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Old 05-08-2008, 05:02 AM   #1
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Abnormal Liver Results

Hi,

I wonder if someone could give me some information please.

For the last month I have periodically been experiencing severe upper stomach pains, usually lasting about 10 minutes. I started taking Gaviscon to relieve the pain, and after a short while the pain eased.

I went to see my GP who felt my upper stomach (which was sore) and he said I had acid refluc and prescribed ant acids to stop the acid forming. However, last week I was in such agony I had to call an ambulance in the middle of the night as the pain would not subside.

I was taken to hospital and the doctor took some blood tests. They came back showing I was slightly anaemic, but more worryingly, my liver enzymes were slightly raised. She told me to see my GP for repeat tests. She did send me for an X-ray to see if I had any perforation to my stomach which showed I did not. She sent me home with strong painkillers and antacids.

I then returned to hospital for repeat blood tests and have now been told by my GP that there is slight anaemia, slight kidney malfunction (I am late 40's) but more seriously I have 3 very raised liver enzymes. They are the AST, ALP and GGT.

I have to see my GP on Monday who has refereed me for a Laprascpropy (sp?), more blood tests, and a liver scan.

As you can imagine, I am out of my mind with worry and thinking all sorts!!

Last year I had a kind of MOT blood test and that was all clear, so this has come as an awful shock. I have not lost weight, and am not jaundiced although I do occasionally feel tired and listless with little energy.

Would anyone know what these liver enzyme readings could suggest? I am a real panicker and always fear the worst, but I obviously have to face up to whatever is going on.

Your thoughts, ideas or information on this would be really, really, appreciated.

Many thanks in advance!!!!

Strawberry

 
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Old 05-08-2008, 08:02 AM   #2
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Re: Abnormal Liver Results

i am just wondering why you are actually being sent for a lap when a simple ultrasound could give you ALOT of solid info and would not be the least bit invasive for you or carry the risks? i have a kidney liver disease and all i have ever had to have for my docs to gain all the ifo they have needed to actually monitor my condition is labs and the yearly USs. i would seriously discuss the actual need for a lap vs the simple ultrasound which can also take a good look at real bloodflow thru the organs with the doppler tool they have(a lap is just an exploration which does have some issues that come along for the ride with doing it). this just sounds like a bit much for what your real needs are right now,thats all. there are a few different types of liver/kidney diseases out there that you could possibly have evenhad since birth that just had not yet showed themselves in any way yet becasue the labs would not have changed til the real damage hits a certain level. i found out about my particular liver/kidney issues when i was actually 40 years old after our then 12 year old son became extremely ill and we were told that he got it from one of us,his parents. while my actual lab numbers are all amazingly within the norm ranges, my kidneys and liver show a totally different story upon simple ultrasound. alot of cystic development going on but still have great labs. crazy but true.

i would seriously speak with whoever ordered the lap and ask if you can at least start this process with a simple ultrasound first,before anything else more invasive gets done. its just not actually needed right now,honestly.

there could possibly be many different reasons for the changes in your numbers. its kind of hard to say based on this particular type of forum. but one big thing i found out when my son went into liver failure is that jaundice is NOT always the first indicator of liver problems. my son was actually down to having only about 20% of his actual liver function left when we found out that he was even sick. but no jaundice actually set in til a few months later. really suprised me since i had always assumed whenever there was something affecting your liver,that jaundice was kind of an automatic thing you saw first? not so,believe me.

personally,and based upon my experience,i do thing just obtaining that non invasive US and just the bloodwork for right now would really be the best next steps for you. the US really does get a very very accurate look along with the real bloodflow than other types of testing for what you need right now. once you have obtained that US,it would dictate any further types of testing that may be needed, but i just think your GP is kind of doing a bit of overkill for what you actually need to know right now,ya know? you can just find out alot of solid info with just doing that US than you could with a lap without any risks to you at all. its a simple first line type of testing.

just by the way,they DO have a really great liver board here if you just take a scroll on down a bit further from here. i do wish you lots of luck with this and hope this isn't a disease process for you to have to deal with. you just really never know what is actually going on inside anyones body til you take that good look inside. in your case,an US would suffice for now,really. please keep me posted on what you find out. FB

 
Old 05-08-2008, 10:54 AM   #3
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Re: Abnormal Liver Results

feel bad ... sounds like you have polycystic kidney disease ... as an FYI(hope if you're high risk, (+) family history of a brain hemorrhage, headaches/neurologic symptoms, or have job that would be incredibly dangerous to yourself/others if you passed out like a bus driver, that you get aneurysm screening ...

anyways back to strawberryx7 ... couple of things ... about your liver function tests ... 1) AST is a very specific for damage to liver cells(it's an enzyme released when cells are damaged/inflamed), so it being elevated is suggestive of some liver "damage"/inflammation, but if you drink any alcohol, this could be one factor which caused this to be elevated ... 2) the alkaline phosphatase(you referred to ALP) and the GGT(gamma glutamyl transferase) go hand in hand, if you have liver problems, more characteristically blockage of the bile ducts in/around the liver, the alkaline phosphatase can be elevated and a lot of people will either fractionate the ALP(to directly determine the source of the ALP, as it can come from liver, bone, pancreas etc etc) or order a GGT or 5'-nucleotidase, which are other enzymes suggestive of liver damage .. so the picture of an elevated alkaline phosphatase and GGT suggest some sort of liver pathology

to really be able to intepret you liver function test, it is important to know the actually values including you ALT/AST/alkP/total bilirubin/direct(unconjugated) bilirubin, but also you albumin/total protein/PT/PTT/INR(which relative measures of your livers synthetic function) .. I would also be interested to see what your amylase and lipase were when you were in the emergency room

just to echo what feelbad sad, how is it that you haven't had a RUQ(right upper quadrant) ultrasound, even if you went to the EW, most would check this to make sure that you don't have gallstones .. the symptoms you are describing could very well be biliary colic(crampy pain usually associated with meals, especially fatty meals, that represents the gallbladder contracting against biliary ducts blocked by a stone(s)), could be bile reflux, which unlike GERD/reflux which involves high acid in the stomach will not respond to the H2 blockers(Zantac/tagamet) and proton pump inhibitors(prilosec), the other thing, especially with your age and labs, would be primary biliary cirrhosis(which is an autoimmune phenomenon seen in middle aged women, it's genetic, involves destruction of bile ducts and can be asymptomatic initially and first diagnosed by labs, but also presents with fatigue/itching/abd pain ... heck there are other causes which could account for this, but these are some of the basics

in regards to your other abnormalities ... slight anemia/renal dysfunction, let's take it one at a time ...

what are your blood counts, aka your hemoglobin/hematocrit/MCV(size of red blood cells)/MCH(tells us about the amount of color in your red blood cells)/RDW(tells me and you about the variation in size of your red blood cells/reticulocyte count(tells me about the number of young red bloods cells your body's producing to make up for the low counts), you're youngish to have had a colonoscopy, but did anyone ever do a rectal exam to see if you had blood "hidden" in your stool, or even better have you ever noticed frank blood in your stool or black stool ... assuming your still having periods, you could very well be iron-deficient, but it sounds like your anemia needs to be worked up a little better

in terms of you kidney dysfunction ... what was your BUN/Cr .. based on your age/race/gender/Cr did anyone ever mention what your GFR was .. your renal failure/kidney disease sounds like it could be from many different things ... are you dehydrated, take a lot of NSAIDs(ibuprofen/aleve), take any prescription meds ...

it does seem like a explor lap would be aggressive, especially because the w/u for your lab abnormalities hasn't been fully completed, but I assume your GP has her/his reasons

best of luck

 
Old 05-08-2008, 02:19 PM   #4
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Re: Abnormal Liver Results

Hi FB & Hermes,

Thank you so much for your very informed and detailed replies.

Hermes, I do not know the actual counts of my ast/alp/ggt results, but I shall ring my GP tomorrow and ask him if he can tell me and then I will post them up.

My anaemia is not bad (seem to remember my GP mention 11.something? - just slightly down) but I do suffer from heavy periods.

I don't quite understand why my kidney is showing signs of malfunction as I don't have any symptoms.

But I am extremely worried about my liver results, and all terrible thoughts are racing through my head.

Do you think there could be a connection between these dreadful upper stomach pains I have been suffering intermittently and my liver? My GP seemed convinced I had acid reflux and when he pressed my mid upper stomach it was incredibly tender. However, I am wondering if this is just coincidence and the two problems are unrelated?

Gallstones is something that did cross my mind, but the doctor in the emergency department of the hospital seemed to rule them out as she said I wasn't jaundiced (but as FB says you don't necessarily need to be jaundiced).

Unfortunately, here in the UK the health service can be a bit hit and miss, and depending on which hospital you go to the treatment can vary enormously.

I am booked to have more blood tests as you know, and an ultra sound scan of my liver. I am absolutely dreading the lap - not just beacuse of what they may find - but the actual procedure. I wonder if I ask them if they could just do the ultra sound first and see if they can discover what's wrong by that?

Hermes, you say my ALP and GGT readings could be suggestive of some sort of blockage: could that be a tumour or a gallstone? What is the most usual blockage? Also, would a blockage cause symptoms 24/7 or could pain come on intermittenly?

I will try to find out what my Amylase and Lipase readings were at the hospital for you - hopefully they will be able to give them to me.

I am so worried about all this, and being a panicky type of person doesn't help either. I keep bursting into tears and thinking the worst, but I know I have to face up to whatever is going on.

Thank you so much for your detailed replies - I cannot tell you how much I appreciate your advice.

Best wishes,

Strawberry

 
Old 05-08-2008, 02:28 PM   #5
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Re: Abnormal Liver Results

Hi - me again.

Sorry, I think in my panic I may have mixed up laparoscopy with endoscopy. My GP said to me today I would need to have one, but after putting the phone down I was so worried I might have confused the two.

I will phone my GP tomorrow to confirm which procedure it is and let you know.

Kind regards,

Strawberry

 
Old 05-08-2008, 07:14 PM   #6
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Re: Abnormal Liver Results

gallstones tend to cause intermittent pain unless one get trapped in a duct(whether it be the cystic duct which connects the gallbladder to the common bile duct or the a stone stuck in the common bile duct -- the so called choledocholithiasis) and cannot move ... otherwise gallstone pain usually is intermittent because stones are only temporarily obstructive(like a kidney stone) and it's greatest when your eating or really after, when the bile system is contracting ...

definitely don't need to be jaundiced by exam for gallstones, as you bilirubin levels may not be high enough to color your mucous membranes, sclera, or skin ... from what I remember you must have Tbili's greater than 1.5 to really start to see the yellowness ...

also know, that even though gallbladder pain tends to be in the right upper quadrant of the belly, gallbladder pain does not have to be typical .. it wouldn't be out of the question to see epigastric(over/around the stomach) pain actually be gallbladder pain ...

in terms of blackages ... biliary blockages are almost always from gallstones(cholelithiasis) ... yes there are tumors/infiltrative disease/infections/etc that can cause this but don't get worked up until the data comes back ...

best of luck

 
Old 05-09-2008, 12:31 AM   #7
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Re: Abnormal Liver Results

Hi Hermes,

Thank you so much for your reply! You've really helped me to try and stay rational and not get too worked up before the results of my tests.

I'm hoping it is just Gallstones (who would think anyone would wish they had Gallstones?!) but I do fear the worst, and try as I might I still feel a bag of nerves.

I'll try to find out today from the hospital what my amylase and lipase counts were when I went to emergency (although whether or not they'll give them to me I'm not sure - they may tell me to see my GP instead - but I'll try). Would my GP have those readings in the latest blood test too do you think? And would both readings give you more information to the possible cause?

I've a feeling my enzymes are more raised in the second blood test than they were in the first blood test when I went to emergency. What could that mean?

I remember the doctor in emergency telling me my liver enzymes were slightly raised (but maybe she didn't want to alarm me as I was in so much pain), but my GP told me on the phone yesterday that my enzymes were either very raised, or high (can't remember which as I sort of went numb). I was also alarmed that the hospital returned my blood test results so quickly (the next day) - they usually take a week to come through - so I would guess they are fairly raised.

If they are rising what could that suggest?

Sorry to bombard you with so many questions, but you are so helpful and I'm working myself up into a panic again.

Best wishes

Streawberry

 
Old 05-09-2008, 06:49 AM   #8
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Re: Abnormal Liver Results

wow hermes,you really DO know your liver stuff. yep, i do have PKD with liver involvement and we went thru the aneurysm stuff in 05. came as a huge suprise to me. luckily i used to have a very highly experienced and knowledgable neurosurgeon who has since retired on me,who sent me for the MRA despite the fact my aneurysm,just becasue it was in a bend in an artery did not actually fully show itself on my MRI. he was an amazing man who removed another vascular malformation from within my spinal cord in 03. its that naturally weaker vessel crap that caused this malformation too. except i was actually born with this glob inside my cord,just didn;t have a clue til i had an MRI done on my c spine for a herniated disc and it just "glowed" inside my cord up there.

strawberry, all the info H gave you is right on the money. the endo makes ALOT more sense than a lap,really. they are looking for signs of possible varices within your throat and stomach with that test. my son had this once he reached the portal hypertension stage. its a back up of blood from the liver when the portal vein gets closed off from scar tissue. considering your low hemo,this just could be one reason for it. the veins within that area just become a bit more pressurized and can break and bleed into the stomach. this was where my son was at when he first presented with this stuff. have you happened to notice any 'darkened/blackish" type of stools lately? or something that looks like coffee grounds?

your amy and lipase are actually pancreatic enzymes/labs used to check their functions. my son ended up with pancreatitis with his liver issues. this gave him some pretty severe pain in the lower LQ. one thing about your mid upper pain, my son used ice packs all the time on this area,he said it just made things feel better. just a thought for you.

you really do need to have the further testing just to see what is actually the cause of your ongoing symptoms and raises in your lab numbers. there has to be an underlying reason/condition that you have going on to affect both the liver and the kidneys. the disease i have could be one of the causes. just so you know,with GB issues,it is also possible(only becasue of how a particular nerve runs) to actually have left sided chest pain,and also with liver issues too. my son had shoulder pain on that L side with his liver problems,and i know other people who have actually experienced this too. just an FYI incase it should occur with you.

i don;t know for certain just how medical record acess is over there but you should be able to legally obtain ANY part of your own medical records without problems. i do think that much would just be a given in anywhere you live. i know it is in the US. i have all madical records from my ongoing medical issues and my sons too. one huge thing you really need to start doing is obtaining every single copy of any ongoing labs. doing this one thing got my son the attention he desperately needed one night when i had to call his GI doc and i started rattling off the big changes in his lab numbers from three seperate ER visits all done within that last three weeks. espescially in any hospital,they can just make a copy right there for you before you even leave the place. its all in their computer system,all you have to do is just ask. this is what i kept doing. obtaining all medical records in an ongoing way and keeping them all in some type of expandable folder really helps tons in just having all of your impotant info when you see other docs or even have to go back to the ER. it saves a ton of time and gives the docs a "baseline" of info to work from. just take that folder to every doc appt and er visit. believe me, you will be glad you did at some point. it helps that much trust me.

the reasons for you raising numbers could be many,but what those numbers actually indicate for the most part is overall organ function. so the higher they go,the less function you actually have. don;t mean to freak you out here just really want you to know as much as possible. just start obtaining ALL records and most importantly all lab and testing results from here on out and get what hads already been generated. this does help,alot. and also allows you to keep on top of all things too.

your GP "may' have the labs but if not,he certainly could get them for you. all most docs have to do is call a particular number from their office(to that particular hosp) in most cases,and they can get all of your labs directly from the hospital lab, it isn;t that hard.

with more direct testing,they should be able to give you better more solid info as to just what it is you are dealing with here and possible treatment options too. with one ultrasound,they could tell for certain if this is what i have with the PKD or not. the cystic development is very distinct with PKD in just how the cysts themselves actually look. but as H and myself stated,this could be from a bunch of different possibilities.PKD is just one of a few different types of liver/kidney diseases. or stones can really throw your numbers too since they can actually block areas completely which would affect the functions of other organs too. right now unfortunetly,you are in the test and wait mode. this IS just part ofthe process unfortunetly. been here way too many times to count actually.

so just when are these tests actually scheduled for? i do hope this is something more minor that can be easily fixable or treated. you will just have to wait and see how things go. i wish you nothing but good luck with this. please keep us posted on anything you find out hon,K? FB
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Old 05-31-2008, 05:02 AM   #9
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Re: Abnormal Liver Results

Hi Feelbad,

Thank you for your detailed reply and kind words.

I just thought I'd give you an update on what happened.

After speaking to my GP's surgery again I was told to go and see him the next day. When I saw him he seemed very irate (we've known each other for 20 years and are almost like friends) and he was all in a state about my raised liver enzymes. Of course, this made me more nervous than ever.

Apparently, my liver enzymes back in December were totally normal. One of them (can't remember which) was 32 - which was perfectly normal - and then the recent test showed it to be 676!!! My other enzymes were all totally off the radar too and he said something must have happened within the last 6 months to make them soar to such high levels.

He then told me he'd booked me in for a liver scan the next day and told me to phone him after I'd had it done.

I went the next day for the scan and was soooo worried what they would find. But the doctor was very nice and put me totally at ease. He did the scan and immediately saw that I had 3 gallstones! Phew.....relief!

They are very small and he said that when I had the severe attack of pain I probably passed one which was blocking the bile duct; hence my raised liver enzymes.

Luckily I do not need surgery to remove them (they can be treated with a medicine to dissolve them) and he told me that my liver looked normal; was not inflamed, and that gallstones are very common.

I think I've had these gallstones for some time because I have in the past had interment pains where I have felt like I could shoot myself! Touch wood I haven't had any repeat episodes of these attacks, and once they are dissolved, hopefully that will be the end of it.

Anyway, I would like to thank both you and Hermes for being so helpful and informative, and I shall keep you updated.

Best wishes

Strawberry

 
Old 05-31-2008, 06:54 AM   #10
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Re: Abnormal Liver Results

thanks for letting us know hon. i am relieved for ya too. those stones can really make certain numbers go crazy just from blockage of the normal flow in there. at least you have a reason/explanation for your symptoms and that in and of itself is a biggie. alot of people spend years trying to find the true source of certain problems and pain. hope things continue to go well for ya. FB

 
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