Elevated liver enzymes: ALP/AST/ALT -- cause uncertain

[chipofbags]

Hi. Elevated liver enzymes are unexplained, but not for want of trying.

Last December a routine physical showed elevated enzymes, though bilirubin fine. In the course of getting an ultrasound (mild / incipient fatty liver suggested but even that has later been discounted), a pancreatic neuroendocrine tumor was discovered. This led to quite-successful surgery to address the tumor. In fact the discovery may have sidetracked the original problem.

But lately, trying to explore it further. It's worth mentioning that so far have done many specialized blood tests. In particular none of the hepatitis tests or iron/ferrin elevation test show anything. Have had liver MRI, MRCP, CT scan (3 times, even), octreotide scan, original ultrasound. Some of these were because of the pancreatic tumor, some were liver focused. Nothing uncovered. In particular MRCP showed no duct blockages / problems.

A liver biopsy was done at time of surgery. Nothing found there other than some possible incipient fibrosis.

No drug use (other than some youthful indiscretion in college 25 yrs ago), off alcohol for mos (even though was only @ ~ 5 beers / week anyway). No present drugs of any kind. Nothing wacky like herbal supplements in diet.

Results (at least some are in). Only 1 of 3 proteins continued down; Bilirubin remains normal. I haven’t yet heard from my liver doctor. Suspect a liver biopsy will be ordered, unless for some reason just ALP (the first one) matters.

If it helps here are some of my recent numbers, sorry not more legible:

|----Standard 3/26 5/28 7/12 8/13
ALP 31-95 U/L 252 456 237 209

|----Standard 3/26 5/28 7/12 8/13
AST 17-42 U/L 80 109 44 89

|----Standard 3/26 5/28 7/12 8/13
ALT 12-60 U/L 135 180 67 163

|----Standard 3/26 5/28 7/12 8/13
Bili 0.2-1.3 mg/dL 0.8 0.5 0.6 0.7

[chipofbags]

I got some updated results, on ALP/AST/ALT.  ALT and ASP have reverted to near normal.  ALP remains elevated so maybe ALP in particular is of interest?

|----Standard 3/26 5/28 7/12 8/13 10/10
ALP 31-95 U/L 252 456 237 209 212

|----Standard 3/26 5/28 7/12 8/13 10/10
AST 17-42 U/L 80 109 44 89 46

|----Standard 3/26 5/28 7/12 8/13 10/10
ALT 12-60 U/L 135 180 67 163 61

[chipofbags]

Bumping this thread with a quick update.  I have since had an additional liver biopsy which uncovered nothing.  A follow-up CT scan (focused on the pancreatic neuroendocrine post-surgical situation) also showed nothing.  Will be getting some updated blood tests in a week or so.  As I understand it, the only semi-mainstream thing not tested so far & included in that next round of blood testing is Celiac disease (but I have no other symptoms for it).

So of course this is very befuddling.  Enzymes suggest something is wrong, and yet... all attempts to find something find nothing.

I'll update this thread as / when I learn anything else...

[Dr Santos]

Hi,
I understand your concern regarding the elevated liver enzymes. Increased in these enzymes may  indicate inflammation or damage to cells in the live. There are many diseases and conditions that can contribute to elevated liver enzymes and additional diagnostic tests may indeed be requested. More common causes of elevated liver enzymes include medication side effect, alcohol drinking, heart failure, hepatitis, nonalcoholic fatty liver disease, obesity as well as other conditions such as autoimmune hepatitis, Celiac disease, Cirrhosis, cytomegalovirus (CMV) infection,  and a lot more. It is best that you discuss the results also with your doctor for proper evaluation.There are many factors to consider also such as symptoms present, medical history, results of other diagnostic tests, among others. Hope this helps. Take care and do keep us posted.