Elevated Liver Enzymes?

[ChristineL1969]

My husband (48) went to the Dr a couple of weeks ago because he had been having some black diharrea...the Dr assessed it as probably a bleeding ulcer and put him on some medication.  During that exam, blood was taken and came back w/elevated liver enzymes and an ultrasound was ordered.  The ultrasound was 'clear' and a physical was scheduled.  They told him at his physical that his enzymes are 'very elevated' and in looking at his blood test results we see that his ALT-SGPT (which they list the normal ref to be 40-60) is 270.  It also showed his AST-STOT (which they list the normal ref to be 17-59) is 134.  Can you tell us what this may mean?

[LivingInHope]

I wonder why the doctor did not send your husband to a gastrointestinal specialist for an EGD scope diagnostic procedure, since he/she suspected your husband to have an ulcer?  Did the doctor order a blood test for h. pylori since he/she suspected an ulcer?  

While black tarry stool can be a sign of hidden blood in the stool, did your husband's stool test positive for occult (hidden) blood there in the office?  In the blood tests ordered, was a complete blood count and iron testing done, since the doctor suspected a bleeding ulcer?  

I have A Manual of Laboratory Diagnostic Tests, 2nd edition by Frances Fischbach.  It lets a person know highly elevated ALT/SGPT are found in.  It also lists what mild and moderate increases can mean, but I want to focus on what says high increase in the book can potentially mean and also where it doesn't specify a low or moderate amount of the elevation since it was so high:
('hepat...', just so you are aware, has to do with the liver)

"Hepatocellular disease (moderate to high increase)"
"Infection or toxic hepatitis"
"Liver congestion"
"Hepatic injury in myocardial infarction complicated by shock"  (myocardial infarction= heart attack)

It says:
"B. SGOT/SGPT comparison"  
paraphrasing here:
                 1. The AST level is always elevated with an acute heart attack, but the ALT does not always go up in proportion to it.

                  2. The ALT/SGPT is typically elevated to a larger degree than the AST with acute biliary obstruction originating outside the liver.  

(There is a biliary duct system in the body.)

It lets a person know there are a number of medications that can falsely increase ALT/SGPT.

Increased AST/SGOT it says can happen with :

heart attack,
liver disease (a few listed),
acute: inflammation of the pancreas (pancreatitis),
hemolytic anemia
(this type of anemia a website says diagnosed typically with red blood cell and hemoglobin measurements),
kidney disease,
'trauma and irradiation of skeletal muscle',
'severe burns',
'cardiac catheterization and angiography',
'recent brain trauma' with death of tissue in the brain,
'crushing injuries' and
'progressive muscular dystrophy'

Again with AST/SGOT, there are a host of drugs that can cause levels to be increased as well as vitamin A.

[mikesimon]

His elevated liver enzymes (ALT & AST) suggests that something is going on with his liver. Without knowing a lot more about him I couldn't even guess what's going on. If your husband is over weight then fatty liver disease might be involved. Frequently when a patient presents with elevated liver enzymes the doctor will order tests to determine whether viral hepatitis is the cause - Hep A, B, C etc. Once viral hepatitis is ruled out then other possibilities are considered.

I do not want to alarm you but black stools in a patient with elevated liver enzymes makes me wonder about varices. Varices are distended vessels in the esophagus and/or stomach which develop because of changes in the liver. These varices can leak blood and can cause black stools. I had very bad varices which suddenly burst and caused a major bleed. I had Hep C but, until that bleed, I had no idea that I was sick at all. Varices is just something I'd want to rule out. There are treatments to manage varices to insure they don't leak - banding is one technique. It's a relatively easy procedure so don't panic.

I think you might want to be seen by a hepatologist(liver specialist) if one is available. If not then a gastroenterologist would be the next best doctor to see. I would not want a PCP to handle this without the aid of a specialist.

I want you to know that I am not in the medical profession in any capacity. I am a patient who had Hep C and has learned a little along the way.

I wish you good luck,
Mike