Results from Liver/URQ Ultrasound - Still a bit confused

[ksilv]

Hello, looking for your opinion doc and anyone else who may have some thoughts. I was the one who posted a topic back in April "Elevated Liver Enzyme Concern, Pls help"....

Well, I FINALLY got to see the Gastroenterologist and also completed my ultrasound exam and panel work up. Here were my results from a few months ago:

ALT 97
GGT 103
Bilirubin 1.9
All others within normal range

6/15 labwork

All enzymes returned to well within normal EXCEPT ALT still "a bit" high according to doc at 84. Everything in the blood looked okay besides this one enzyme. Hep was negative.

Abstained from alcohol completely for 2 months between labs.

ULTRASOUND RESULTS - Liver, Gallbladder, pancreas all looked "perfectly normal".

While this is a relief, I'm still a bit confused. The Specialist sees no need for concern - I am still a bit concerned because ALT is still not normal, so there has to be something going on, right??

While I have no problem abstaining from alcohol, I do occaisionally like to go out with friends and have a beer or have a glass of wine with dinner with my wife.....never to the point of binge drinking - do I have to cut ALL alcohol out or not....I do not want to drink at all if it will have a truly damaging effect on me...however if it is okay I would like to not have to feel like I'm killing myself if I have an occaisional drink. Do you have any thoughts on this? Or on what could be going on to still have my ALT a bit high after 2 months of abstaining?....How high is 84 anyway?

The doctor does not reccomend any further testing at this point.....????

Would love your thoughts, thank you very much.

[Kevin Pho, MD]

I cannot make any specific recommendations without evaluation.  

The ultrasound would rule out many of the major structural or anatomical causes of liver or gallbladder dysfunction.  I would also checking blood tests looking for viral hepatitis.  

An ALT level if 84 is only mildly elevated - and is not high enough to warrant a liver biopsy.  Abstaining from alcohol temporarily is an option to see if this has an effect on the ALT.  

If all the tests remain negative, simple observation by drawing serial ALT levels periodically can be considered and discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[ksilv]

He has not commented yet on alcohol intake.....I'm hoping to get some recommendations when I follow up with him, hopefully next week.

[Linda J]

HI there, you say your doctor is not interested in further testing. What did he tell you then about alcohol intake? Does he recommend any follow-up liver panels down the road?

I don't blame you for being concerned, although the ALT does not seem all that high (yet above "normal").

Linda J

[ksilv]

The 97 was from bloodwork a couple of months ago - then I abastained from alcohol for 2 months and RE-TESTED before my ultrasound....the results were normal EXCEPT for an ALT of 84 in the second test. The level had come down but is still not in the normal range.

[Kalio1]

The point is, if you stop alcohol completely and give it time and it normalizes then you know why it was high. No, I am not saying you get sloshed at all, I am saying that some people can not tolerate alcohol as well as others, even in small amounts. If stopping it is working and your ALT is going down (although not as fast as you would like) you have pretty hard proof you are sensitive to alcohol as your liver is telling you so by reacting and inflamming, which raises enzymes, then you stop alcohol and they begin to go down. You are fit and work at your health and nothing else is out of whack which is why the doctor says to do nothing and keep an eye on it.  To try to get to the bottom of why it is high, go through a process of elimination, start with alcohol, you have done that, it's working. If you don't drink or rarely drink and not drinking at all it has gone down 13 points in 2 months, to me it seems like what you want, a lower ALT. I say give it 6 months no alcohol and recheck, if it continues to go down, there is the reason. Maybe it won't work more than the points it has already fallen since you stopped but if you don't try you won't know. If it does keep going down then you know that you are very sensitive to alcohol and you have the benefit of modern medicine telling you YOUR liver stresses when it has alcohol, even in small amounts. It is a misconception that you have to "slosh it down", different amounts affect different people differently.  
Some people's bodies "handle" alcohol better than others.

[ksilv]

I appreciate your thoughts.........I like to have an OCCAISIONAL beer with friends or a glass of wine once in a while with my wife when we go out to dinner - this is suggestive of an alcohol problem?? Not like I'm getting sloshed every night??

Literally, "a beer" or "a glass of wine" once or twice a week is a problem?

[Kalio1]

If your ALT has gone down and the only change you made was to stop alcohol, that indicates that alcohol is probably the reason your ALT is high. Two months is not very long, it can take many months or longer for the ALT to return to normal after drinking for many years.
You stop drinking, it starts going down. The two seem connected and not drinking has already brought it down some. Now you want to drink again and are thinking about drinking again? Why? Do you need to drink that badly? If so, then that issue should be addressed. If you are just waiting for the day you can drink again that indicates a psychological dependence on alcohol. Why do you even want to drink when your ALT is going down since you stopped drinking? Why are you looking for some other reason other than your alcohol consumption as the reason when it seems obvious that cutting alcohol has brought it down some already. I'd bet money that if you abstain from alcohol, eventually that ALT will normalize. You have NO other issues and ALT is KNOWN to rise due to alcohol use/abuse. Didn't your doctor advise you to stop drinking and point out to you that raised ALT can be related to alcohol consumption?
Even if you don't drink large amounts, each person and their bodies ability to tolerate alcohol is different. Yours seems to be sensitive to alcohol and your liver is trying to tell you that.

[Kalio1]

I am confused, you list your ALT as 97 but you refer to it in your post as 84. Which is it? Here is a bit of info on AST/ALT that might help you. Just remember alcohol is a toxin and if your liver is under stress, any alcohol is hard on it.