New and confused..AST,ALT & GGT results

[haljas]

Hello everyone,

Thank you for being here and I am hoping that someone out there can shed some light for me. I live in Canada, not sure where everyone is from around here.:)

I am being investigated for Liver tests, so lsat week I had AST and ALT done and to my endo's suprise they were abnormal. AST 81 u/l and ALT 133 u/l. So she wanted to do a liver panel..So yesturday we have these results: AST 99 u/l,ALT 193 u/l, and GGT 74 u/l..Should I be worried, I was told by the endo to call and get an app't with my GP, as she is not investigating me for liver issues. She is currentl;y investigating me for hormones, hypoglycemia and pitutary possible issues. So I called my GP and she said she could get me in next week...Never before has there been an issue with these blood tests before.

Everything I google leads me to alcohol or hepatitis. Confused as I no longer drink, been at least a year, and I was only a very occasional drinker...maybe a cooler a night for a couple of nights...MAYBE....

Any help would be awesome.

Thnx
Haljas

[Thomas D Schiano, MD]

from this information i think there is a distinct possibility of having fatty liver which in most people will be non-progressive.  the treatment is weight loss.  a biopsy may be indicated but there are also non-invasive markers of fibrosis. the cortisol deficiency could be contributing also

[Thomas D Schiano, MD]

the elevations are not worrisome, but you should have additional testing.  the most common of abnormal liver tests is fatty liver or related to medications. You should also have an imaging study performed.

[haljas]

Well we shall see...I will keep you posted and thanks for your help and advice....

[Thomas D Schiano, MD]

a gastroenetrologist should be fine to assess what's going on.  it still could be fatty liver.

[haljas]

Well I am seeing a gastroenterologist,,,,isn't he qualified??? What do you see in the numbers if anything??  I don't what is said here as gospil...I take in everything I read and learn from it....

Thank you

[Thomas D Schiano, MD]

i think its best that you see a hepatologist regarding your abnormal blood tests.  I know some doctors in Toronto.

[haljas]

Thanks....
So this morning when I woke up my fingers were slightly swollen and painful.. I had to take off my engagement ring as the finger was getting very uncomfortable...I have also began to get flu like symptoms...Could any of this be a warning sign?? My last bloodwork was not good again...Here are the numbersactually here are the entire list over the lsat 2 months...
AST 113 68 45 92 54 41 57
ALT 205 130 95 165 123 95 117
Alk Phos 96 101 95 91 98 101 104
GGT 105 114 78 66 73 78 60
LDH 235 198 170 202 178 183 278
ALB 42 40 38 38 37 38 39
Bilirubin 7 5 5 8 8 7 9

Is there anything about these numbers??? Also CT scan was normal, and ultra sound was also normal....

I live in Canada...so anyone who can help ...please....I get Upper right queadrant pain,,,,also spreads across to my back, along where the bra strap in back would be....so right to middle pain...I am getting freaked out here.....

Thanks

[riqyboy]

HALJAS i dont know where you live but here in Indiana if you have never had a biopsy/liver transplant before they usually put you out. point being after you have a transplant many of the nerves are cut and you dont feel mech. i've had three within a three week time limit. i have never had a transplant before my surgey but kow of two people who have had them with no surgery and both were put under. hope that helps.

[Thomas D Schiano, MD]

it would prognosticate and let us know how much scarring there would be and if its plain fat versus steatohepatitis (has more problems with scarring).  Also, there are rare causes of liver conditions that might only be seen on a biopsy if the blood tests are negative for a cause.

[haljas]

Oh, so a liver biopsy,,well what would that show?? Cancer??? No alcohol, no drug interferance,no hep of any kind, no HIV...possibly no fatty liver..So what else is left??

[Thomas D Schiano, MD]

a fatty liver might not necessarily show up on a scan.  if the liver tests are similar to what you outlined above they are not extremely elevated but a biopsy may be necessary.

[haljas]

So here we are now...had CT scan and that was normal, had more bloodwork done and it still show AST,Alt and GGT as high...had an ultrasound done and that was normal..had more bloodwork done and that once again shows Alt, als and ggt eleveated more then last....So what happens now? If it was a fatty liver then should it have shown on ultrasound? Getting kinda of worried now. Any advise would be great.

Thnx

[Thomas D Schiano, MD]

liver biopsies are done most often percutaneously by radiologists or gastroenterologists.  local anesthesia is used and the procedure is done with a needle.  it should not be painful.

[haljas]

Thanks ...I saw the hemotologist today and there is no blood disease which is great, BUT he was very concerned with the pattern of liver tests, and he actually called the gastroenterologist while I was there, and they discussed getting my referral bumped faster. as he believes that I should be seen ASAP.....as the pattern is increasing , and fast....so they also discussed liver biopsy...could you tell me a little of what that is and what to expect....is it painful??? Also, I asked if I should be worried and he said NO but your doctors should be.....arrgg.....

Thanks

[Thomas D Schiano, MD]

the liver tests remain elevated in a pattern consistent with fatty liver.  the lung changes are not concerning--maybe evidence of an old infection.  atelectasis means small portion collapsed lung--nothing to worry about.  the LDH is very non-specific and can be elevated with many different things inside or outside the liver.

[haljas]

Sorry AST of 113 not 13

[haljas]

So here are some results, CT scan showed no abnormalities in abdominal area. BUT it did show some mild linear increased attenuation in the lower lungs consistent with some mild scarring or subsegmental atelectasis. Could someone explain this in regular language please,,,,

Also, concering the liver, well had more bloodwork done today and AST went from 99u/l to 13;ALT was 193u/l to 205;GGT was 74 u/l to 105;lactate dehydrogenase was 212 u/l to 235.

Is the lactate the one that is for lung function??? I see hemotologist tomorrow..

Thanks

[haljas]

Interesting...thank you..I will let you know how it turns out.

[haljas]

Dr. Schiano,

Thank you, I was really freaking out. I am having a CT scan done Monday morning for my Hemotologist, as he is also investigating some unusual bloodwork. He is doing a Ct of abdominal/pelvic series. I am also going to see my GP concerning this liver panel. If it is fatty liver what happens?? What further testing? Not a biopsy?? Scared of that.

I also have cortisol defiecency. here is my list:
-Fibromyalgia
-GERD
-Hiatal hernia
-High Cholesterol (with a very low good cholesterol)
-Hypothyroidism
-Hypoglycemia
-Gastroparesis
-Osteopenia
-Endometriosis
-Tachycardia
-High RBC,High Hemoglobin
-and newly diagnosed Cortisol Deficincey

So there are alot of meds involved and yes I am overweight....5'5 weigh about 215lbs..
Now we are looking at this liver panel, which makes me very nervous.

Are there any other numbers you would need to see (blood test results), cause I have alot of them.

Thanks
Haljas