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Old 12-19-2012, 07:25 AM   #91
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Re: Elevated liver enzymes, pain under right rib cage, coarse texture on ultrasound

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Originally Posted by ladybud View Post
I assume you have been tested for chronic hepatitis C, not just A & B. Maybe your GP would order these tests before your hepatologist visit so there is a more complete picture to go on. I would either make a list from my suggestions or print my posts so he understands the rationale for each. Good luck. I hope you get answers soon. On the plus side, your enzymes are not terribly high and fluctuating in a range is better than trending upward. Indicates something more stable than progressive, and possibly treatable.
I've been tested for A, B, and C three times over the years and my doctor out here in Florida also tested for hep D and E. all have been negative. Thank you so much for your help!!

 
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Old 01-07-2013, 10:21 PM   #92
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Re: Elevated liver enzymes, pain under right rib cage, coarse texture on ultrasound

Did you ever find out what it was? I am curious because the pain you describe is EXACTLY what I have had for awhile.

The right rib cage, which varies from dull to really uncomfortable; sometimes like there is a pinch or things are twisting up in there; and sometimes if I do something semi-strenuous, I have it in the back in kind of the same spot. Occasionally a feeling of pain on the left side.

Also have had a few times where I couldn't eat AT ALL, and I usually have a pretty healthy appetite, but if I started to eat a meal, I would get so uncomfortably full so fast, it was strange, and I wouldn't really be hungry again for the rest of the day. Had to eat really small meals for awhile.

 
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Old 01-08-2013, 06:29 AM   #93
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Re: Elevated liver enzymes, pain under right rib cage, coarse texture on ultrasound

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Originally Posted by WilkesG View Post
Did you ever find out what it was? I am curious because the pain you describe is EXACTLY what I have had for awhile.

The right rib cage, which varies from dull to really uncomfortable; sometimes like there is a pinch or things are twisting up in there; and sometimes if I do something semi-strenuous, I have it in the back in kind of the same spot. Occasionally a feeling of pain on the left side.

Also have had a few times where I couldn't eat AT ALL, and I usually have a pretty healthy appetite, but if I started to eat a meal, I would get so uncomfortably full so fast, it was strange, and I wouldn't really be hungry again for the rest of the day. Had to eat really small meals for awhile.
I have not found out yet. Have you had any tests done? Or is the pain fairly new?

I just saw my hepatologist the other day. My appetite has been getting a little bit better over the past month (still really low though) but I have been able to eat more without feeling so uncomfortable. I think I owe a lot of that issue to a major amount of stress. As soon as things started settling down (I had a big break between doctor's visits and other outside stressors diminished) I felt like eating a little bit more and didn't feel so awful while eating. I just didn't want to eat before so eating felt gross. I still feel like I get fuller faster than I usually do, but maybe I'm just more in tune to my fullness cues? I don't know. Having had an eating disorder I'm really messed up in terms of my hunger and fullness and I was told that may have come into play as well. What I was told though is that if it gets worse again or really bothers me that I should schedule an endoscopy with my GI specialist to see if there is anything else going on.

I just got some blood work run though and am scheduled for a liver biopsy for next Wednesday (the 16th). I wasn't able to get in to try to order any more blood work before my hepatology visit, so he ordered for more to see if I have autoimmune hepatitis or primary biliary cirrhosis because the ANA test I had done did not rule that out. He also ordered for celiac serology. I will get the results of my blood work on the day of my biopsy and I'll let you guys know how that goes!

 
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Old 01-08-2013, 05:11 PM   #94
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Re: Elevated liver enzymes, pain under right rib cage, coarse texture on ultrasound

I first started feeling it on and off about a year ago, but I didn't have health insurance, so I never went to the doctor. It has gone away and come back a few times since then.

Oddly enough, it felt quite a bit worse today than usual. After reading these forums last night I decided to take some vitamins and a water pill this morning and I don't know if those aggravated it or not. I also am currently sick with the flu (for the second time this season which is aggravating) so I don't know how much that impacts it either. I can feel that pain more when coughing and stuff.

I'm wasn't sure what kind of doctor to go see, but I was planning on scheduling an appointment sometime in the near future. I just REALLY don't want to continue to get referred to others, which sounds like a pain.

 
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Old 01-09-2013, 09:29 AM   #95
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Re: Elevated liver enzymes, pain under right rib cage, coarse texture on ultrasound

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Originally Posted by WilkesG View Post
I first started feeling it on and off about a year ago, but I didn't have health insurance, so I never went to the doctor. It has gone away and come back a few times since then.

Oddly enough, it felt quite a bit worse today than usual. After reading these forums last night I decided to take some vitamins and a water pill this morning and I don't know if those aggravated it or not. I also am currently sick with the flu (for the second time this season which is aggravating) so I don't know how much that impacts it either. I can feel that pain more when coughing and stuff.

I'm wasn't sure what kind of doctor to go see, but I was planning on scheduling an appointment sometime in the near future. I just REALLY don't want to continue to get referred to others, which sounds like a pain.
I hear ya. Do you have health insurance now? I think either way just seeing your general physician first would probably be the way to go, but I would expect to possibly be referred to a specialist eventually, depending on how testing goes. If you do have insurance, you'd probably need a referral to go to a specialist anyway in order for it to be covered so you would still need to see your regular doc first.

I currently do not have health insurance. A visit with my regular doctor is $85, my GI specialist was $195, and my hepatology visit is between $395-605 (have yet to get the bill.) Then there is blood work and imaging on top of that. I do have share of cost with Medicaid so my biopsy and possibly my hepatology visit will be covered. Also, I have a supplement plan with BCBS that pays 100% of my blood work and that only costs me $25 a month. It's still been expensive though. And yes, it is a pain. Honestly, I really wanted to opt out of the hepatology appointment and still don't want to do the biopsy. I'm just sick of it and am not optimistic about them finding anything at this point. At the same time, I was told by my GI specialist that this really isn't something that I can just let go of...I need to find out what is wrong no matter how much it costs me. So, onward I go! But it sure is driving me nuts.

I would definitely see the doc though and see if they can run some blood work, do liver function tests and stuff. I don't know much about the gallbladder but I know they had checked to see if I had gallstones that could be causing all of this (which I don't.) I know what I've been tested for and what they've told me about what is currently going on, but that's about it! You know your body though and if you feel something is wrong or if something is bothering you for that long, I would definitely see a doc. Even just to give you a piece of mind!

 
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Old 01-19-2013, 02:48 PM   #96
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Re: Elevated liver enzymes, pain under right rib cage, coarse texture on ultrasound

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Originally Posted by Hypochondriacyy View Post
Are the whites of your eyes yellow? You would turn yellow before you would start itching. People would point it out to you. Its probably not bilirubin
Thats not true. My first symptom was intense itching all over particularly in hands and feet and I went jaundiced about a month later. Backup of bile in ducts and high bilirubin.

 
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Old 02-08-2013, 06:10 PM   #97
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Re: Elevated liver enzymes, pain under right rib cage, coarse texture on ultrasound

How did you liver biopsy go?

 
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Old 02-15-2013, 03:39 PM   #98
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Re: Elevated liver enzymes, pain under right rib cage, coarse texture on ultrasound

Dear abouttwodays,

I am new to this site - I actually came here looking for something completely unrelated, but your post caught my attention.

I didn't read all the pages of replies and conversations, but through all that I did read, I've seen a lot of discussion about CTs, gallbladder trouble, lab values, etc.

The first thing that came to my mind when I read your INITIAL post, and what I have NOT seen mentioned ONCE in this thread, is an autoimmune disease of the liver, primary biliary cirrhosis (PBC). Your symptoms are very consistent with that diagnosis. I noticed someone asked about your bilirubin, and someone else (quite mistakenly) said that you would have jaundice before itching. That is absolutely not true.

I have had PBC for 20 years. My liver enzymes are usually mostly normal (or borderline), except for my alkaline phosphatase, which is ALWAYS elevated. I have only recently begun having itching to a greater degree than in the past. Repeat blood work shows continued elevation of my alk phos but new elevation in my ALT and AST. While a GGTP is very elevated, my bilirubin remains normal.

All of this to say that you may have PBC (or similar disease) and still have some very normal lab values. Only a liver biopsy will be completely conclusive. It would be a good idea to have AMA tested as well (a positive result is almost always the case in PBC).

Please do update us about your condition and the latest in your care.

Sincerely,
Glenda

 
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Old 02-15-2013, 08:04 PM   #99
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Re: Elevated liver enzymes, pain under right rib cage, coarse texture on ultrasound

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Originally Posted by GlendaM View Post
Dear abouttwodays,

I am new to this site - I actually came here looking for something completely unrelated, but your post caught my attention.

I didn't read all the pages of replies and conversations, but through all that I did read, I've seen a lot of discussion about CTs, gallbladder trouble, lab values, etc.

The first thing that came to my mind when I read your INITIAL post, and what I have NOT seen mentioned ONCE in this thread, is an autoimmune disease of the liver, primary biliary cirrhosis (PBC). Your symptoms are very consistent with that diagnosis. I noticed someone asked about your bilirubin, and someone else (quite mistakenly) said that you would have jaundice before itching. That is absolutely not true.

I have had PBC for 20 years. My liver enzymes are usually mostly normal (or borderline), except for my alkaline phosphatase, which is ALWAYS elevated. I have only recently begun having itching to a greater degree than in the past. Repeat blood work shows continued elevation of my alk phos but new elevation in my ALT and AST. While a GGTP is very elevated, my bilirubin remains normal.

All of this to say that you may have PBC (or similar disease) and still have some very normal lab values. Only a liver biopsy will be completely conclusive. It would be a good idea to have AMA tested as well (a positive result is almost always the case in PBC).

Please do update us about your condition and the latest in your care.

Sincerely,
Glenda
Hey, thanks for your response. I did post my biopsy results on a new thread (titled "finally got a diagnosis"). I am currently under treatment for autoimmune hepatitis. My biopsy showed severe chronic hepatitis (grade 4) with bridging fibrosis (stage 3). Interesting you talk about the PBC though because my biopsy also showed signs of bile duct damage and though it said the biopsy as a whole supported the diagnosis of AIH, it also said there is a possibility of overlap syndrome with PBC. Now, every autoimmune marker I was tested for came back negative. I don't have my records in front of me but I know I was tested for many and they included those for PBC as that along with AIH were the primary concern for my hepatologist. But he told me since the marker was negative and that its pretty accurate, the likelihood of me having PBC was low and he's not too worried. I am not so good with asking questions on the spot so I neglected to ask about the bile duct damage and if that was something caused by the AIH or what. I do have a follow up on March 14 to see how I'm responding to treatment and I will ask then. So far I have had one lab test for my LFT's two weeks after starting the meds and not much has changed. AST has lowered only slightly (maybe an improvement but could be a fluctuation, too early to tell), ALT stayed the same, and alkaline phosphatase went up and is now mildly elevated. I am getting blood drawn again next Friday, will probably get my results the following Monday and we will see if things are improving then. I am on 3mg/day of Budesonide.

 
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Old 02-16-2013, 08:56 AM   #100
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Re: Elevated liver enzymes, pain under right rib cage, coarse texture on ultrasound

Hello there. I'm so glad you responded. So, the budesonide is a steroid for the inflammation? I, too, would be very curious about the bile duct damage. I would also ask about the possibility of benefit from taking ursodiol, just in case there is a component of PBC. One last thing, so your AMA is negative as well? It is rare, but it CAN be negative in PBC. For those who have PBC but a negative AMA, close monitoring with ultrasound and biopsy is important. As you probably know, those with PBC and other autoimmune diseases are at increased risk for hepatic carcinoma.

Please do keep in touch, and I'm here if you ever have any questions about PBC.

Sincerely,
Glenda

 
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Old 02-16-2013, 09:05 AM   #101
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Re: Elevated liver enzymes, pain under right rib cage, coarse texture on ultrasound

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Originally Posted by GlendaM View Post
Hello there. I'm so glad you responded. So, the budesonide is a steroid for the inflammation? I, too, would be very curious about the bile duct damage. I would also ask about the possibility of benefit from taking ursodiol, just in case there is a component of PBC. One last thing, so your AMA is negative as well? It is rare, but it CAN be negative in PBC. For those who have PBC but a negative AMA, close monitoring with ultrasound and biopsy is important. As you probably know, those with PBC and other autoimmune diseases are at increased risk for hepatic carcinoma.

Please do keep in touch, and I'm here if you ever have any questions about PBC.

Sincerely,
Glenda
Is that the mitochondrial antibody? I had the mitochondrial tested and yes, it was negative.

The budesonide is for the autoimmune, it is used in place of prednisone because it has less side effects. I'm not sure if they are going to put me on Imuran with it or not. In March I will get a better idea of where I am going with my meds depending on how my body responds by then. I will definitely bring up the bile duct damage at that appointment.

Thank you!

 
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Old 04-09-2013, 05:07 PM   #102
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Re: Elevated liver enzymes, pain under right rib cage, coarse texture on ultrasound

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Originally Posted by abouttwodays View Post
Is that the mitochondrial antibody? I had the mitochondrial tested and yes, it was negative.

The budesonide is for the autoimmune, it is used in place of prednisone because it has less side effects. I'm not sure if they are going to put me on Imuran with it or not. In March I will get a better idea of where I am going with my meds depending on how my body responds by then. I will definitely bring up the bile duct damage at that appointment.

Thank you!
Abouttwodays: How are you doing? I hope all is well!

 
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Old 07-26-2013, 07:14 PM   #103
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Re: Elevated liver enzymes, pain under right rib cage, coarse texture on ultrasound

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Originally Posted by gjet68 View Post
Hello, your post caught my eye as I can def relate to what you are going through! I got Penumonia about 10 years ago and ended up in the ER during their routine battery of blood work my Liver Enzymes came back elevated. They referred me to my GP and on the day of my appt they reran the blood work and it came back 7 times the norm, needless to say they were running crazy and freaking out. So they referred me to a Gastroenterologist who then referred me to a Hepatologist and I had a Liver Biopsy done.

It came back Fairly Normal with Minimal Inflammation. My Hep ran all sorts of tests on me, regular Hepatitis screens always come back normal, as did Ultrasounds and other blood work. My ALT/ALP were elevated too. I am also anemic. My hep doc decided to just keep a watch on it and run blood work on the basis of every 3 months. He stated in his opinion we could rule out fatty liver disease and that he felt it might be Autoimmune Hepatitis but not bad enough to warrant treatment. He said unfortunately it was just going to have to be something we would have to watch over time.

So, the past ten years for me have been spent repeating abdominal ultrasounds and LFT`s with the lab. In March of 2012 I had the most severe pain in my gallbladder/liver region that I have had to date. I presented the the ER at which time they did a cat scan and blood work. The ER doc had pulled my records from 10 years prior and stated that My Enzymes were elevated but not bad like they had been before. They seem to roller coaster for some reason. The CT scan revealed that my Gallbladder wall was thickened but there was no evidence of any stones. They attributed the pain to Billary Colic and gave me a couple shots of meds for that. They advised me to have my GP refer me to a surgeon.

At that time I had no insurance and we recently moved to a bigger city. So the pain has been getting worse along with a feeling that something is wrong. So once we were settled here I made an appt with an Internist to establish care and get his opinion as I could not get in to see my Hepatologist until January, given the fact that I had not been there since 2007 they treated me as a new patient. This doc ran a good blood work up and ordered a sonogram of the abodmen/liver/gallbladder the results indicated Gallbladder Polyps.

The internist referred me to a surgeon and a Gastroenterologist. I saw the surgeon a couple weeks ago and he stated that Gallbladder Polyps should not be causing me any pain, period. He stated that he felt those Polyps may be actual small gallstones stuck to the gallbladder wall. He has me scheduled for a HIDA scan tomorrow morning. He said that if that indicated my GB was functioning normally the next step would be to have the Gastro doc scope me and see if he could locate the source of my pain. He further indicated that he felt the elevated LFT`s played no bearing on this current situation.

These are my symptoms:

General Weakness/Tiredness/Achy Flu Like Feeling (Some days worse than others)
Anemia (Ongoing take Iron Supplements)
Pain in the Upper Right/Mid and even lower Abdomen at times.
Loose Stools (Frequent)
Indigestion/Reflux
Nausea
Sweating/Clammy feelings
The pain in my abdomen is a steady burning pain and its sore to the touch, sometimes its so bad it keeps me awake at night. It hurts when I lie down worse too. Holding a heat pad against it seems to help some.
Sometimes I have pain between my shoulder blades that I describe as feeling "tight" as though someone was stretching a hide over something and pulling it taught.
Occasional itching
Occasional Joint Pain
Weakness in my wrists and hands occasionally

Medical History:
Migraines (take meds for those)
Hypertension (Been on meds for those since I was 15)
Trigeminal Neuralgia (unmedicated because the docs felt that meds would do my liver more harm, I only get pain meds when it becomes too bad to bear)
Anemia
Heart Valve Leakage/Murmur

Now, with the thought of having possible AIH and it running in families I have to say that my mother had Pernicious Anemia and Thyroid Disease she is also Diabetic. My sister has Fibromyalgia and Thyroid Disorder. I know that these can all be indicative of Autoimmune Disorders.

I was hoping maybe we could compare symptoms? Any thoughts from anyone else? I am wondering if the Pain I am having could be coming from my liver? The Surgeon was asking me about the liver and seemed concerned a bit tho he stated he felt my GB would need to come out within the next month he did state he was not 100 percent certain even that would alleviate the pain.
I'm having very similar issues to some of the posters on here ... one that intrigues me is the heart murmur/valve issues. Have any of you with this in common ever figure out what's going on? Here's a brief history of my issues ...

Just had my second child on 5/7. Had heart palpitations/extra heart beats during pregnancy pretty bad. I've had issues with my mitral valve since I was a child.

3.5 weeks after delivery I started having horrible abdominal pain and ended up in ER, diagnosed with gallstones. I had my gallbladder removed after another painful attack a week later. I was great for 2-3 weeks ... then started having painful attacks again. They're to the point now that they feel very similar, so I wonder if it was never my gallbladder.

I've been in the ER 4-5 times in June and July. My labs are almost always normal, however, now the attacks are getting to be the worst yet and my liver enzymes are elevated quite a bit (ALKALINE PHOSPHATASE, ALT, and AST). Basically an attack goes like this:

30-90 minutes after eating (or drinking any alcohol)
- HORRIBLE upper central abdominal pain
- Nausea
- sometimes followed by vomiting or diarrhea
- Bloating
- Sometimes chest pain
- Sometimes shortest of breath or passing out (I think this is due to when the pain in very severe)
- Pain can become so severe that I can not get comfortable and am in worse pain than labor, literally

I've had the following and all are normal:
- HIDA scan
- Ultrasound to check for missed stones
- Endoscope
- Labs for bilirubin

Only thing abnormal (other than the pain/attacks)
- Liver enzymes elevated

I FINALLY got approval for a CT scan of entire abdomen/pelvis if I end up in the ER again and am symptomatic

I'm supposed to go back to work from maternity leave next Thursday and I'm very nervous. When I have one of these attacks I'm dragging someone over to my house (usually in the middle of the night) to watch my toddler, while my hubby and 2 month old take me to the ER. Then I'm out 1-2 days. I'm so sick of pumping and dumping since Iím breast feeding, and putting people "out" who have to help me and my kiddos. My poor hubby has taken so much time off work and it's getting old. Not to mention I miss eating and drinking anything other than water. But Iím sure all of you on here you can relate.

Any ideas? Particularly people with the heart valve connection ....

THANKS a million

 
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Old 08-03-2013, 04:27 AM   #104
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Re: Elevated liver enzymes, pain under right rib cage, coarse texture on ultrasound

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Originally Posted by tummy123 View Post
I'm having very similar issues to some of the posters on here ... one that intrigues me is the heart murmur/valve issues. Have any of you with this in common ever figure out what's going on? Here's a brief history of my issues ...

Just had my second child on 5/7. Had heart palpitations/extra heart beats during pregnancy pretty bad. I've had issues with my mitral valve since I was a child.

3.5 weeks after delivery I started having horrible abdominal pain and ended up in ER, diagnosed with gallstones. I had my gallbladder removed after another painful attack a week later. I was great for 2-3 weeks ... then started having painful attacks again. They're to the point now that they feel very similar, so I wonder if it was never my gallbladder.

I've been in the ER 4-5 times in June and July. My labs are almost always normal, however, now the attacks are getting to be the worst yet and my liver enzymes are elevated quite a bit (ALKALINE PHOSPHATASE, ALT, and AST). Basically an attack goes like this:

30-90 minutes after eating (or drinking any alcohol)
- HORRIBLE upper central abdominal pain
- Nausea
- sometimes followed by vomiting or diarrhea
- Bloating
- Sometimes chest pain
- Sometimes shortest of breath or passing out (I think this is due to when the pain in very severe)
- Pain can become so severe that I can not get comfortable and am in worse pain than labor, literally

I've had the following and all are normal:
- HIDA scan
- Ultrasound to check for missed stones
- Endoscope
- Labs for bilirubin

Only thing abnormal (other than the pain/attacks)
- Liver enzymes elevated

I FINALLY got approval for a CT scan of entire abdomen/pelvis if I end up in the ER again and am symptomatic

I'm supposed to go back to work from maternity leave next Thursday and I'm very nervous. When I have one of these attacks I'm dragging someone over to my house (usually in the middle of the night) to watch my toddler, while my hubby and 2 month old take me to the ER. Then I'm out 1-2 days. I'm so sick of pumping and dumping since Iím breast feeding, and putting people "out" who have to help me and my kiddos. My poor hubby has taken so much time off work and it's getting old. Not to mention I miss eating and drinking anything other than water. But Iím sure all of you on here you can relate.

Any ideas? Particularly people with the heart valve connection ....

THANKS a million

I have mild Mitral and Tricuspid valve regurgitation with moderate Pulmonary valve regurgitation with mild restrictive lung disease. The main symptom is occasionally mild shortness of breath but only when I eat and lay down. So it is not the caused of my pain.

My HIDA ejection fraction was 26%. Other than that was normal. GI said it was an inflammation of gallbladder, referred me to a surgeon but he refused to operate as he did not think that my pain was caused by that.

Then I had a comprehensive blood work Celiac disease done - positive but colon biopsy was normal. GI said it could be Autoimmune Celiac disease so was on Gluten free diet for a while but did not see the differences.

Now all specialists I have seen contributed the cause to Lupus. (I have lupus as well). Anyway, they all said since nothing big really popped up so it could be an autoimmune disorder.

Started in Feb 2011 until now, no one has found the "real" cause. The pain is still there but luckily it is only mild-moderate so I bare with it (not taking pain killer due to Chronic Hepatitis stage 2). I was frustrated for years. Now I am back to stay positive and trying to live my life more happily.
I personally think that if I really have something bad, eventually, it will show itself, become very severe, damage something and then hope that someone will find the cause.
I kind of think that they could not find it because maybe it was mild.

Anyway, I wish you the best. Give me updates if they ever find anything.
The only symptom I don't have is Loose stool. My bowel movement is always normal.
Good luck!

 
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Old 08-05-2013, 03:36 PM   #105
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Re: Elevated liver enzymes, pain under right rib cage, coarse texture on ultrasound

I to have elevated liver enzymes,heart murmurs,pain under my left rib not right.This past year I added sensativity to light,cold feet&hands,fatgue,fibromyalgia pains and muscle tension.After 20000$ in tests and similar answers from doctors that many of you get (no answers) I changed my diet.Overall I do know food intolerances(not allergy) cause all these items including elevated enzymes.I cut out gluten,caffeine and cut down on eggs and my ibs calmed down and my alt is 51 so 10 points too high but all the others that were high dropped into normal range.Alrhough my albumine is 49 at the limit,its still normal compared to before.Hopefully I'm on the right track,hopefully someone here may be helped by my case

 
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