high level of sgpt oncontinuous basis

[brijen_1974]

dear sir,
recent blood test of my wife showed high level of sgpt .they were 41. also she had blood test before 2 month and it also showed sgpt at 37. she is frequently having symptoms of dieheria  and slight fever. we consulted lever specialist and we conducted sonography and lever function test .sonography results are normal and results of lever function tests are    s.bilirubin: 0.3 mg/dl
                s. billirubin direct :0.1mg/dl
                s.bill indirect: 0.2 mg/dl
                sgot(ast) : 36iu/l
                sgpt(alt)   :44 iu/l
            s.alkaline phospate: 118 iu/l
           s. total protine:           7.7 g/dl
          s.albumin:                 4.7 g/dl
           s. globulins:             3.0 g/dl
           protein A/G ration:    1.57

my doctor says that the results are normal except high sgpt. and he advised to repeat these tests monthly for about 4 months to get exact track of sgpt.

but, about 9 months back she was having vomiting problems and my family doctor did lever function test which showed sgpt at 60 and rest was normal. at that time we also checked for sonography and tests for hepatities C & E.   both viruses of hepatities was nil in results. and after 1 month of that problem her sgpt came  at 30 and she was having no problem.

she had never gone for alcohol anor long medication.

my questions are
1) if her sgpt will remain around 40 ,on continuously basis will it be normal ,or any indication of lever damage.
2) what are the other testes for detailed dignosis of high sgpt /lever function other than sonography, and hepatities c/e virus test.

3) are there any medicines that can bring down sgpt level.



please guide me about the same. as i am very much in depression after this proble, and my doctor told to wait for around 4 months results.

thanking you.  

[fretboard]

Different tests have different ranges of what is perceived as being normal.  Although I don't know the name of the specific manufacturer, these are the normal ranges on my liver panel that was done a couple of months ago.  My point is her SGPT is fairly normal, take the advise you got uptop and have her see the doctor to look at other areas.  She's not HepC positive, so obviously it's something else.  To be honest with you and someone else mentioned this above, it could be something parasitic in nature or something else, not related to her liver at all.  God Bless  

AST (SGOT)  Reference Range  0-40
ALT (SGPT)   Reference Range  0-45
ALKALINE PHOSPHATASE      42-139
TOTAL PROTEIN                      6.0-8.0
ALBUMIN                                 3.5-5.5
BILIRUBIN, TOTAL                    0.2-1.2
BILIRUBIN, DIRECT                   0.0-0.3
BILIRUBIN  INDIRECT                0.2--1.0

[Trinity4]

It gets scary sometimes to when recommendations for intrusive testing is given without merit.  This happens alot.  

[brijen_1974]

thanks a lot to all for valuable information.

bye. brijen

[jmjm530]

"CoWriter" is correct. Testing and follow-up so far seems appropriate, and there is no reason to conclude either liver disease, liver damage or to recommend a biopsy. Its obvious that you're a loving and caring husband, but there is absolutely no reason for you to be worried or depressed at this point.

As CoWriter suggests a stool culture is always a good idea although chances are it  may find nothing. Non-specific gastro problems are sometimes hard to figure out and the diagnosis is often made by elimination, no pun intended :) In other words, they have already ruled out several things via tests already done.

If anxious, you can always get a second opinion from another liver specialist or a gastroenterologist. (Not even sure a liver specialist (hepatologist) is necessary at this point.) While it seems your specialist is handling the case correctly, sometimes they get stuck on their initial diagnosis (or lack of diagnosis) and a fresh mind on the case can be helpful. BTW, slightly elevated enzymes can sometimes be caused by medications either prescription or OTC such as Tynelol. If relevant, mention to your doc.

All the best luck, and again, no reason to worry so much, these do not appear to be serious symptons at all.

-- Jim

[CoWriter]

All the results you posted are within NORMAL limits.


"she is frequently having symptoms of dieheria  and slight fever."

Sounds to me like she may have a stomach or bowel problem rather than a liver problem.  

The doctor can order a stool culture to check for parasites that could be causing the  diarrhea and fever.

If the diarrhea continues, ask the doctor about doing a colonoscopy (an examination of the large colon).  

Last, but not least, increasing her fiber intake may help.

[CoWriter]

"40 is at the upper range of normal, the higher the number the more liver damage and the necrosis (death of cells) is what produces the higher numbers."

That's not true.  Liver enzymes do not correlate with the amount of liver damage.  You can have low liver enzymes and lots of damage or high liver enzymes and little damage.
  

" her Alkaline phosphatse is a little high, and her protein, but not bad, just slightly elevated."

Actually, both her Alkaline Phosphatase and Total Protein are NORMAL.  

Her Alkaline Phosphatase is 118 ....and normal is 30-126 (may vary slightly in some labs).

Her Total Protein is 7.7 .....and normal is 5.5 to 9.0   So both results are in the normal range.


"the test I would recommend is a liver biopsy so you can make a quality decision about treatment.".....  "you may wish to wait to treat until Teleprevir becomes avail."

You're recommending a biopsy to someone who has normal liver enzymes and a NEGATIVE Hepatitis C test (her husband said tests for Hep C and E were negative).  

I really doubt that any doctor will want to do that.


"Vomiting and fever can also be due to gall bladder disease"

But the main symptom of gallbladder disease is PAIN....and he didn't say anything about her having pain.



Sources:
http://www.webmd.com/a-to-z-guides/total-serum-protein?page=2
http://www.webmd.com/a-to-z-guides/total-serum-protein?page=2

[merryBe]

if you want the doctor to answer look to the right and click on Related Expert Forums towards the bottom.

What I know is that 40 is at the upper range of normal, the higher the number the more liver damage and the necrosis (death of cells) is what produces the higher numbers.

In later stages this number can go into the hundreds, so your wife is still in fairly safe territory, her Alkaline phosphatse is a little high, and her protein, but not bad, just slightly elevated.

the test I would recommend is a liver biopsy so you can make a quality decision about treatment. Some folks have significant fibrosis without elevated enyzmes which is why the biopsy is still the only certain way to know the extent of her damage, if any. Biopsy is still the gold standard. If she is at stage 1 or 2, you may wish to wait to treat until Teleprevir becomes avail in 2010 presumably.

Vomiting and fever can also be due to gall bladder disease, which closely mimics HCV.
I had them both concurrently. You need a Hidascan test to be sure of GB function, an ultra sound may show stones, or not, but cannot show other states of the disease, nor function. Is she sick after she eats fat or protein more than other foods? In this case I would get this checked even if you know already she has HCV, because if the GB leaks it causes peritonitis and can be fatal.
hope that helps.
mb