Extreme itching and high liver levels

[walzallen]

My husband is a 35 year old non drinker or smoker.  He is 6’7 and 220 lbs.  He presented with right upper side pain on January 13th.  The medical staff deemed it was an appendectomy and took out his appendices on January 14th.  Once removed they said it was mildly irritated so that should have been the issue.  Over the past few weeks and beginning about 10 days after surgery he began to have orange urine.  He also began itching all over.  Within a week he has felt fatigued and had yellowing of skin and eyes.  He went in on Monday to the PCM and found elevated liver levels as follows. AST: 116 ALT: 463 Total: 3 and Alph (not sure of spelling) 313.  He has had a CT with contrast and a sonogram all normal.  All hepatitis and mono came back negative as well.  He is very uncomfortable not to mention concerned as he needs to go back to work.  Can you give us any idea on what we need to go as the PCM does not seem to have a clue?  

[walzallen]

THis is getting crazy.  He saw a specialist today and they are running more blood test.  I asked why this wasn't done 2 weeks ago, but of course I got no response. This process is too drawn out and we haven't gotten a single answer.  They also told him they'd like him to not work: I mean please, if he doens't work the loses his job and with the economy like it is who can risk that?  I told him to tell the doctor, well if I dont' work I won't be seeing you anyways as I won't have health insurance.  Maybe that will get a faster response as the doctor and hospital would have not incentive to continue to drag this out.  I am wondering, is it dangerous for him to work, as if it is, you'd think they'd speed up the diagnosis or put him in the hospital to get the answers faster.  I don't know if seven times the recommended limits is life threating that is what I rely on the doctors for, as aren't they suppossed to be the experts.  I'm sorry for the venting but this is getting extremly frustrating.  Any ideas on how to get this process moving faster would be helpful.

[endrun]

Any kind of abodminal surgery increases the risk of liver disease.  Mine developed after my gallbladder was removed.  My liver enzymes were much higher--through the roof, and I developed cholangitis and had to be hospitalized just due to the pain.
  In my case, PSC hasn't been diagnosed, yet that seems like the most likely Dx based on a number of factors, not the least of which is chronic Celiac Sprue.  They supposedly did a liver biopsy but got NO LIVER CELLS.  I'm not sure what they got, but I have a really good suspicion that what they WILL get is a bunch of papers that add up to a LAWSUIT.  Without a liver transplant I probably will not last past this year.

[Sir_Osis]

Best of luck to your husband - his plight sounds similar to mine in a few ways - I am finding how frustrating it can be to sort out hepatic matters - even with the aid of 3 hepatologists!

Your Primary Care Phys should refer him to a competent G.I. Hepatologist!

While im no doc, I have found eating smaller meals, lower fat and sodium helps, and I take milk thistle as a precaution 3x a day

[CCRN34]

To answer your question "what is a very high liver level"?...every lab varies a little...but the "normal" range for ALT=4-42, AST=10-40 and Alk Phos=30-120.

[CCRN34]

Those liver enzymes are definitely elevated. He definitely needs to follow up with a gastroenterologist. I am not going to say that you should be alarmed, but it is of high importance that you get him to someone who can properly diagnose what is going on with his liver.

[walzallen]

Thanks for the insight.  I thought he should have wnt to a specialist ASAP as most GP's don't know about this, but he hasn't and is still having issues and just keeps letting them do another test after another.  I guess he has to make the decision.  But what is a very high liver level.  Are these really high: AST: 116 ALT: 463 Total: 3 and Alph (not sure of spelling) 313 and should we be really concerned?

[yoops]

I had the same things happen to me and I was dx with PSC.   I had an ERCP done and found the pronblem in my liver.  Scaring closed my bile ducts. Good Luck

[KjFlicka]

Well, I CAN tell you the severe itching and the jaundice you speak of is related to his bilirubin. I'm not sure if they test for bilirubin in normal CBC tests, but I know they do on a liver panel blood test. Have the doctor do a liver panel test. If you've got decent insurance, just go seek out a hepatologist (liver specialist) and they won't fool around.
My general/family doctors are not very good at the liver stuff... if it's beyond Prilosec, seems like it's beyond them. A gastroenterologist would also work.

Good luck and the itching WILL get better! (I had it too.)

Take care,
Nicole