chronic hepatitis of unknown origin- what does this mean??

[lisa812]

Hi- I was just wondering if anyone might have some ideas for me. I am a 32 year old female. Had a baby 10 months ago. Last couple of months I've been exhausted all the time. I went to see a primary doc, had routine labs- cbc and cmp. Not surprising to find out i was iron deficient however my alt was 545, alt 267, alk phos 152, other labs were basically normal ranges. being a rn i reviewed the labs with a GI doc. he sent me for lab ever few days results were- viral hepatitis a b and c neg, antimitochondrial antibodies neg, antinuclear antibodies neg, pt and inr normal, platelets normal, wilsons disease neg, alpha-1-anti trypsin normal, abdominal ultrasound normal, ct scan of abdomen and pelvis with po and iv contrast showed bilateral nonobstructing renal calculi, pancreas normal, adrenal glands normal, a "prominent appendix" cannot rule out early acute appendicitis, and splenomegaly. We followed up with a liver biopsy results are

The specimen consists of multiple fragments of liver parnchyma showing adequate portal areas. The portal areas contain a moderate chronic inflammation composed predominantly of lymphocytes and occasional eosinophils. Moderate piecemeal necrosis with erosin of the limiting plates. No evidence of steatosis. There is patchy lobular inflammation with hepatocyte dropout and occasional acidophilic bodies. Lymphocytes and macrophages are present. Stains for iron are negative. Trichrome stain shows a moderate focal fibrosis with focal portal to portl bridging fibrosis..

Diagnosis: chronic hepatitis, moderately active, etiology  unknown.
Moderate portal fibrosis with focal portal to portal bridging fibrosis. no evidence of cirrhosis.

any input would be appreciated. I am so overwhelmed by all this and my gi doc just suffered a terrible tragedy so all of us that are his patients are waiting for appointments to be rescheduled.

Thanks.............

[lisa812]

Thank you for all your responses! They are truly appreciated. I have an appointment with my GI doctor on July 14th so I'm anxiously waiting to see what he comes up with, as I have a great deal of faith in his abilities as a physician. I had my appendix removed last week- laproscopically at least, because I suddenly came down with nausea, vomiting, and chills at work. I went to see a new primary the following day and he direct admitted me to the hospital with a surgery consult. Following a cat scan they took me right to surgery. At least my tummy feels better!

To respond to a few questions I do not believe I have an exposure or toxicity issue because I just had a baby in July of 2007 and I was nursing him until I became aware of my liver enzymes. So, I avoided taking medications for almost two years other than occasional tylenol or ibuprofen. I stopped nursing for fear that I would transmit something to him via the breastmilk, however my docs have assured me that what I have is not contagious.  

I have learned that my AST and ALT levels have dropped some, woohoo! They are still considerably above normal values but not as high as they were previously. My alk. phos. with first labs was slightly elevated but with repeated labs has been within normal ranges. A doctor told me that the alk. phos. level may be elevated while breastfeeding so they were not concerned with it. Bilirubin has remained consistently normal with all labs. The GGT level I do not know, I'm not sure if it was checked and it does not sound familiar to me.

Thanks again for the time you all spent with your responses. It is so difficult to just wait for results. I have three children and I just want to be as healthy as possible to take care of them. Right now I am not working for a few weeks to recover from the appe so I'm just taking the opportunity to be as close to my kids as possible. I will send out updates as soon as I know more.

Have a great day!
Lisa  

[IAmTheWalrus]

Doesn't sound like infection of the viral kind. Other guesses would be toxicicity from environment, foods, drugs, etc. Regualr overuse of Tylenol (acetominophen) is linked to liver failure. A biopsy soon looks like the best step.

Best luck, we're here for you,
Brent

[HectorSF]

Hi.
I didn't see your bilirubin and GGT levels. Do you have them?

You definitely want to find out what is causing your liver damage.
You are at stage 2 or 3 out of 4 with moderate inflammation.
2 = portal fibrosis
3 = portal fibrosis
4 = cirrhosis

There are many causes of liver damage. Autoimmune, drug related, inherited liver disease, etc. Not just viral causes. Which could be why you tested negative to hep antibodies.

There are two general categories of "liver enzymes." The first group includes the alanine aminotransferase (ALT) and the aspartate aminotransferase (AST), formerly referred to as the SGPT and SGOT. These are enzymes that are indicators of liver cell damage. The other frequently used liver enzymes are the alkaline phosphatase (alk. phos.) and gamma-glutamyltranspeptidase (GGT) that indicate obstruction to the biliary system, either within the liver or in the larger bile channels outside the liver.

I hope you can see your doctor soon to you can find out what is causing your liver damage. Let us know what happens.

Best of luck to you.
Hector

[Mary4now]

Gosh, (havent used that word in a while) I remember when I was getting my biopsy there was a young guy next to me who had liver problems due to accutane.  

[Willy50]

I know more about HCV.  You don't seem to have it unless you also have no antibodies.

I assume that you meant to type ALT 545, AST 267, instead of them both ALT?
Those are pretty high and it would be of concern it they stayed that high.  The question might be asked what type of chemical or drug exposure you may have come across since you don't have Hep A, B, or C.

You need to stay away from alcohol, limit use of pain killers and perhaps review them with a pharmacist before taking any if you can't talk to your DR.  Often you can ask in an emergency to speak with the doctors nurse and they may be able to coach you a little while you wait for the doctor to get back to you.  If you are on any medications you should google them or run em past the RN or pharmacist while telling them about your recent LFT scores so that you don't suffer any problems due to interactions with an already inflamed liver.

You might start looking back in you memory about possible exposures from chemical (many chemicals are hepatoxic),  fumes (same deal?), drug exposure (Tylenol OD?), or some past medical issue that could have caused an issue.  There sure could also be other causes.  I'm not that knowlegable.  Better to find out than to speculate further.

The good news is that you have no infection to clear up, or so it would appear.  The liver is often generally able to regenerate itself.  I would presume that to be the case until you are told otherwise.  Assume the best, not the worst while you wait.  Take care of yourself WHILE you wait.  Stay up on your sleep, drink plenty of clean water, fresh air, and remember; no stressing!!!!!!  I know; easier said than done.

take care,
willy

[Mary4now]

Your biopsy sounds like hepatitis (based on what my reading was), but you tested neg. Should you get another blood test just in case?
Could there be another strain of the hep virus that isnt revealed through testing, like hep c was before 1992?  
I would go see a hepatologist..
Good luck and let us know what you find out.  blessings, Mary