LIVER DISORDERS COMMUNITY
Should I be concerned about bile duct blockage?

Should I be concerned about bile duct blockage?

I have rheumatoid arthritis, lupus, hypothyroidism, and osteoarthritis. About 15 years ago I had my gall bladder removed.  For the last three years I have suffered from increasingly debilitating diarrhea and vomiting.  I have been hospitalized four times in the last two years for acute gastritis. In December I was once again in the emergency room for acute gastritis.  In the last 4 months I have had an abdominal sonogram, CT scan, and MRI.  My GI doctor (whom I’ve seen for years) referred me to a liver doctor after reviewing my blood work:    
     ALP-  254       AST-  228        ALT-  124         GGT-   NA       Direct Bilirubin –    NA      Bilirubin-   NA        
The liver doctor diagnosed probable autoimmune hepatitis.  He ordered a liver biopsy which came back negative.  The liver doctor ordered new blood work.  The results are below:
    ALP-  235     AST-   230     ALT-  244    GGT- 369     Direct Bilirubin- 4.0      Total Bilirubin-  7.2                        
The liver doctor then referred me to a bile duct specialist.  The bile duct guy reviewed my CT scan and said he disagreed with the original radiologist and said he believed that I had a bile duct blockage.  He did an ERCP and found my primary bile duct pretty much blocked at the ampulla.  He opened the sphincter muscle, removed the blockage and sent a sample to be biopsied.  The biopsy showed no malignancy.  One month later, most of my liver enzymes have declined:
  ALP-  369       AST-  48        ALT-  67         GGT-  509        Direct Bilirubin-    0.3   Total  Bilirubin-  0.9            
I had been led to expect all of them to decline.  The ALP and the GGT, however, have increased.  What would cause these values to continue to increase?  I am in the process of scheduling a follow up ERCP (requested by the bile duct doctor if the biopsy results came back negative).  Is there likely to still be a blockage in one of the lesser ducts?
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Avatar_m_tn
I don't know how quickly ALP and GGT normalize once the blockage is cleared but your bilirubin looks as if the bile is getting through - your direct bilirubin is just slightly above high normal on the lab sheet I'm looking at. Mine says < .3.

I think you are wise to be extremely vigilant.
Things certainly look a whole lot better except for the ALP and GGT and that's encouraging.

Good luck,
Mike
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