What could cause continually mildly elevated liver enzymes?

[njtopa77]

Hello, I was wondering if somebody could help me find causes for my mildly elevated liver enzymes. It started with blood work that showed my ALP at 188 (normal u/l 115) and my other liver enzymes normal. I was asked to retake two weeks later and ALP was at 231, AST was at 43 (normal u/l 30) and ALP was at 54 (normal u/l 29). My doctor ordered an ultrasound which showed 3 lesions and questionable fatty liver. He also tested me for all three HEP viruses which came back normal (no virus). He recommended me to go to a GI. The GI ran a multitude of blood tests - IGA, IGM, smooth muscle, AMA, ceruloplasmin, ferritin, the irons, markers for celiac, markers for arthritis, bilirubin, albumin, etc and all came back normal. He also ran the alpha fetoprotien marker for the lesion which came back normal. But now my ALP is at 213, AST is at 40 and ALP is at 59. He's suggesting another blood test next week and if still elevated a liver biopsy. We are waiting for MRI to be approved to figure out lesions as well. I'm not taking any medicine and the only thing I've changed since the second blood test is I started taking tumeric and milk thistle which apparently had no effect either way to help my liver. Anybody know any other causes other than fatty liver - I don't have the characteristics for it. No alcohol for normal fatty liver. No obesity, diabetes, high cholesterol, metabolic syndrome for NAFLD. Thank you for your help.

[njtopa77]

And I'm very sorry to hear about your PSC. I wish you the best and hope that with a liver transplant you will be well again.

[njtopa77]

I thought it was PBC at first as well even though both doctors told me it wasn't (it has a genetic predisposition).  I don't think it's constricted ducts - all my bilirubins were well within normal range - total was .6 (range .2-1.2), direct .1 (range <.2) and indirect .5 (range .2-1.2). I think that's why they want to perform the biopsy, the blood work is showing any of the normal causes. But I was wondering if there was other causes I hadn't found in my research. It could be fatty liver from all I read but since I don't have the normal characteristics for that, I was trying to find other potential causes.

[fntn]

I just noticed that you did get tested for AMA and it was negitive. This means that you do not have PBC. Another possibility that I forgot to mention is that the liver lesions that you have are constricting some of your intrahepatic bile ducts. This will usually cause a mild elevation in your bilirubin and tends to cause elevations in you AST and ALT levels, as your hepatocytes are injuried in the back up pooling of the bile. Livers are very complicated for sure.

[fntn]

Your numbers and situation is very familiar to me. Understand that we are not doctors here and certainly cannot diagnose. Your liver enzymes describe a chronic cholestatic disease with munimal or no hepatocytic damage.

There are two major forms of chronic cholestasis: primary schlerosing cholangitis (PSC) and primary biliary cirrhosis (PNC). I have advanced PSC, stage-4 which is end-stage (ESLD) and I am decompensated which means I will need a liver transplant soon. Men typically have PSC more often than women, and women have,PBC more often than men. But anyone can have either disease.

My doctors were very confused at first like your doctors. I am not saying that you have these disease, but they are a possibility. You are getting a MRI veru soon which is a great next step. You should insist that they include a MRCP in addition to the liver/abdm contrast MRI for the lesions. If you have PSC, then it will likely show up in the MRCP. PBC will not show any unusual in the MRCP.

Also, I was first diagnosed with a large liver lesion, of undetermined type, and they did the MRI/MRCP which helped in the PSC diagnose and also the lesion. They also did a bunch of liver biopsies which confirmed the PSC diagnoses. Your doctors may very likely want to do a biopsy on you. They are not as bad as they sound, so I would recommend one in your case, if your doctor remain uncertain about your doagnosis. Many times the MRCP will be sufficient in disgnosing PSC, the bile ducts will be a mess.

I hope this info is helpful. And I hope your doctors can pin things down for you soon. Nothing worse than not knowing what's going on in your body. Take care and feel free to ask any other questiobs you may have.