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Old 10-19-2005, 07:47 PM   #1
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Need advice, does high liver enzymes= biopsy?

Hi I am hoping I can get some advice on something. In July I had an annual physical and nothing unusual except I had high liver enzymes: ALT=189, AST=130. Since I am normal weight, have low cholesterol, don't take drugs, etc., my doctor thought this was too high to ignore, so two weeks later he sent me for another blood test for Hep C and another liver test. Hep tests came back negative, and enzymes went down ALT=104, AST=33 (normal). He also sent me for a full abdominal ultrasound, and my liver, gallbladder, etc. looked fine.

So after all this he wanted me to have another blood test in 60 days, which I just had. Well my enzymes went back up again (don't have the numbers) but he wants to discuss at my next appointment. Here is my question: If this was anything serious, wouldn't it show up in the ultrasound? Basically I don't want to have a liver biopsy (my doc doesn't like them either and is not recommending one), but I am not sure what else we should check for. Have we ruled out anything serious? Should I be worried? I feel fine so I am not really worrying about this too much, but maybe I should be?

Thanks.

 
Old 10-20-2005, 07:09 AM   #2
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Re: Need advice, does high liver enzymes= biopsy?

I really do think that so far,your doc has been doing all the right things here,really,so at least THAT should ease your mind a bit just incase you had any real doubts about that.I really do think that maybe an MRI,with contrast and ct with contrast would be the best next step here before resorting to the biopsy.a liver biopsy just carries a bit of a risk that you would not have to face,at least not yet if you could find out more in depth info by doing some more deeper exploring with other tests,you know what I mean?hopefully they will find the culprit soon.marcia

 
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Old 10-20-2005, 01:58 PM   #3
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Re: Need advice, does high liver enzymes= biopsy?

have they done tests for other non hep diseases? PBC or PSC. are you taking vitamins? drink at all? take tylenol? biopsies are so invasive. if the ultrasound is normal do they need to do one? i myself, would want them to just monitor me every few months since liver enzymes can fluctuate.. do you take herbals by the way. those can cause elevations too! sounds like a good doctor!

 
Old 10-21-2005, 01:08 PM   #4
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Re: Need advice, does high liver enzymes= biopsy?

Thanks for the replies. To answer some of the questions, no they haven't done any other tests... PBC and PSC (sorry not sure what those are?) I don't take vitamins, don't drink at all (although I used to drink alot, but that was like 10 years ago), and don't take tylenol, although I do take aspirin for headaches. I don't take herbals either. Basically I cannot see anything that I am ingesting that would cause this.

By the way, what would an MRI or CT tell?

 
Old 10-21-2005, 01:21 PM   #5
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Re: Need advice, does high liver enzymes= biopsy?

By the way, my other blood tests were as follows (all normal), so maybe these are the other tests??:

PROTEIN 7.1
ALBUMIN 4.4
GLOBULIN 2.7
ALKALINE PHOSPHATASE 111
BILIRUBIN 1.0

 
Old 10-21-2005, 02:10 PM   #6
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Re: Need advice, does high liver enzymes= biopsy?

mri is a less invasive way to look at the liver/.... no needles! they may still do some simple bloodwork if they are really thinking there is a problem. the numbers are a little high, but not dangerously high, so i wouldnt really worry, i would just watch them if i were you. your doctors sounds pretty darn smart. they just have to be dilligent about watching the labs and making sure there are no sharp increases in them... if the numbers start to rise, they will do alot of testing. PBC and PSC are autoimmune liver diseases marked by increased elevations in the ALK PHOS, they are progressive over decades, but treatable. i think there will be a cure soon with all the research going on!! there are several places to learn more about the autoimmune liver diseases on the internet... the ALF *American Liver Foundation, has great direction in this regards.... good luck and feel well!!

 
Old 10-24-2005, 12:27 PM   #7
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Re: Need advice, does high liver enzymes= biopsy?

Quote:
Originally Posted by Mikej2000
By the way, what would an MRI or CT tell?
I had a CT scan with contrast several times. It shows if your organs are swollen or enlarged; it shows if you have a fatty liver; it shows if you have any lesions or sores on them. I've had elevated liver enzymes many times - from taking epilepsy medicines. Once I had two lesions - my gastro said it was from diabetes - but they went away.

 
Old 10-25-2005, 02:33 PM   #8
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Re: Need advice, does high liver enzymes= biopsy?

I went through a similar phase of hepatits of uknown origin for 6 months (ALT max 806 and steady 350 for 6 months) , and my doctors were pushing for a biopsy. Since they had basically ruled out autoimmune hepatits, and all the metablolic problems like Wilson's disease etc, and viral Hepatits A,B,C,E, EBV and CMV, I figured I had some other viral syndrome for which a biopsy would not give ANY additional benefiicial information. In restrospect, I am glad I refused since I eventually found out that I was was suffering from a primary HHV-6 and HHV-7 infection, and my liver numbers eventually returned to normal (ALT= 20 now). Whatever you decide best of luck, but try to exhaust EVERY possible alternative through blood tests and a 24 hour copper test etc before resorting to that.

By the way, during my 6 months of hepatits my liver enzymes also fluctuated, going from 350 to 800 to 350 to 600 etc, so this CAN happen in a viral syndrome.

Quote:
Originally Posted by Mikej2000
By the way, my other blood tests were as follows (all normal), so maybe these are the other tests??:

PROTEIN 7.1
ALBUMIN 4.4
GLOBULIN 2.7
ALKALINE PHOSPHATASE 111
BILIRUBIN 1.0

Last edited by Aristo; 10-25-2005 at 02:35 PM.

 
Old 10-26-2005, 06:47 PM   #9
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Re: Need advice, does high liver enzymes= biopsy?

Well I have an update......

(by the way thanks for all the replies, I guess I am not getting notification emails). Anyway I had the appointement with my doctor and found out the new numbers are ALT 315, AST 88. These are the highest yet, and after they went back almost to normal.

Well my doc says he is now ruled out everything he can check for (hepatitis, fatty liver, cancer and cirrhosis), and wants to send me to a gastronomist because he can't explain the numbers...... I don't drink alchohol, I dont take any drugs or vitamins or herbs, and I am of normal weight, and I don't work around toxic fumes (I work in an office). In the past 2 years with this doc i've had an abdominal ultrasound, upper GI, chest x-ray, heart ultrasound, and wore a heart monitor and all came back normal. My doc said he feels pretty good I don't have any other liver diseases because my other hepatic panel numbers are normal and have been every time.

But, I guess now I am getting worried. I mean something has to be causing this right? My doc is still not recommending a liver biopsy because he said there's no evidence I have any of the usual diseases/conditions that they can treat. In other words, the best they could probably do would be is to tell me is to stop drinking alchohol, which I don't do anyway. So what would be the point?

Does anyone have any advice for anything else I can do? The thing that is so frustrating is that I feel normal, I have no symptoms of anything else, except these blood numbers. So it's like I don't know how I should feel?? Also, I have never had these liver blood tests before this year, so for all I know, I might have had levels like this for the past 10 years and maybe this is normal for me. Or not normal for anyone? I don't know I am confused

 
Old 10-26-2005, 10:22 PM   #10
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Re: Need advice, does high liver enzymes= biopsy?

Well i've done alot of reading since I made my last post on some of the conditions people mentioned. I guess I am more worried now.... one of the articles I read said that high ALT numbers prove there is a liver problem it's just a question of which problem. If that is so, then if my doc says i don't have fatty liver, cancer, hepatitis or cirrohsis, and I don't have any symptoms (i.e. mono or viral type symptoms), then what the heck can it be? I read up on some of these other conditions (i.e. Wilsons disease, AIH, etc.) and those don't really seem to fit either. I don't take meds or drink and not overweight so there is no "lifestyle" modification I can make. Arrrggghhh, I almost wish my ultrasound would have came back with fatty liver or something, at least I would have a clue of what to do....

Has anyone had this problem before?

 
Old 10-27-2005, 08:41 AM   #11
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Re: Need advice, does high liver enzymes= biopsy?

Sounds like youre doing the right thing now, going to a specialist. AIH is a diagnosis that is somewhat difficult to make because the criteria are not clear cut (they base the diagnosis on a point scale that determines really how likely it is you have it). My hepatologist also mentioned that with AIH you usually dont see fluctuations in ALT, just a steady rise. I guess they will rule out the metabolic problems like Wilson's disease and hemocromatosis? These are pretty easy to check for, as for the former they will probably check blood ceruloplasmin levels and do a 24 hour copper urine test, and for the latter they will check your ferritin levels. If these dont check out, I'd say dont rule out a viral syndrome altogether, since your symptoms dont necessarily have to be systemic. Best of luck and hope we hear something conclusive.



Quote:
Originally Posted by Mikej2000
Well i've done alot of reading since I made my last post on some of the conditions people mentioned. I guess I am more worried now.... one of the articles I read said that high ALT numbers prove there is a liver problem it's just a question of which problem. If that is so, then if my doc says i don't have fatty liver, cancer, hepatitis or cirrohsis, and I don't have any symptoms (i.e. mono or viral type symptoms), then what the heck can it be? I read up on some of these other conditions (i.e. Wilsons disease, AIH, etc.) and those don't really seem to fit either. I don't take meds or drink and not overweight so there is no "lifestyle" modification I can make. Arrrggghhh, I almost wish my ultrasound would have came back with fatty liver or something, at least I would have a clue of what to do....

Has anyone had this problem before?

Last edited by Aristo; 10-27-2005 at 08:42 AM.

 
Old 11-09-2005, 06:58 PM   #12
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Re: Need advice, does high liver enzymes= biopsy?

Well I have another update. I had another blood test done yesterday:

ALT: 83
AST: 44

So, basically back to normal (or near normal) ranges, and this is actually the lowest they have been since my first test in July. I haven't done anything or changed anything since my last test, so these enzymes just seem to be swinging up and down with no clear pattern. I have my appt next Monday with the gastro specialist, wish me luck

 
Old 11-10-2005, 05:16 AM   #13
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Re: Need advice, does high liver enzymes= biopsy?

The bodys organs and all the many things it produces will not stay the same al the time they will fluctuate. For a biopsy i think they doctors need to know that it's a neccesity. Ie high liver levels over a sustained period.

 
Old 11-23-2005, 09:57 AM   #14
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Re: Need advice, does high liver enzymes= biopsy?

Its been over two years since my doctors finally realized there was something not quite right. My therapist wanted me to have a physical (I'd never had one before), because she said I was too tired, sat to still, talked to slow, ect ect. After a bunch of blood work, they realized I had elevated enzymes and a lump on my neck. The lump was a LARGE nodule on my thyroid-which they removed with a partial thyroidectomy.....luckly no cancer. The enzymes-they dinked around about-constantly saying lets wait...they aren't that high, probably a fatty liver or something. The Ultra sound and MRI didn't tell them much. Other blood tests showed nothing to worry about. They hemmed and hawd about a biopsy. I finally put my foot down and said lets get it over with. The result- a shocked gastro doctor. I had a liver disease similar to that of an alcoholic-only I've never drank in my life (NASH instead of ASH). It was already fibrosis. Its been a little over two years since the diagnosis. I know it sounds silly, but I can literally feel my disease progress. Every so often, its like my body shifts into a worse state of exhaustion (this time it was followed by nausia and vommitting). Last time it shifted, I had my blood drawn (standing order at the hospital), and found my enzymes had doubled. I just seen my specialist again last friday, and she had me in for another biopsy yesterday, and blood tests more frequently.
I'll know more next week. The doctor isn't sure if or when I will need a transplant. And if I do, she said she can't guarantee I will make it thru one. She said the meds lower your immune system to one similar of a person with aids. My health isn't that good anyhow (too many illnesses-to little time). The worst part- I am a single mom, 28, with 4 small kids-10,6,4, & 18months.
I guess what I'm trying to say is don't give up. And don't always listen to "they aren't that high yet". Don't be afraid of the liver biopsy- it isnt that bad. Like I said- Im in rough shape- I've had 13 surgeries, and if they told me I had to have one more and let me choose which it would be- I would choose liver biopsy. The procedure is ALMOST painless-more uncomfortable than anything. You are awake through the entire thing, so no side effects of anestesia. And your not cooped up in the hospital for days after wards. And my favorite- you don't have to loose dignity laying buck naked on the operating table in front of a bunch of strangers...LOL.

Take care,
Lisa

 
Old 11-28-2005, 04:15 PM   #15
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Re: Need advice, does high liver enzymes= biopsy?

how is everything Mike??

eddie

 
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