Elevated ALT and GGT

Sorry my background and question is very long winded. - Part One

The problems started over a year ago when I went to the doctors with a rash on my upper arms, face and scalp. He prescribed many different treatments all of which didn’t work before referring me to a dermatologist. She ordered some blood tests which showed raised liver enzymes with both ALT and GGT in the 90’s. She diagnosed me with seborrheic dermatitis on my face and scalp with chronic urticaria on my arms. I have been taking Fexofenadine for the chronic urticaria which is meant to burn itself out after 12 to 18 months. In March 2010 I had my appendix removed after which the doctor described it as a nasty case of appendicitis with the appendix having a sloughy surface.

Since then I have had numerous blood tests to work out the cause of the elevated liver enzymes and all of which have come back negative. Because of this I have been referred to a Gastroenterologist who has sent me for an endoscopy, ultrasound on liver and thyroid plus barium follow through, all of which have been negative.

I am still experiencing the same symptoms of uncomfortable irregular bowel movements, pain after eating red meat or high fat foods (I have changed to a low fat diet on recommendation which has helped a little), constant mouth ulcers and discomfort in bottom side of right ribcage when lying on my right side. I am also experiencing pain around the left hand side appendix scar when I stand up for any length of time or walk any great distance.

I am a 22 year old male in the UK, who is a non-drinker and non-smoker who has been taking Citalopram for about a year but is now taking Venlalic for depression with anxiety.

I am still suffering with the seborrheic dermatitis and chronic urticarial both of which I cannot seem to shake off. My ALT and GGT are still raised in the 90’s over a year on.

[Thomas D Schiano, MD]

one does not have to be fat to have fatty liver.  however, mild fatty liver can be seen in other conditions such as wilson's disease, celiac disease and as a nonspecific finding in people having collagen vascular diseases.  i would seek consultation with a rheumatologist or at least have serologies checked to r/o SLE, etc such as an ANA.

[Football10]

Part Two

Three months later I visited the specialist. After a long discussion with the specialist, her best guess at a diagnosis was Non Alcoholic Fatty Liver Disease. She then referred me for a repeat ultrasound on my liver and abdomen to check again for abnormalities and fatty deposits. These were normal and showed no abnormalities. A repeat blood test still showed two enzymes, ALT and Gamma GT to be slightly raised. A Flexible Sigmoidoscopy was then performed and the results were also normal. In early June I then had an ultrasound guided liver biopsy, the results have just come through the post and quoted in the letter reads that “essentially it shows some fatty infiltration in the liver, as we discussed in the clinic, but no other changes at this point”.

I am around 183cm in height and weigh around 85kg. I am only slightly overweight and aged just 22.

My question is how can I be deemed to have a fatty liver when I’m not severely overweight or very old? I am still suffering with all the symptoms I originally described plus I now find myself sleeping during the day and being awake at night. I am also still eating a reasonably low fat diet. Is there an underlying reason why there would be fat in my liver?    

[Football10]

Thanks for your response. I recently spoke with my GP and raised the questions you posted. I have been tested for Wilson’s disease, Celiac disease and ANA all of which were negative. She was unwilling to refer me to a rheumatologist as she deemed it unnecessary. Are there any other possible reasons or is it just that I have a fatty liver without being overly fat or overweight?

[Thomas D Schiano, MD]

this can be a familial issue.  stop all alcohol use and medications and adopt a regular exercise program and let's reassess.