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Liver function tests abnormal

Discussion in 'Duodenal Switch' started by DianaCox, Jan 16, 2017.

  1.  
    DianaCox

    DianaCox Bad Cop

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    First - just sharing this because we ALL go through weird test results, and shit happens. So I'll post this from the beginning, and follow up as I get more information - as well as asking if anyone else has had abnormal liver function tests and what happened.

    I connected with a new PCP in my new city a couple of weeks ago, and he insisted on running all my labs again. My only real complaint is lack of appetite and having trouble eating enough, especially protein, as well as general lack of stamina (which is probably due to my lack of sufficient physical activity).

    I got a call today from a local radiology office to make an appointment for an abdominal U/S. Naturally, I asked why, because I hadn't seen my LFT results come in yet on my portal. Well, apparently, the message from the doctor regarding that set of labs didn't get sent, so I didn't see them. We got that straightened out, and I'm having the test on Wednesday.

    Over the last 13+ years, my levels have occasionally been at the top of normal or slightly over. I had an U/S in 2011, just to be sure. This time, two of them are quite high:

    7/10 1/11 7/11 7/12 4/13 7/13 7/14 4/15 7/15 7/16
    Alkaline Phosphatase

    26 - 137 U/L
    102 124 119 112 93 104 98 101 110 102

    ALT
    0 - 60 U/L
    91 H 70 H 40 49 37 38 29 69 H 75 H 67 H

    AST
    0 - 37 U/L
    45 H 37 18 23 19 23 14 25 35 44 H


    My labs last week (ranges are slightly different):

    ALKALINE PHOSPHATASE, S
    39-117 IU/L
    93

    ALT (SGPT)
    0-32 IU/L
    162 Above High Normal

    AST (SGOT)

    0-40 IU/L
    136 Above High Normal

    So those numbers are significantly high.

    I'm not drinking much - not even remotely every day - maybe 3 drinks/week. I'm not taking statins - just thyroxine, Protonix, a smidge of Adderall and 1/2 Lunesta and 0.5 mg Ativan to fall asleep. Hardly a pharmacy's worth of meds.

    I had a liver U/S in 2011:
    Indication: Elevated liver enzymes, status post cholecystectomy 2003
    Comparison: None
    Report: The pancreas is normal in appearance, partially obscured at its tail by bowel gas. The abdominal aorta is normal in caliber. Slight increased hepatic echogenicity, borderline with questionable suggestion of mild steatosis. No suspicious focal hepatic lesions. Normal hepatopetal portal venous flow. No ascites. Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation. Spleen is normal in size and appearance. The inferior left kidney demonstrates a tiny 4 mm probable tiny cyst, though difficult to definitively characterize sonographically. The right kidney measures 10.4 cm and the left measures 10.6 cm in maximal longitudinal dimension and are otherwise unremarkable.

    IMPRESSION:
    1. Very mild increased hepatic echogenicity, suggestive of possible mild hepatic steatosis. Recommend clinical and laboratory correlation.
    2. 4 mm probable tiny left renal cyst, though difficult to definitively characterize. Limited follow up ultrasound could be obtained in 6-12 months to monitor stability.
    3. Status post cholecystectomy. ​

    I had a CT scan in 2014 for blood in my urine (turned out to be nothing). The following were the incidental findings:

    Multiple sutures and clips are noted along the stomach and gastroesophageal
    junction, consistent with previous partial gastrectomy there also appear to be
    sutures along the right side of the liver. The liver and spleen are normal in
    size and contour and demonstrate homogeneous attenuation, without focal or
    diffuse abnormality.
    The pancreas and adrenal glands are unremarkable. The
    gallbladder is nonvisualized and may be surgically absent. The abdominal aorta
    is normal in caliber. No lymphadenopathy is appreciated, although there are a
    few nonenlarged mesenteric, retroperitoneal, and inguinal lymph nodes. No free
    or loculated fluid collections are identified. There is a line of anastomotic
    sutures surrounding a bowel loop in the anterior midabdomen. The unopacified
    small and large bowel appears otherwise grossly unremarkable. There is a 2.2 cm
    wide focal defect in the left anterior abdominal wall just to the left of
    midline, just above the level of the umbilicus, through which some mesenteric
    fat probably extends. A smaller defect in the upper midline anterior abdominal
    wall is also noted, which also contains fat.. The lung bases are clear. Minor
    degenerative changes of the lumbar and visualized lower thoracic spine are seen.
    Osseous structures appear otherwise intact.
    So, hmm, wonder what all this means? I am of course consulting Dr. Google ... to my detriment.
     
  2.  
    hilary1617

    hilary1617 First time at the rodeo.

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    @DianaCox , I'm sorry to hear that this set of tests is out of whack and hope it's some testing anomaly. That said, seems like your new PCP is really on the ball. I think you have chosen wisely. Please stay extra hydrated while they figure this out!
     
  3.  
    Marquis Mark

    Marquis Mark Well-Known Member

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    Wish I could contribute some scientific understanding, but all I can offer is good vibes that you'll get this sorted out ASAP. Not knowing is the worst part.
     
  4.  
    DSRIGGS

    DSRIGGS Yes, that is chocolate covered bacon

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    I am glad you are getting it looked at but Dr's have told us that unless the numbers are something along the line 10-15 times the high limit they don't usually worry. Cameron has had some times in the past when his AST and ALT came back at 250 and the ER docs (was there for something else) said it was no big deal. Naturally that has always frustrated me because why have a maximum at that level where you (Dr) tell me is not significant.

    Hopefully everything comes back fine. I know Dianna had some blood work about 6 months ago and her AST and ALT came back high. She didn't think about it and had a glass of wine the night before. Our PCP said that one glass of wine is enough to elevate your numbers temporarily but he had here retested. It came back fine.

    Best wishes and I hope you are just fine.

    BTW, even with my Stage 3 liver disease my function is great so that is one reason I was relieved when the GI said I was okay

    upload_2017-1-16_23-51-41.png
    upload_2017-1-16_23-52-50.png
     

    Attached Files:

    Rainerific likes this.
  5.  
    DSRIGGS

    DSRIGGS Yes, that is chocolate covered bacon

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    and LOL I am the King of using Dr Google. Sometimes I wish they would just say, "hey it looks good to me" rather than Doc speak they use. The worst was a lumbar spine MRI that basically called out about 20 things that sounded like I was going to be wheel chair bound in three weeks but when I talked to my Neurosurgeon's PA she basically said nothing is bad enough that we need to do anything other than some PT. I would hate to see what a bad MRI reading stated.

    Again, hope this is all just precaution and your liver is fine. You have too many bottles of wine and margaritas to drink to have your damn liver messing with you. :D
     
  6.  
    aaa

    aaa Well-Known Member

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    Good job by your PCP. Definitely important just to check things out like you're doing.
     
  7.  
    Clematis

    Clematis Well-Known Member

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    Try not to worry about it until a doc tells you to be worried. You haven't even had the US. As Scott said, liver enzymes have to be WAY off for there to be a real concern. It's probably nothing at all.
     
  8.  
    Munchkin

    Munchkin Full of Fairy Dust

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    It's a wait and see thing. Don't start worrying till there is something to worry about!
     
  9.  
    OldBroad

    OldBroad Well-Known Member

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    Do you take a lot of Tylenol?
     
  10.  
    DianaCox

    DianaCox Bad Cop

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    I take almost no Tylenol nor any other pain meds. I had a headache for the first time in a year or two a couple of months ago, and that was the first time I'd taken anything in a long long time (yay me!) and it was Aleve. But I couldn't swear I didn't have a beer with dinner the night before the bloodwork - I have one about 3x/week.

    I now have medical student's disease or nosophobia (http://well.blogs.nytimes.com/2013/09/05/when-med-students-get-medical-students-disease/?_r=0) - am I slightly queasy? Yes! (But I just ate some cold steak and feel better.) I had a stabbing pain in my liver area today! (But it was probably gas.) Are my eyeballs jaundiced? (No, not really.) But I'm on the lookout for any and all symptoms!
     
  11.  
    DianaCox

    DianaCox Bad Cop

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    Oh and I forgot - I'm having the ultrasound tomorrow at noon - and I am supposed to go TWELVE FUCKING HOURS WITH NOTHING TO EAT OR DRINK!! How the hell am I supposed to do that?? I drink in the middle of the night multiple times or my mouth is too dry! No coffee in the morning! How am I going to poop in the morning??

    I actually have this mug, given to me by one of my loving children, but it is WAY too small - I use a 5 cup sized flagon:
    [​IMG]
     
  12.  
    DSRIGGS

    DSRIGGS Yes, that is chocolate covered bacon

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    Yeah NPO sucks but you will make it. You are too damn ornery to have anything seriously wrong with you :p so hang in there and study hard for this test so you ace it! :D
     
  13.  
    DianaCox

    DianaCox Bad Cop

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    I'm now trying to convince myself that we went to Red Lobster the night before the blood test - I had a tall mixed drink that night (a Mai Tai, IIRC). But jeez, while I'm hoping that's what it was - why would one damned drink do that to my liver? I really rarely have two drinks in one night, and rarely have alcohol two days in a row. I get buzzed really easily, and it wears off fast too.

    I've been studying for this test all day - all I've done is freak myself out. Oh, and the PCP sent me a message today that he's not going to review the test results - he's referring me to a GI/liver specialist. WTF? Did I worry him in our first meeting that I'm a special (litigious) snowflake? I mean, I need a new GI doc, because I'm supposed to get an EGD sometime soonish to check on my GERD (I've had a couple of middle of the night barf-fests in the last couple of months), but this seems a bit over the top.

    And apparently, the PCP ordered iron bloodwork without ordering ferritin. Need to get a new order for that - not bad for a first time order though. I have a follow up appointment with the PCP on the 27th - I'll ask him to order the ferritin and repeat liver function tests (and won't drink the night before).
     
  14.  
    DSRIGGS

    DSRIGGS Yes, that is chocolate covered bacon

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    Yeah I guess alcohol is harder on the liver than I had realized. My wife had one glass of a Pinot Noir and really elevated hers. I bet that is all it is but at least this guy ones to check it. To me a guy who errors to that side of the equation is superior to Docs who are so conservative that you have to wait for months to get them to do anything.

    Okay, stop studying now.
     
  15.  
    DianaCox

    DianaCox Bad Cop

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    I'm spending the next hour and 10 minutes eating my face off. Second supper (lobster cakes). Then no food for 12 hours. Imma gonna DIE - and the worst is, no food for 8 hours -> crampy diarrhea - I only have to drive about 3 miles to get to the radiology place, but OMG - I'd better not hit any lights!!

    I wrote that last night, and didn't post it. I am now in the middle of the misery - diarrhea and hunger and thirst and no caffeine. But I just weighed myself, and 163.8 is a new low. I'd smile about that, but I'm too weak.
     
    JuliaDS and Susan in Tennessee like this.

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