Does It All Tie Together?

[txgirl671]

In 1987 I was dx with a carcinoid tumor of the appendix that transversed the wall with cancer cells found in lower colon.  I had a hemi-colectomy with a small intestine resection.  In 1990 I was dx with Crohn's Disease.  In 2004 I began to have neurological sx.  I was originally dx with CIDP, but when a lesion was found on my cervical spine dx changed to possible MS.  No further MS criteria has been establishe
d.  I still deal with nerve and muscle pain.

My past three blood tests have shown elevated ALT/AST and increasing ALP


12/2/12 AST 191, ALP 78
12/19/12  AST 31, ALT 42 ALP 88
12/9/13 AST 46, ALT 67, ALP 111

I had a colonoscopy on Friday and it looked fairly good for my history, although I know my Crohn's in my small intestine could be active.

I have done blood work for Hepatitis and go in this morning for an ultrasound.

Any insight? Is this merely related to my Crohn's even though based on my colonoscopy it doesn't look like I'm in a flare?  

Thanks for any advice

[Dee1956]

Hi I hope you have received some information or have an appointment with your doctor.

I was thinking of you and wanted to come back to check in.

Let us know how you are doing.

Take care
D

[pooh55811]

"Is this merely related to my Crohn's"
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This article from Crohns and Colitis Foundation of America may be of interest to you:

Liver Disease and IBD

"Several complications of IBD are related to the liver and the biliary system, which are closely interconnected with the intestine. The liver acts as a “processing plant” in the body, taking what we ingest and breaking it down. It then sends some of that material to blood cells throughout the body. The rest is filtered out and eliminated as waste. The liver also produces cholesterol, acids, and bile salts that are stored in the gallbladder until they are required to help break down digested fat. The function of the bile ducts is to transport bile or waste from the liver to the upper small intestine. The pancreas, which is connected to the same common bile duct as the liver and gallbladder, also transports enzymes to the intestines to break down food.

The liver may develop active inflammation, which usually subsides with appropriate treatment of IBD. Serious disease involving the liver affects only about 5% of people with IBD.

    Low energy and fatigue tend to be the most common symptoms.
    Symptoms of more advanced liver disease include itching, jaundice, fluid retention, fatigue, and a feeling of fullness in the upper abdomen.
    Blood tests can usually confirm the presence of liver disease, although an ultrasound, X-ray, or liver biopsy may be necessary to make the definitive diagnosis.

FATTY LIVER DISEASE (HEPATIC STEATOSIS)

This is the most common liver complication of IBD and a relatively harmless one, affecting people with ulcerative colitis and Crohn’s disease equally. However, the condition also is linked with many other unrelated conditions—including pregnancy, diabetes, and obesity. Fatty liver is caused by an abnormality in liver metabolism that results in the accumulation of fat. Because it is a fairly minor problem and causes no symptoms, it generally does not require any treatment. It also does not progress to chronic liver disease. In some cases, doctors may prescribe steroids for steatosis.

PRIMARY SCLEROSING CHOLANGITIS (PSC)

This condition is a particular form of severe inflammation and scarring that develops in the bile ducts. About half of all PSC patients have IBD. PSC occurs more frequently in people with ulcerative colitis than in those with Crohn’s disease, affecting men more than women. Symptoms include jaundice, nausea, weight loss, and itching. PSC may not improve with medical treatment for IBD and may ultimately require liver transplantation. The cause is not known and there is no effective medication for PSC. To correct severe narrowing of the bile ducts, a balloon-tipped tube may be inserted into the duct to enlarge it. Fortunately, the incidence of PSC is rare among people with IBD: Only about 3% of ulcerative colitis patients (and those are individuals with extensive disease) and 1% of Crohn’s disease patients develop this condition. On extremely rare occasions, cancer of the bile ducts (cholangiocarcinoma) may develop. There is also an increased incidence of cancer of the colon in IBD patients who have sclerosing cholangitis.

GALLSTONES

The gallbladder is a sac attached below the liver to the common bile duct. Gallstones form when bile (the liquid stored in the gallbladder that is used to help the body digest fats) hardens into pieces of stone-like material (mainly hardened cholesterol). When stones block the mouth of the gallbladder, they may cause severe pain— particularly after eating fatty foods. Gallstones occur in 13% to 34% of Crohn’s patients with disease of the terminal ileum (the last segment of the small intestine). This group is at increased risk for developing gallstones because the diseased terminal ileum cannot absorb bile salts, which are necessary to allow cholesterol to dissolve in bile. Ultrasound confirms the presence of gallstones. Treatment for symptomatic gallstones ranges from medications to surgical removal.

PANCREATITIS

In some cases, this inflammation of the pancreas may be related to gallstones. In others, it may be a side effect of immunomodulators or mesalamine used to treat IBD, requiring discontinuation of the drug in question. Even after the pancreatitis is resolved, the drug should not be reinstituted. If gallstones are the cause, a stone may have passed down the common bile duct to the area where it joins the pancreas. Symptoms include severe abdominal pain, nausea, vomiting, and fever. Surgical removal of the stone resolves the inflammation.

CHRONIC ACTIVE HEPATITIS

Hepatitis is a generic term for inflammation of the liver. Chronic (long term) hepatitis can be from inflammation of the liver itself related to the IBD, called autoimmune hepatitis.   It is treated with the same kinds of medicine that ulcerative colitis and Crohn's disease are treated with to decrease the inflammation. Hepatitis can also be from viruses like Hepatitis A, B or C infection and should be treated the same as in patients without IBD."

http://www.ccfa.org/resources/liver-disease-and-ibd.html

[txgirl671]

Hi Dee,

Thanks for the response. I have not heard anything back on the blood work yet.  I think my doctor may be waiting to get everything back before calling me.  The ultrasound tech said it should be sometime this week when the report is sent over to my doctor.  

Thanks for the advice on the diet.  I actually drink a lot of water. I gave up diet sodas about 4 months ago and have replaced those with water.  

I take Asacol daily for my Crohn's disease and Zanaflex to deal with the muscle spasms caused by a lesion on my spine.  When I have a Crohn's flare they add prednisone.  

You read it correctly.  The AST was much higher a year ago.  I think my doctor wanted to pursue the testing because even though the AST came down significantly it is still a little high but now the ALT is also elevated. I haven't actually spoken to my doctor yet.  They posted the test results in my on line account along with the note to come back in for the follow up blood work and schedule the ultrasound.  When I called the nurse she said the doctor would call me when all the results came back in.

I really appreciate you responding.

[Dee1956]

Hi I wanted to say I am sorry for what you are experiencing.  Did you receive the test results back for the Hepatitis? I am not saying that  you have it, just curious.

I may be reading wrong but it looks like 12/2/12  your AST was 191,  on 12/9/13 it was 46 that is not bad, unless I am reading it the wrong way.

Assuming I am reading wrong, are you on any medication? Medication can increase the liver enzymes.  Unfortunately that is what my doctor thought for 15 years, when my liver enzymes were slightly elevated, he assumed it was one of my medications. Or...maybe he thought I was drinking and did not say.

Without knowing too much the first thing I would suggest is start drinking water to help your liver function better.
Cut out all processed foods, like lunch meats, frozen dinners, etc.
Try, as much as possible to eat vegetables, fruits,  chicken, fish.

Try to be as kind to your liver as you can.  Everything that you eat, drink, put on your skin and in your eyes has to be processed by the liver.

The liver can get overwhelmed, inflamed, irritated and enlarged.

I am sure others will be a long soon to help.  Please stay in touch, let us know how you are doing.

What has your doctor said about  your concerns?

Take care
Dee