Liver function tests abnormal

[JackieOnLine]

I guess I'm not getting a liver biopsy any time soon.

 

[Spiky Bugger]

Lo


I decreased my D3-50 from 28/week to 21/week. I’m afraid to be more aggressive in D reduction without frequent D, PTH, calcium rechecks (which she will only do yearly unless I’m out of range at last test, grrr).

The sum-total of my knowledge on this part of this topic follows:

Whilst ordering my Vit D on Amazon, I noticed that there seems to exist one, or more, DIY home Vit D tests for around $60. The end.

 

[DianaCox]

Well crap.


Hepatic Function Panel (7)
Protein, Total
6.5 NORMAL Reference Range: 6.0-8.5 g/dL
Albumin
4.3 NORMAL Reference Range: 3.6-4.8 g/dL
Bilirubin, Total
0.8 NORMAL Reference Range: 0.0-1.2 mg/dL
Alkaline Phosphatase
92 NORMAL Reference Range: 39-117 IU/L
AST (SGOT)
86 HIGH Reference Range: 0-40 IU/L **
Bilirubin, Direct
0.22 NORMAL Reference Range: 0.00-0.40 mg/dL
ALT (SGPT)
173 HIGH Reference Range: 0-32 IU/L *****

I guess the liver doc will call me ...

I did my annual labs on Tuesday - it will be interesting to see what my D3 and A levels are. I'm currently taking 5 50K D3/week, and 2 25K A/week.

 

[Marquis Mark]

Well crap.


Hepatic Function Panel (7)
Protein, Total
6.5 NORMAL Reference Range: 6.0-8.5 g/dL
Albumin
4.3 NORMAL Reference Range: 3.6-4.8 g/dL
Bilirubin, Total
0.8 NORMAL Reference Range: 0.0-1.2 mg/dL
Alkaline Phosphatase
92 NORMAL Reference Range: 39-117 IU/L
AST (SGOT)
86 HIGH Reference Range: 0-40 IU/L **
Bilirubin, Direct
0.22 NORMAL Reference Range: 0.00-0.40 mg/dL
ALT (SGPT)
173 HIGH Reference Range: 0-32 IU/L *****

I guess the liver doc will call me ...

I did my annual labs on Tuesday - it will be interesting to see what my D3 and A levels are. I'm currently taking 5 50K D3/week, and 2 25K A/week.

Yikes. Good luck with that. BTW, It seems like you don't take much Vitamin A or D. Is the amount you take normal for a DSer or on the low side?

 

[DianaCox]

I cut back when my liver levels went wonky - I was taking 10 D3/week and my D was finally at 100; I was taking 3 A/week and my A was at 81; I cut back to 5 D3 and 2 A per week. My D3 and A labs were drawn on Tuesday. In December they had dropped a bit:
Vitamin A, Serum
71 NORMAL
Reference Range: 26-82 ug/dL

Vitamin D, 25-Hydroxy, Total
Vitamin D, 25-Hydroxy, Serum
76 NORMAL
Reference Range: All Ages: Target levels 30 - 100

 

[Marquis Mark]

I cut back when my liver levels went wonky - I was taking 10 D3/week and my D was finally at 100; I was taking 3 A/week and my A was at 81; I cut back to 5 D3 and 2 A per week. My D3 and A labs were drawn on Tuesday. In December they had dropped a bit:
Vitamin A, Serum
71 NORMAL
Reference Range: 26-82 ug/dL

Vitamin D, 25-Hydroxy, Total
Vitamin D, 25-Hydroxy, Serum
76 NORMAL
Reference Range: All Ages: Target levels 30 - 100

Wow, I EVERYDAY I take 150,000 of D and 75,000 of A. My D only averages about 50, my A about 70. You, on the other hand, seem to have gotten away with taking relatively little. Had no idea it affected your liver like that.

 

[JackieOnLine]

Dang, I hope you can fix it.

 

[DianaCox]

Labcorp is taunting me with the fact that the other labs have been done, but they won't release them to me until Monday. WHY?

The liver numbers may have nothing fundamentally to do with my DS. Years of obesity and resulting NASH may be the triggering factor.

 

[southernlady]

Labcorp is taunting me with the fact that the other labs have been done, but they won't release them to me until Monday. WHY?

The liver numbers may have nothing fundamentally to do with my DS. Years of obesity and resulting NASH may be the triggering factor.

Because they hold them long enough to have your PCP review them. Even if he doesn’t, it still gives him/her a chance to see them.

 

[DianaCox]

Calling Larra , DSRIGGS and anyone who has had experience with liver issues.

My liver numbers in July were quite high (see above), and I had a follow up appointment with the liver specialist on Monday. They did another lab draw, and the discussion was that it may be time for a liver biopsy to see what's going on. I just got a call from her office, and my numbers were down quite a bit, but still high - she wants me to schedule a liver biopsy:

AST (SGOT)
July: 86 HIGH Reference Range: 0-40 IU/L ** NOW 40 something
ALT (SGPT)
July: 173 HIGH Reference Range: 0-32 IU/L ***** NOW 70 something

I'm a little unsure why she would want a biopsy now, when my numbers are clearly trending down. In May, I started taking an anti-anxiety medication which frankly didn't do anything, so about 7 weeks ago, I switched to a different medication. Seems to me I should wait for getting a biopsy until after at least one more liver function test, to see if the numbers come down further.

Now normally, I'm all for diagnostic testing to find problems before they get worse, but I'm not sure what this one would be for, and it's pretty invasive. I don't know if anything about my treatment (keeping my A and D3 levels mid-range rather than at the high end, for example) would change. I'm waiting for a call back to clarify the reasons.

 

[DSRIGGS]

Calling Larra , DSRIGGS and anyone who has had experience with liver issues.

My liver numbers in July were quite high (see above), and I had a follow up appointment with the liver specialist on Monday. They did another lab draw, and the discussion was that it may be time for a liver biopsy to see what's going on. I just got a call from her office, and my numbers were down quite a bit, but still high - she wants me to schedule a liver biopsy:

AST (SGOT)
July: 86 HIGH Reference Range: 0-40 IU/L ** NOW 40 something
ALT (SGPT)
July: 173 HIGH Reference Range: 0-32 IU/L ***** NOW 70 something

I'm a little unsure why she would want a biopsy now, when my numbers are clearly trending down. In May, I started taking an anti-anxiety medication which frankly didn't do anything, so about 7 weeks ago, I switched to a different medication. Seems to me I should wait for getting a biopsy until after at least one more liver function test, to see if the numbers come down further.

Now normally, I'm all for diagnostic testing to find problems before they get worse, but I'm not sure what this one would be for, and it's pretty invasive. I don't know if anything about my treatment (keeping my A and D3 levels mid-range rather than at the high end, for example) would change. I'm waiting for a call back to clarify the reasons.

I have stage 3 liver disease which means the walls of cells in my liver are hardened and crusty but my liver function has always been very good and never out of range.


I just saw my GI, well NP, last week because I have been having chronic diarrhea for a while now (occasionally swings too far the other way) and she said I need to have follow up testing every 6 months. Next week they are doing an ultrasound of my liver and while in the office they drew more advanced labs including looking for a tumor marker. Those came back fine.

My biopsy was done during a surgery when Dr K noticed my liver didn't look so swell. I hear a liver biopsy is not a whole lot of fun and yes your numbers appear to be trending well so I would think your suggested course of action makes sense.

Best wishes my friend!

 

[DianaCox]

So I was told that, based on U/S and labs, plus a FibroScan, I have stage 2 NASH (non-alcoholic steatohepatitis), presumably from years of being obese/MO. But it sounds like you (Scott) have something else, since your liver enzymes aren't elevated.

There are medications being developed for fibrosis, and my initial evaluation at Banner was to see if I qualified for a clinical trial. I did not. I'm wondering if this staging is solely for the purpose of qualifying me for a clinical trial (which I might consider), or if there is any other good reason. My numbers swing wildly from test to test, so I've been trying to isolate environmental factors (I barely ever drink; excess vitamins; something missing from my diet?) that might affect it, rather than taking an experimental drug for something that may be controlled by adjusting my diet or vitamins or medications.

I'm certainly not opposed to clinical trials - before my DS, I volunteered for a Phase III clinical trial for 16 months on a drug for obesity that I had to inject into my belly every day, had to drive 100 miles each way once a month to the clinic running the trial to get bloodwork and my next month's supply of the medication, and I had to keep the drug refrigerated when I traveled, which I was doing a lot of and it was a huge PITA. The drug turned out to be a failure, because it was a protein that most people (including me) made neutralizing antibodies to. Very disappointing. But I was willing to try anything with a reasonable chance of working before I submitted to bariatric surgery. I just don't see the urgency of this procedure at the moment, without more evidence or basis for doing it.

 

[Larra]

Did you ask what was the purpose for the liver biopsy at this time? If it's to qualify you for some kind of clinical trial that you can't qualify for without a tissue diagnosis, your doctor should tell you this. If it's just because she/he thinks these abnormalities have gone on too long, even though improved, that's a different story. Is the timing crucial? Given the improvement, would it also be reasonable, and not dangerous, to wait 2-3 months and re-test?

It sounds like there has not been sufficient communication as to the reason for a liver biopsy now. Maybe there really is a good reason. If so, the doctor should be able to communicate this reason to you in a way that makes sense to you. It sounds like you already had a u/s - would a CT scan be a less invasive alternative?

 

[DianaCox]

Good questions - I asked some of them already of her assistant, and I'm waiting to hear back from the PA (the original doc left the practice and she is the one recommending it), including how my treatment might change depending on the results.

 

[DSRIGGS]

So I was told that, based on U/S and labs, plus a FibroScan, I have stage 2 NASH (non-alcoholic steatohepatitis), presumably from years of being obese/MO. But it sounds like you (Scott) have something else, since your liver enzymes aren't elevated.

There are medications being developed for fibrosis, and my initial evaluation at Banner was to see if I qualified for a clinical trial. I did not. I'm wondering if this staging is solely for the purpose of qualifying me for a clinical trial (which I might consider), or if there is any other good reason. My numbers swing wildly from test to test, so I've been trying to isolate environmental factors (I barely ever drink; excess vitamins; something missing from my diet?) that might affect it, rather than taking an experimental drug for something that may be controlled by adjusting my diet or vitamins or medications.

I'm certainly not opposed to clinical trials - before my DS, I volunteered for a Phase III clinical trial for 16 months on a drug for obesity that I had to inject into my belly every day, had to drive 100 miles each way once a month to the clinic running the trial to get bloodwork and my next month's supply of the medication, and I had to keep the drug refrigerated when I traveled, which I was doing a lot of and it was a huge PITA. The drug turned out to be a failure, because it was a protein that most people (including me) made neutralizing antibodies to. Very disappointing. But I was willing to try anything with a reasonable chance of working before I submitted to bariatric surgery. I just don't see the urgency of this procedure at the moment, without more evidence or basis for doing it.

I meant to reply to this the other day, Dianna but I guess I got busy and forgot (yeah I am losing my mind lol). Anyway I have stage 3
Non-Alcoholic Fatty Liver Disease (like you do but mine stage 3) or bridging fibrosis....it is from non alcoholic fatty liver from 12 years of diabetes and 20 years of morbid obesity. Here is a definition/explanation of the stages:

he first stage is referred to as simple fatty liver or steatosis;

This occurs when the liver cells start to build-up fat, although there is no inflammation or scarring at this stage. There are often no symptoms in this early stage, so many people are unaware they have a fatty liver. For many people, fatty liver does not develop any further, and with a healthy diet and regular exercise, the excess fat in liver cells can be reduced. It is thought that approximately 20% of people with simple fatty liver, will go on to develop non-alcoholic steatohepatitis or NASH.



The second stage of NAFLD is non-alcoholic steatohepatitis (NASH);

This stage occurs when the build-up of fat in the liver cells is accompanied with inflammation. This stage is thought to affect up to 5% of the population in the UK, or 1 in every 20 people. Inflammation occurs when the liver is repairing damaged tissue. If the amount of damaged tissue increases, the liver may eventually struggle to repair it fast enough and the inflamed tissue can remain as a scar. When scar tissue starts to develop, this is known as fibrosis.



The third stage of NAFLD is fibrosis;

This occurs when there is persistent scar tissue in the liver and in the blood vessels around the liver. The liver can still function quite well at this stage, and removing or treating the cause of the inflammation may prevent further progression or even reverse some of the damage. However, if over time, the scar tissue starts to replace a lot of the normal liver tissue, the function of the liver is affected. This can lead to cirrhosis.



The fourth stage of NAFLD is cirrhosis;

At this stage, the liver stops working properly, and symptoms start to appear, such as yellowing of the skin and whites of the eyes and a dull ache in the lower right side of the ribs. The scar tissue in liver cirrhosis is difficult to remove, although further progression can be halted if the cause of the liver damage is removed.



Most people with NAFLD have the early stage of the disease (simple fatty liver or steatosis) and only a small number develop the more serious stages. It can take several years for fibrosis or cirrhosis to develop. Although there are often no symptoms accompanying the early stages of NAFLD, it is important to think about the health of your liver.

So I had an ultrasound today and labs last week that they said were good but I didn't see the numbers. I just know my function has been excellent and my Dr is not concerned but he wants me to see him every 6 months for follow up. Not sure why you AST and ALT are elevated at stage 2 but I am guessing this is why they want to do the biopsy because maybe you are stage 3 (hope not and hope there is a fixable reason for your elevated numbers).