How long before cholestasis damages the liver?

[Jesssesmom]

I know this is a forum for liver transplant patients but I can not find anyone else to answer my questions. Please take a few minutes to look at my sons information. My son is 10 years old. He has cholestasis that came on after surgery. He is being treated by the surgeon for the cholestasis.His lab dropped a little the firest day after he started taking actigall and phenobarbital but there has been no dramatic change since then. I will put the lab results at the bottom of this. Do you think he should be seeing a hepatologist and not just the surgeon. There is a endrocincologist involved who is not in agreement with the surgeon. The fact that the 2 are openly disagreeing on what is going on and the lab work not changing has me scared that his liver could be gettign damaged while he may not be getting proper care. Am I over reacting here or is his liver in danger? How long before permanent damage could happen? Does it sound like this would be the proper treatment? Please help.
I'm including some of his lab work but there are lots more that are high. If there is anything you need to see to answer please let me know. Thank you so much for your time.
Lab results:
                    Alt               Ast      Bili total     Plt
Sept 26th-  1,156        887          1             970
Sept 27th-   1,060       543           4.1         941
Sept 28th-      892        344          4.9          
Sept 29th       831        310          4.3
Sept 30th       856        396           5             658

[jmroxx]

Rash could have been from high bile salt acids that built up from the blockage

[Thomas D Schiano, MD]

i think also that he passed a stone.  when people are sick their gallbladders cannot empty and they cand evelop gallbladder problems.  The rash sounds like a drug reaction (? due to the antibiotics).  i am hopeful that everything will be OK now.

[Jesssesmom]

Jess had the ERCP. There was no blockage but the bile ducts were dialated. He is still running a fever, has a really weird rash on him that starts out looking like white bug bites and then turns to a red raised bumpy rash that gets better and then worste again, is having night sweats. His Alt and AST are only slightly high now, Lipase is 797,his GGT is  126, albumin level is 3.1, WBC 15.2, platelets 913,Lymphs 23,Monocyte 12,eosinophil 11,....I expect him to be sent home tomorrow and I can't shake the feeling that there is still someting else going on. Again, his history was that his gallbladder had stopped working (no sludge in it and no stones in it), had surgery a week later liver enzymes went up and rash and fever started, a few days later pancreatitis started, rash started getting better but now has started to come back. Once we are home, we are several hours away from a medical facility. The gastro Dr thinks this was all due to a stone that passed before the ERCP. He can't explain the reason the gallbladder stopped working to start with, or the rash or sweats but doesn't seem worried. Am i over reacting or does it sound like something more could be going on? Thanks again for all your help.

[Thomas D Schiano, MD]

i presume that he is taking some antibiotics now.  Not many people have technical capability/comfort level doing ERCP in kids so they may be waiting for the expert to be available.  i think its OK to wait as long as he is hospitalized in the interim.  I am sure that it will work out OK.

[Jesssesmom]

Dr Shiano,

Thank you so much for your help. You helped my son more than you know.  I knew in my heart that something was not right but your answer gave me confidence that I was right and he needed better treatment. I had to be assertive, but I finally was able to have him moved to Cincinati Childrens hospital. With an ultrasound they were able to see that there was some type of irregularity to the duct or a blockage. They are going to do an ERCP as soon as possible. That could be as late as Monday-today is Thursday. He is still running high fevers. He also has some fluid on his lungs. I am relieved and feel that we are headed in the right direction, but I'm still worried that waiting could cause more damage. Any more advice?

[Thomas D Schiano, MD]

this type of decrease in ALT could be due to passage of a stone absolutely. they should get an MRCP.

[Jesssesmom]

Thank you very much for your insight. His ALT is now 590, his ast is 172. Could he still have a blockage in the bile duct with the numbers going down? What test would be used to find out? His Lipase is 821.

[Thomas D Schiano, MD]

if he has pancreatitis then there is a very strong possibility that he has a common bile duct stone.  in addition his portal vein should be imaged for thrombosis.

[Jesssesmom]

He had his spleen and gallbladder removed. Since I last posted, his liver enzymes have came down some although still high.  He now has pancreatitis also. I am very worried still. .

[Thomas D Schiano, MD]

i am very concerned about the blood test results and think your son should be seen by a pediatric hepatologist ASAP. What type of surgery did he have?