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Liver enzyme lab levels mean?

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Old 10-14-2013, 04:39 PM   #1
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Liver enzyme lab levels mean?

My 36 year old son has a history of Pancreatitis, Lyme Disease, High Blood Pressure and high cholesterol/triglyceride levels.

He recently had lab results that had some liver enzyme levels that looked concerning. I was hoping to get some input on what they could mean.

Bilirubin, Total 1.3 H Ref # 0.2-1.2 mg/dl
AST 61 H Ref# 10-40 U/L
ALT 107 H Ref# 9-46 U/L
LD 250 H Ref#100-220 U/L
GGT 383 H Ref#3-90 U/L

Sodium 133 L Ref#135-146 mmol/L

I appreciate any input!

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Old 10-14-2013, 08:23 PM   #2
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Re: Liver enzyme lab levels mean?

Hi JS; Liver labs can be difficult to interpret as there are many different causes for elevations. LFT's are also rather fluid and dynamic and can change quite a bit over relatively short periods of time. GGT in particular can jump around a lot, and even moderate amounts of alcohol can spike GGT. 383 IS impressive though.

Many medications can elevate LFT's too. You mention his cholesterol/triglyceride levels are high... Is he on statins to control these? Is he taking over the counter or prescription pain meds for any chronic condition?

What's most often misunderstood about LFT's is that they are not a very good indicator of cumulative damage to the liver, but rather a good indicator of just how angry or inflamed the liver was in the days leading up to the blood draw. Many liver patients with substantial/permanent damage have liver enzymes that return to normal once their hepatitis, alcohol or whatever have been resolved. Likewise, those with acute liver disease (hepatitis A) can spike sky-high enzymes for several months, but recover with little or no permanent damage.

Most doctors don't get too excited about mildly elevated LFT's until levels reach double the normal upper limits over a period of several tests done over several months time. As 2 of your son's enzymes are double or more normal, this is a rationale/justification to monitor these enzymes more closely than the usual annual checkup. 90 days is the usual period for a re-check in situations like this, and if his doctor hasn't requested he come back to follow up in this your son should request this.

In the mean time, you might want to look into "possible suspects" for what might be causing this problem. Medications, alcohol, a high carb diet (especially fructose), elevated weight (fatty liver is epidemic), toxic exposures at work, and many other things might be to blame.

Moderately elevated LFT's like this shouldn't be cause for major alarm, but aren't the kind of thing you want to ignore either. You've got to work on the cause until you find it, and keep going back for labs to be certain nothing is getting worse and you've got things headed in the right direction.

Best of Luck to you both!

Last edited by BillinSD; 10-14-2013 at 08:29 PM. Reason: addition

Old 10-14-2013, 09:09 PM   #3
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Re: Liver enzyme lab levels mean?

Thanks BillinSD for such a thoughtful response. He just met with a nurse practitioner. She said the elevated liver tests are probably due to his pancreatitis. His health has been such a mess the last few years that I'm on hyper alert. He and his wife don't want to think about any of it as it is depressing.

With the pancreatits, it has so interrupted his life that he is depressed and very stressed and in a lot of chronic pain. Lyme disease on top of it all. He didn't have health insurance for 8 months so he had very high blood pressure that went untreated as well as all the cholesterol, etc. Now he has some county assistance, so he is getting a bit of help - however limited.

He stopped drinking completely when he had his first bout with pancreatitis. But some dr told him he only needed to stop for six months and then he could drink moderately. His wife drinks a fair amount, so he has 2 or three drinks a week with her. She smokes, so he gets a bit of second hand smoke.

He does take medication for his chronic pain. But he just got on statins last week. He has been gradually eating more sweets, and putting on a bit of weight. He is only moderately overweight, but it is worrying considering everything else. He feels he eats well, as they eat whole grains, etc. But they eat a lot of pasta, breads, etc. He is in denial on a lot of things, but i think the stress and depression just make it too difficult.

I read something about AST/ALT ratio. It said that anything under 1.0 was about 80% indicative of NASH = Nonalcholholic Steatohepatitis. His was .59. Seems like that should be something to look into.

Thanks though for your reply. It is very helpful to have someone to bounce some things off of and to get some sort of direction!

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