Elevated Liver Function Tests

[cjenk919]

Dear Forum,

I recently had a routine physical done, and my labwork returned an abnormal liver function test. My results were AST: 88 (norm of 0-40) and ALT: 58 (0-55). He indicated that because of the numbers were "abnormal" protocal was to follow up for Hep B and C among other tests. Each of the other areas of the LFT were returned normal.

My hep B and C tests were returned negative, to which he indicated would rule out hepatitis. As you can imagine, I have spent a considerable amount of time on this forum, and as such, wondered if an acute or newly infected person would have numbers reflective of mine AST 88 and ALT 58 in the instance of a new infection or if they would be much higher?

It is worthy of note that I am about 50 pounds overweight.

I have read that typically ALT is higher than the AST and the numbers in an acute case are generally 10 times the high end of what is considered normal? What is the testing window for tests to be considered conclusive?

Are my numbers considered abnormal, mildly elevated, high or dangerously elevated?

When do some of the tests become conclusive in terms of Hepatitis B and C - I am unsure if I have cleared the window period or not....

[mikesimon]

When I came here in 2002 I knew nothing. This place truly saved my life. There were really brilliant people here who taught me so much and got me headed in the right direction. So I try to treat others like I was treated. That's about all any of us can do.

If you do not see antibodies to HCV at 3 months I would relax about Hep C.

I could research the Hep B question but off hand I don't know the answer. Hep B is just a different animal and thankfully I have never had to deal with it. I know that it behaves differently than HCV but beyond that I don't know much. My basic understanding is that the antigens which are initially detectable disappear and then they test for antibodies to a different antigen. I would assume that your doctor knows this stuff and has tested you correctly but I have also learned that people do make mistakes and I trust almost no one these days. I try to verify everything I am told.

I'm sure you know about liver enzymes. Your numbers are just not that high but I can relate to being concerned about anything out of range. I'd guess that once viral hepatitis is ruled out you'll undergo some type of imaging test(s) - probably an ultrasound. You'll get it figured out and then you'll get it straightened out.

Good luck,
Mike

[cjenk919]

Mike,

Firstly, I have read some of your other posts, and there is no question that you are quite knowledgeable in this area, and I think we all know that as patients, we communicate with our doctors enough, and do enough of our own homework to be able to give highly reassuring opinions.

I have a quick follow up question is you are ok with it, based on your statement regarding the HBsAG test - I had the test done 8 days after exposure, nine weeks after exposure, and 12 weeks after exposure. Is this conclusive at this point?

I ask this question because it sounds like a later stage in the acute phase, the disease will no longer be detected. I wondered if my testing throughout the first 90 days negates this somewhat?

In temrms of Hep C I have had the same testing frequency, 8 days post exposure, nine weeks after exposure, and now 12 weeks (84 days). From your post, it appears that I could be covered.

In terms of my liver function, thank you for you reply, when you spend a considerable time on the net, you see some pretty scary things with regard to liver function. Naturally, I have further testing going on with my doctor, but I was trying to rule out Hepatitis, especially in the acute phases and how they would impact testing.

I am sorry for restating a few things, and for asking a few more questions.

Thank you for your reply! The prob with this forum is that it is annonomous, so I guess i will just have to pay your kind gesture forward by spreading sound information....

[mikesimon]

"It is worthy of note that I am about 50 pounds overweight."
If you exclude viral hepatitis then fatty liver is something you should consider.

"What is the testing window for tests to be considered conclusive?"
Hep C antibodies can take up to 2-3 months from the time of infection to appear.
Hep C RNA can detect hepatitis C in 1 week or 2 from the time of infection.
I assume that you were tested for Hep C antibodies.

"Hepatitis B is diagnosed by detecting one of the viral antigens (HBsAg).....
Later in the acute disease, HBsAg may no longer be present, in which case a test for antibodies to a different antigen—hepatitis B core antigen—is used. If HBsAg can be detected in the blood for longer than six months, chronic hepatitis B is diagnosed.
(http://medical-dictionary.thefreedictionary.com/Hepatitis+b+antibodies)..."

If you had a recent exposure risk then it's possible that your tests might not be conclusive for either virus - Hep C or Hep B. If you haven't had a recent risk then I would assume the tests are valid and that you are not infected with viral hepatitis.
Since you are overweight I would try to rule out fatty liver because that is a rather common liver disease and particularly so in overweight patients.

"Are my numbers considered abnormal, mildly elevated, high or dangerously elevated?"
I would not characterize your enzymes as significantly high or dangerous. Your AST might be called moderately high and your ALT slightly elevated. I have seen a lot higher enzymes in people who recovered and got very healthy so do not panic about your numbers. Find out what is causing these elevations and address the disorder.

I am not in the medical profession in any capacity. I am only a patient so my opinion really isn't worth much.

Good luck,
Mike