be elevated. Both being overweight and drinking alcohol can increase the risk of fatty liver. The remedy for it is to improve diet, lose weight and limit alcohol as much as possible.
Ultrasound is used to test for fatty liver.

[jmjm530]

It should all work out. If "Cymbalta" did some good, you might talk to your doctor about going back on another AD once your liver enzymes normalize, and then, of course, periodic liver enzyme follow-ups.  A quick "google" of "Cymbalta" shows a number of liver red flags, plus explicit warnings not to take while drinking alcohol. So maybe another AD, not Cymbalta next time. In any event, heavy drinking is never a good idea as it puts a stress on your liver, and apparently that combined with Cymbalta is the likely culprit. I only mentioned seeing the liver specialist as they might want to do some imaging work on your liver but it sounds things will resolve on their own.

-- Jim

[SteveRH]

Other results:
Bilrubin : Normal
Alkaline Phosphate : Normal
Albumin : 4 (max told to me as 6)
Protien : 71 (max told to me as 80)

Auto Immune Results:
ANA, ANCA, AMA, Anti-LKMA, Pariental celi ABS, Reticulin ABS : Normal
Thyrobolulin ABS : 32.3 (max told to me as 60)
TPO Antibodies 5 : (max told to me as 12)

Hepatitis Results:
Hep-B : Negative
Hep-C : Negative

I believe the doctors have been quite thorough, and it is just my original post results that highlighted some concern.

[SteveRH]

Kalio, no I have not been checked for fatty liver but I am aware of it.

I've been trying to learn as much as possible over the past few weeks and what the LFT results actually meant and I believe it narrows down to either alcohol / meds or fatty liver.

I will have to say what the GP says tomorrow.

What I think happened is this:

I think I may, but I have no evidence, have got Hep-A in October.  This would explain why in November I was really sick. (I worked on a construction site and the canteen was near a sewage treatment works for the labour camp that had problems with over-spill.  The contractor had been criticised in the past for storing food items such as fish outside - I didn't go to the canteen often but I started going for the first time around October.  I have learned a common transmission of Hep-A is fecal-oral - a truly disgusting thought).  My symptoms in November where various but mostly I was heavily fatigued and very unstable, both sitting down and standing up.

Incidentally one cause of stress that resulted in me taking the AD was having to find a new job as my company laid me off for being sick through most of November.  Bitterness may rule my judgement but if I ever discover that I was sick from Hep-A caused by their bad management I think I will return to pay a visit to the Project Manager - however, the final word is I should have been innoculated.

Hep-A apparently runs its course over 1-2 months but by end of December I was battering my already overworked liver with drink and a strong anti-depressant.

Hence in January I tested positive for having Hep-A at some point in the past, a positive result for Smooth Muscle Antibodies indicated to my doctor a viral infection such as Hep-A, and I have the elevated LFT's which start to gradually drop after mid-January when I stop drinking and taking the medication.

For March I think I need to get more exercise, and of course stay off the booze, but I will wait to see what my GP recommends.

Thanks for the reply.

[nygirl7]

Kalio just made all of the points I was going to make.

Perhaps it was strictly the drinking or perhaps a different A/D might not even affect your enzymes.  Mine were in the 200s when I started off but even on Paxill they dropped to the 20s (last test 19 ALT!)

Drinking is toxic to the liver (as you already know) and sometimes it's not that hard to quit but...it's a great trade off.  Liver damage or a magarita...that alone helped me to stop for good once I realized the implications.

Good luck it sounds like you are on the right path!

[SteveRH]

Jim, a succint, clear and worry-relieving answer to my ramblings.

Thank you most kindly.

[jmjm530]

You stopped drinking and the medications, your enzymes seem to be falling and you're being followed by a doctor. My guess is your liver enzymes will be back in or close to the normal range within 2-3 months. That said, given your history, you might want to consult with a liver specialist (hepatologist) to mop up any loose ends your doctor may have missed. There's lots in life to worry about, but I think you have every reason at this point to believe things will work out fine. Just take it one step at a time.

-- Jim