elevated ALT and AST

[Lanabk]

For almost a month and a half now I have been feeling sick nausea and fatigue when i went to the ER they found that my ALT is 1890 and AST 780  and direct bili was 1.2 little jundace and dark urine .I am a nurse I don't drink any alcohol or use any drugs..I use only ibuprofen when needed for pain. my Dr. i will be having liver biopsy next week and Iam kinda worried I don't know what could it be.. HEP ABC came back negative and they suggest I have an Autoimmune hepatitis.. what do you think?


This discussion is related to GGT, AST � ALT high.

[h_g]

Please help what is SODs, and where does it start and how, my daughter 24 yrs old, in 2012 was diagnosed with patchy liver calcification when she had a CT for bloating, pains under breast bone and above naval plus finding hard o relieve from gas, and the doctor said IBS had a gastroscopy said mild gastritis,noted if have dairy can cause these issues, 2010 ultra sound showed no patch liver calcification , and microscopic hematuria, however last  year there was no mircorsocpic hematuria, it was clear,
26/3/15 Today she had a sharp painand was crying with a pain on left lower stomach radiating to right flank, stomach was soft, no temp or change in bowel habit, no urinary symptoms, however she had vomited two times  which looked like frothy spit,  they ran blood test dr said  ALT was 40, AST 50 slightly high , urine showed moderate blood, FBC/UEs.rest of LFTs/CRP/lipase-normal, Blood pressure 95/55 HR55, for 1L fluid stat, follow up on USS tomorrow, In the last month she has started slimshake once a day with lactose free milk and also 3 times a week dancing and aerobics for an hour, as well as work full time, I would like to give her a multivitaine but I am wowrried that if it could make cause more liver issues as I want her to build a good immune system as she works with children and there is always someone with a cold and cough .
Also my son is now 22, last year Sep his ALP ws 127, and 6 months prior 117, this should be below 110 (measured different to how my daughters) the doctor said becasue he is growing, is there any other test I should be doing
Worried Mum
God Bess you all

[researchaholic]

Thanks for your concern- I always try to remember that what doesn't kill us does make us stronger and these forums always remind me that I don't have to look far  to see there are many people worse off than me!  Your SOD does sound as if it is taking the same course-my attacks started @ 1-2a year and now occur about every 1-2 weeks so I pray the similarities will not continue for you.  Make sure your doc knows which type you are dealing with-type I-II-III-of which my guess would be type I.  Unless it is contraindicated, you should ask your doc about prescribing Levbid or Hyomax (non-narcotic). When it works for me the relief is 100% and within 20 minutes it's over- which allows me to skip the narcotics or another trip to the ER..  A huge amount of people with this end up addicted to pain meds-one problem I have been lucky enough to avoid.  I'm surprised your doc hasn't suggested the antispasmodics.  Hope that might help you!

[ajcauff]

So sorry to hear about all of your trials...you truly are a strong and courageous woman.  I do not have my gallbladder anymore.  It was removed a little over 3 years ago and about 5 months later is when my SOD problems began.  I have not taken any medication for this disorder, except for the pain meds in the hospital when I'm having my attacks.  They are so severe, as you know, and mine usually have subsided within 8 hours.  During my last attack I had quite a bit of nausea and I have even passed out during previous episodes.  After the initial attack is over, my body is very sick and feels poisoned, and it usually takes me 2-3 days to recover and even a few more days for my liver enzymes to return to normal.  On occasion I have noticed a few pains that are mild and only last a few minutes, kind of like the pot is starting to brew!  For now I am just wondering where this will all lead and if my attacks will become more frequent.  With the unpredictability and the little treatment available for this dysfunction, only time will tell.  I've always told myself I can live with it and tolerate it if my attacks stay 6 months apart, only twice a year, but whose to say when that could change.  I do pray that new treatments will be available soon!  I hope you are blessed with quick healing and we can someday get some answers for this SOD dilemma.  Take care and many blessings!  Amy  

[researchaholic]

While pregnant with my 2nd child I began having "gallbladder attacks" and was diagnosed with gb sludge instead of stones and had my gb removed after the 2nd birth, only to have a more severe attack several days later and continued every 3 months or so until my last prenancy during which I had none.  Last child was 2 mnths early weighing 21/2 pounds for unknown reasons.  Five months later the attacks became more severe and frequent. To date I have had two ercps-one with balloon dilatation and one where the sphincter was  again cut- very deeply this time- which left me with typeI&II (from the scarring).  Also, MRIs,MRCP,CT scans, and HIDA scan . The pain has evolved to the point I now get referred pain in my right and left shoulder in different combos so I'm always afraid I could be having a heart attack. The scan showed a possible stricture but the docs just don't think it is a prob and I should learn to live with it.   I use Hyomax antispasmodic which worked almost 100% of the time until the second surgery- now it's 50/50. The best I can do when that fails is use strong narcotic medicine to cover it up and wait it out but the narc. themselves can cause additional spasms.  I also use breathing techniques I learned for labor to get me through and make sure my children don't witness these frightening events.  After natural childbirth, 5 kidney stones, being kicked by a horse, etc., I can easily say I would trade any two of those for one bile spasm but amazingly a large number of docs question if this problem is even real.  I was treated like a depressed housewife the first two years of this nightmare and I can warn you to seek care from nothing but an expert in this area- the orig. gb removal and both eERCPs have  caused more problems than the problem itself and my weight has dropped from160# to trying to stay at 100-throwing up bile every day for a year cost me my teeth-Rec'd dental implants last year.  If your attacks are the same you know what an impact this has on everyday life- cancelled plans, etc.  I was an investigator, reserve officer, EMT, worked with mentally challegened adults, PTA secretary and just a very strong person before I went in for a "simple gb removal".  When I finally took matters into my own hands and demanded answers, I found that all electrolite, vitamin,mineral levels were in the malnutrition range and correcting them has helped overall but I still walk around every day with the SOD grenade and never know what will set it off.  I've kept every kind of diary you can imagine trying to find a pattern with no luck.yet.  This has been going on since 2000.  I haven't heard anyone who has tried them having success with calcium channel blockers but will probably try that next.  I'm hopeful about the Botox but trying to wait until there is more experience with it because I am tired of being the guinea pig with new procedures because so far all interventions I have had for this have left me much worse off!  I just finished 6 weeks of at home IV therapy from a MRSA infection in a bone graft to repair a broken foot and just don't have much faith left in the med. community.  I think because the main sufferers with this are women from 30-50, (or as the docs call it "fit, fat, fertile and forty)it's not considered a life threatening problem, and the fact that this wasn't even a recognized disorder until the mid 80's in med schools that there isn't much concern over it-although some docs are finally starting to check the sphincter function before yanking gallbladders out-but most don't unless a patient knows enough to request it.  I have also tested positive for AMAm2 which is a marker for biliary cirrhosis but haven't had the nerve yet to request a liver biopsy since the doc says he thinks the test was a false pos. and and doesn't think I have PBC.-.  Other than the ERCPs and further cutting there just really aren't any other treatment options yet but you would be wise to have them keep an eye on your liver enzymes and your nutritional status as well as your weight.  Wondering if you use antispasmodics and if they help?  Interestingly-like your case- I had no problems during the last pregnancy but now they are worse than ever and when the initial attack is over I have 2-3 days of aching pain from the spasm(sore muscles) and as soon as the sphincter opens and dumps several hours worth of bile into my stomach I am unable to eat anything for days, which has also resulted in ulcers.  I now live on a liquid diet 80% of the time to combat that.  If time permits I would be interested to hear how you handle the attacks-do they last the same amount of time(mine started at about 30 minutes but now go on for 7-8 hours most times) because I'm curious if yours are evolving the same way.  Are you having any luck with antispasmodics?  What do they say is the status of your gb if you still have one? If so would not let them take it to "see if it solves the problem" b/c you really need a gb unless it is nec. to remove it.  I firmly believe that this dysfunction was the only problem I had before gb removal and once removed there is nowhere for the extra bile to be stored exept into the bile duct which causes great pressure build up when it has spasmed shut- and would have been much better off had it (gb) been left alone. This problem has severely affected my quality of life and my ability to interact with my kids the same way(before SOD) and I sincerely hope that since you are still young- something will come along to treat this before you spend the next 10 years the way I have.  Sorry for the length but as an investigator I was trained to find answers and always did so- this, however- has been my toughest case to date and I refuse to give up until people are no longer left to suffer with this insiduous problem!  Maybe if enough of us work together we can force some answers! Namaste and be well... Terri

[ajcauff]

SOD is definitely rare and indeed a troublemaker!  I have severe attacks about every 6 months, why this time frame I'm not sure, but they are like clock work.  I just had my third baby 6 months ago and amazingly never had one when I was pregnant.  I've been pregnant free for 6 months and according to my SOD clock I was due for an attack and had one four days ago.  It's such a crazy thing.  I have had an ERCP where they cut my sphincter trying to relax it and prevent further spasms, but I've had 2 attacks since, so it didn't help me much.  Due to my attacks only coming twice a year and this dysfunction still being relatively new to me, my doctor wants to monitor my condition for now.  If my attacks become more frequent or severely longer, further treatments will be pursued.  I am only 30 years old though, so I'm beginning to look at things from the long-term point of view and am thinking the sooner I can find a fix the better.  The last couple days I have heard about calcium channel blockers and even botox injections into the sphincter that help with the spasms.  What types of treatments have you tried?  Thank you for your information!

[researchaholic]

Isn't it amazing how something most people have never heard of  (SOD) can cause soooo much trouble?!  Just wondering- because I have suffered for years with SOD I&II- what type do you have- what treatments or meds have you found to be helpful?  I am always looking for something else I may have overlooked that might help me.  Thanks

[ajcauff]

My question too is if you still have your gallbladder?  I had mine removed a few years ago and after I began to have attacks of severe upper right abdominal pain with elevated liver enzymes, which I was hospitalized for due to the extreme pain and high enzyme levels.  Unsure of the cause I had several tests and a liver biopsy, which were all normal so the search for answers continued.  To make a long story short, I was diagnosed with sphincter of oddi dysfunction!  This may be a possibility for you!  Take care and many blessings!

[researchaholic]

At least your doc. is taking you seriously by doing the biopsy- they usually take a wait and see attitude but that test should cut right to the chase.  There are many possibilities including auto hep, bile duct problems( do you still have a gallbladder?), primary or secondary biliary cirrohsis among many others.  The nausea can really set you up for other problems quickly (electrolite,vitamins,anemia)- my weight dropped 60 pounds in 5 months and the fatigue can make it hard to keep advocating for yourself to push for answers because those deficiencies can very quickly turn into a cascading number of other problems.  I'm surprised they didn't hosptilize you with those high numbers. I would definately request any and all reports from that and any other appointments.  You might get copies of other blood tests taken routinely in the past, look for anything else that may have changed.  Check into to your family medical history.  With primary or secondary biliary cirhosis you may have no other symptoms than what you are experiencing now and as it is commonly overlooked  I would request a   blood test for positive antimitochondrial antibodies specific to the liver (AMAm2).  Although an invasive procedure- I think the biopsy is what you need and will give you answers or at least rule out something that may need immediate treatment.  I know the nausea really chips away at you and while you are waiting for answers, try to decrease the amount of food you eat at one time and make sure everything you do manage to get down is loaded with with the correct nutrition.  Go to Whole Foods, etc. and get some good nutritional powder for shakes to replace when you can't eat. Boost, Ensure are good but are also loaded with sugar and there are better nutritional supps. on the market.  Keep a nausea and food diary and see if a pattern emerges.  Google some of the above things and see if anything seems like what you are experiencing.  I would be interested to hear what you find with the biopsy.  Good luck, hang in there and mostly make sure that whatever it is- watch your nutritional status very carefully... most docs work from a place of correcting problems once they emerge and often fail to see things cropping up ( anemia, electrolites, etc.) until something overt develops and by watching these things closely yourself on your blood tests, and watching what you can eat, maybe you can avoid having to correct those things as well when you get an answer for the immediate problem.  I ended uphaving a seizure from low calcium levels and when I requested my vit. levels checked, my vit d was at 11!   I would be interested to see what you find out. Good luck to you and hang in there!