ALT jumps to 229 and AST jumps to 135 in 2 month!!! they were previously 50 and 61!

I drank heavily for about 4 months (5-6 beers at night)...took 2 months off...then drank for another 3 months.
I had a blood test done Dec 13th and the results showed my ALT at 50 and my AST at 61.  I assumed that this was from drinking.  I had been on a three month period of heavy drinking (about 6 beers at night).  One month after I had this test done...
1. I decided to stop all drinking.
2. I began taking capsules containing milk thistle and dandelion about 2 or 3 times everyday.  
3. I ate reasonably healthy.
4. I played a moderate paced game of NON-Contact hockey 5 days a week.
5. I did not take any drugs of any sort, legal or illegal.  I cut my smoking down to 1-2 cigarettes a day
--I am 5' 4" and weigh 130 lbs, Male age 28.
Yesterday Feb 14, I went and had another blood test done.  Hoping to see that the levels had normalized...I received a shock.
My ALT had risen to 229 and my AST had risen to 135. Protein level was high at 8.3.  All other levels were normal.
This whole situation is shocking to me.  I have read that alcoholic liver harm usually reveals a 2:1 AST:ALT ratio.  Does this mean that alcohol is probably not the cause?  Could alcohol have kick started something else and it transformed into a whole new disorder?  What do these levels indicate to you (Doctor)? cirrhosis?  What should be done next?

[rpooo]

Thats great that you cut down on your drinking. These levels are extreamly high. What did your doctor tell you about them? were all your other levels okay? Most importantly Did you fast before the blood lab was taken? I highly doubt you have Cirrhosis at your age and/or weight but certainitly is something you should be concerned about. You must get an explanation from your doctor. I cant believe he didnt offer some sort of response. Dont wait for this do it asap and find out whts going on.
Randy

[flyersixer]

all other levels were normal.  hospital said protein was a tiny bit high at 8.3...but in other labs it woul be considered normal.  The doctor i gave the results to was for another medication, not a liver specialist.  However, she said could not give me the meds with these liver enzymes and said i NEED to get this looked at.  However, I am uninsured and have no physician.  I dont know what I can do.  perhaps go to the ER.  
The hospital said I did NOT need fasting for a liver function test.  so I did not fast.
I am just shocked at the steep increase...from 61 to 229...after a month of abstinence and milk thistle everyday.  Any possible explanations?? anyone?

[Sam200819]

Have you been checked for viral hepatitis?

[flyersixer]

no.  like i said...I only got two blood tests...and no insurance.  So...are u saying viral hep because the numbers indicate it??  

[rpooo]

You must fast so this test can give a much more accurate reading. Everything you eat your body breaks it down and it passes through your blood stream. Think about it, you wouldn't want to eat a candy bar before having a sugar test would you? Or perhaps a greasy cheesburger before a cholestoral test. There really is no need for the ER since I am certain many of your numbers are not accuate do to not fasting. Here's a cheap way to find out for sure if your not convinced. Call a doctors office and tell them you are having blood work done and ask them if you need to Fast?
Randy

[flyersixer]

...i think i had maybe a cup of coffee and a spoon of sugar...probably ate a slice of bread n jam...  it seems very striking that that could have this dramatic of an impact on my enzyme levels.  Especially since they (the hospital) claimed fasting for a liver function test was not necessary.

[rpooo]

Dude in the past year I have done 6 blood panels due to the fact I have Cirrhosis. Dont sit their trying to debate me about weather i'm right or not. The test is no good since you were not fasting. The hospital was wrong and I am right. It will have a huge imact on your levels. You seem very worried and I understand, do you know that one of the things that is great about Medhelp is that you can post your questions to real Doctors for the best answer the can give you. Be sure to give them as much information as you can so that they may be able to give you a more accurate answer. To do this go to "forums" then select "ask a Doctor". After you get your answer come back here and appologize. Ha ha I love being right. You are going to be fine buddy.

[Sam200819]

I highly doubt that you have cirrhosis (from alcohol) from the history you have provided. I am not a medical doctor nor in the medical field but my recommendation is to have further testings done. Good luck.

[mikesimon]

Not fasting would not result in an ALT of 229. I don't think fasting has much impact on liver enzymes and I have tested a lot. I usually fast because they want to see a fasting glucose. I have tested without fasting and I saw no significant change in my liver enzymes from lab draws when I was fasting.

"....To confuse issues even further, there are many other factors besides liver injury that could affect the levels of AST and ALT. For example, males have higher transaminase levels than females. And, African-American men have higher AST levels compared with Caucasian men.  Even the time of day that a blood sample is drawn may influence the level of transaminase elevation. People appear to have higher transaminase levels in the morning and afternoon than in the evening.  Food intake does not appear to have a significant effect on transaminase levels.  Thus, levels do not significantly differ in the fasting and non-fasting state.  Finally, transaminase levels may vary from day-to-day...."

See: http://www.liverdisease.com/liverenzymes_hepatitis.html

Mike

[flyersixer]

i'm not arguing.  just letting u know what was consumed and what was told to me at the hospital.  And you input is appreciated.  ...apologize?...um, no. that's a little unnecessary.  

[flyersixer]

well, my whole history goes back about 9 years.  I basically drank daily from age 19-21.  at 21 I was hospitalized with pancreatitis.  after that...the drinking stopped...but for the next two years there was very heavy opiate use...daily.  however...from age 23-26 I was sober completely.  from 26 until 28 (present)...i'd go on 4 month binges of about 6 beers at night...but i'd take about two months off after every binge.  So...that's a more clear picture of the history.

[rpooo]

Opiates are not broken down through the Liver. Thats one of the good things about them exspecially for people like me who deal with alot of pain due to Cirrhosis. There really is no point to discussing this any further. I told you how to contact a Doctor for more professional advice. Good luck.

I did not say that you were argueing with me but that "you were trying to debate weather i was right or not".

it seems very striking that that could have this dramatic of an impact on my enzyme levels.  Especially since they (the hospital) claimed fasting for a liver function test was not necessary. <------Your Words.

[bella106]

Hi

I had hodgkin lymphoma and am in remission since 2006.  I get blood work every 6 months.  I had a cat scan done due to abdominal pain.  Here are my results:

The liver is homogeneous in appearance but reveals decresed attenuation consistent with fatty infiltration.

ALP: 63
ALT: 25
AST: 29
TBili: 1.7
ALB: 4.60
TProt: 8.10

Should I be worried about this?  Doctors tell me no, but I do not know.

Thanks

[rpooo]

Hi Bella,
I sorry I dont know anything about Hodgkin Lymphoma but I can tell you that your panel looks great! Your Total Billirubin is a little high. I would asume this is due to the hodgkin lymphoma. Rest your mind and listen to your doctors. Sure seems like you are doing just fine. If you are still worried then direct your question to a doctore that you can find here at medhelp. Do you know that one of the things that is great about Medhelp is that you can post your questions to real Doctors for the best answer they can give you. Be sure to give them as much information as you can so that they may be able to give you a more accurate answer. To do this go to "forums" then select "ask a Doctor".
I hope thishis out. Randy

[bella106]

Hi Randy,

Thanks!  I am just worried with all that "Fatty liver and decreased attenuation" stuff.  I sent a message to Dr.Kevin and am waiting to hear from him.  Do you think I should worry?  Or have a liver biopsy?

Thanks,
Bella

[bella106]

Also, Randy, thanks for getting back to me ;)

[rpooo]

I dont think you need to worry at all bella. your Bilirubin is the only thing elevated.  Your Doctor is your friend and has no reason to keep anything from you. Trust what he has to say, he really wants the best for you and has gone through all the trouble to educate him/her self to help you. Having a biopsy taken from an organ is a very extreame measure to be taken based on your blood panel. Listen to your Doctors relax and enjoy your weekend! :)
Randy

[bella106]

Thanks, Randy!  When I ask about "fatty liver and decreased attenuation" from my doctors, I feel like I do not get a straight answer.  I just worry because I had chemo and radiation.  Do you know what "fatty liver and decreased attenuation" mean?

Thanks for your time ;)

[rpooo]

Bella,

Yes I am aware of what those terms mean.  Any part of your body can get fat not just our bellys hips and thighs.  Unfortunately an organ can get 'fat' as well- especially the liver.  The decreased attenuation just means that during your scan certain parts of your liver didn't appear as bright as others which can be from things like a malfunction in the machine or abormalities from things like the fat.  People who are in their 40's or older naturally get fatty livers just based on years of a certain diet or having any alcohol or stress to the liver, this is fairly common past a certain age.  Knowing you have a fatty liver is just a reason to behave, eat a wall balanced diet, and don't do the bad things like take too many of the wrong kind of pills, drinking or smoking.  It's also smart to make sure you don't develop hepatits.  A liver can not develop cirrhosis on it's own, it has to become a fatty liver first.  It is the fat in the liver that hardens causing so many problems which does not happen easily- usually by alcohol, hepatitis or certain medications.
I think it's very smart to continue to get tested as often as the doctor recommends.  They're just wanting to keep an eye on your levels because so much can be caught early.
I truly hope this helps you feel more at ease over your test results.

Randy

[mikesimon]

Opiates are metabolized in the liver and any hepatic impairment should be considered when prescribing them.


"...Opioid metabolism takes place primarily in the liver, which produces enzymes for this purpose. These enzymes promote 2 forms of metabolism: phase 1 metabolism (modification reactions) and phase 2 metabolism (conjugation reactions). ....."

"Hepatic Impairment

The liver is the major site of biotransformation for most opioids (Table 4). It is therefore not surprising that the prescribing information for most frequently prescribed opioids recommends caution in patients with hepatic impairment.10,11,13,14,17,18,43 For example, in patients with moderate to severe liver disease, peak plasma levels of oxycodone and its chief metabolite noroxycodone were increased 50% and 20%, respectively, whereas the area under the plasma concentration-time curve for these molecules increased 95% and 65%.11 Peak plasma concentrations of another active metabolite, oxymorphone, were decreased by 30% and 40%, respectively...."

"Hepatic impairment may also affect metabolism of opioids that undergo glucuronidation rather than CYP-mediated metabolism, such as morphine and oxymorphone....

"Currently, no comparable data exist on metabolism of oxymorphone in patients with cirrhosis. However, hepatic disease may certainly have significant effects on oxymorphone pharmacokinetics. Specifically, the bioavailability of oxymorphone increased by 1.6-fold and 3.7-fold in patients with mild (Child-Pugh class A) and moderate (Child-Pugh class B) hepatic impairment, respectively, compared with healthy controls. In 1 patient with severe hepatic impairment (Child-Pugh class C), the bioavailability was increased by 12.2-fold.18..."

See:  http://www.mayoclinicproceedings.com/content/84/7/613.full

[mikesimon]

You said: "...A liver can not develop cirrhosis on it's own, it has to become a fatty liver first.  It is the fat in the liver that hardens causing so many problems which does not happen easily- usually by alcohol, hepatitis or certain medications...."

That is not accurate.

Not all cirrhotics first had a fatty liver. Many, and maybe most, went from a healthy liver to a liver with fibrosis and in time progressed to a cirrhotic liver. That is what happened to me because of hepatitis c and to a lot of people I know. I think the same course of progression is seen in hepatitis b and autoimmune diseases such as PSC and PBC and autoimmune hepatitis. Fatty liver isn't a universal component of cirrhosis.


Mike

[rpooo]

I apollogize, it's fatty or fibrotic cells that are present before Cirrhosis is developed. It's still corrupted cellular activity.
Mikesimon, I do appreciate your pointing out I have yet to better educate myself on the topic Speaking about topic in your last two posts nothing you have said is directed to help the poster. Infact the only other post you have made to this thread barely speaks on the topic, you just trail right off.....
This not what we are about here at Medhelp. Our goal here is to post using the best of our knowledge to help the poster and never to partake in a thread when the only intention is to verbally bash other posters.
You seem very knowledgeable perhaps you could shed some light with all your great wisdom and knowledge. Thank you Mike.


Randy

[flyersixer]

thanks for sending that useful insight to my inbox where it's easy to find.  

[mikesimon]

Flyersixer - you're quite welcome.

Rpooo,
The purpose here is to provide support, good advice and accurate information. When I see inaccurate information I attempt to correct it.

Mike

[rpooo]

Yes Mike, I agree and again I thank you. We are not doctors because we have not gone to school for 8 years to be educated by other proffesionals. We can read all day long but at the end of the day what we have learned is only as good as our abilities to interpetate. Anyone posting here I hope they are aware of that and if a professional opinion is what they are seeking then the options to ask a doctor is available to them. I do not post here to have my opinion approved by you. So your opion would be more appreciated by the poster. Focus Mike, Focus!

[mikesimon]

I never intimated that you need my approval.
I pointed out that your information was incorrect.
If that offends you then perhaps you should be more careful and do some research before you post.

Mike

[rpooo]

I try every day Mike.

[mikesimon]

That's good Randy. It is obvious that you do study this stuff.

Mike

[AnnaMariaQQss]

Those don't sound like your opinions BUT RATHER looks like a real fast COPY & PASTE JOB-not TRUE advice nor opinions given by your thoughts, so therefore-ITS MY OPINION that the information you give is simply DATA obtained by google and HAS LITTLE IF ANY value to the :poster" here. I'm fairly educated with GOOGLE-COPY & PASTE also, thus if someone wanted those types of answers they would do just that!

No verbal attack meant to anyone-but I'd most certainly gave to agree with Randy here-if one seeking advice and or opinions can't understand the tec. answer, then it's deemed UN-VALUABLE INFORMATION! So the research as you called it isn't needed!

Kudos Randy for taking the time to give "self help advice" as it's a personal sacrifice from you and truly was heart felt! XOXOXO  

[mikesimon]

Your agenda is quite transparent.
My posts were intended to correct some misinformation and I believe that they did that.
When I copied and pasted I provided the links to the articles so I made it clear where I got the material. I never tried to suggest that the material was mine and I thought the information  was easy to understand.
Does pasted material from reputable sources make it less credible? I think not.
I see you are a friend of Randy's and I also see that you're a new member.
And it's understandable that you would try and support him. You should read the thread close[y and see what was said before you start pushing your agenda.
It is good to give heartfelt advice but the information should also be correct.
I think accuracy is the most important factor and that is what I addressed here.

Mike

Mike

[rpooo]

Sorry Mike your always wrong and I'm always right. Thats just they way it has to be. It's cute when you try though. ha ha j/k How ya been doing buddy? I hope everything good your way! I'm glad to see your still always out here! Take care my friend.
Randy

Anna your also very sweet for what you had to say, I really apreciate you noticing I try to to be as heart felt and accurate as I can for such wonder people such as yourself. Mike is also a very good guy and talented with helping out here on Medhelp. I think this was the first post we ever posted together on.Our overall goal is the same. :)
Randy

[mikesimon]

I've been well Randy and thanks for asking.
I saw your posts on the liver transplant board so I think I have a inkling of how you're doing.
I always wish you the best and I know it can be a tough road at times.
Just keep doing what you're doing and let's hope your situation improves rapidly.

Be well,
Mike