Usually post on Crohn's, looking for advice. Sky High AST and ALT

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Zanne
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Date Joined Apr 2005
Total Posts : 3763
   Posted 4/18/2012 7:07 PM (GMT -7)   
Hi All,

I usually post on the Crohn's board. I went to the ER on Monday with a bowel obstruction. Of course they ran blood work before they did anything and to every one's surprise my Liver panels were off the charts. I didn't get all the numbers, but the AST and ALT were 25 to 30 times normal. I have tended to be 1 to 2 times normal, then my panels go back within range at the next test (I get blood work every 3 months). To be this high after being tested 2 months ago was shocking. The Hep panels came back negative for A, B, and C, so that is good. But my doctor and I have no idea what might be going on. I will be having some repeat blood work tomorrow. I can't find any information on the internet about levels as high as mine. The most I can find is 4 or 5 times normal. To say I am a bit freaked out is an understatement.

I am really tired, have a headache and generally just don't feel well. All things that can/could be explained away by a bowel obstruction (finally cleared). I am always achy due to joint issues. I had a cold with a cough that I can't seem to shake. These are all things that they asked me about. I am not sure if any of them have to do with my liver or if they are just incidental. I just don't have any information.

Does anyone have any ideas as to what I should be watching for, questions I should be asking, ideas as to why my tests are so high, treatments I should be asking about, anything I haven't thought of?
Suzanne

CD 22 years officially, 32 unofficially. 4 resections '93, '95 '97 '11
Managing with strict low residue diet, keeping symptoms to a minimum. Hoping last resection took care of all adhesions and blockages will be a thing of the past! Still have a great time with my 2 daughters and husband!


Prednisone, 6MP,Prevacid, B12 shots, Bentyl, Xifaxan.....

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 4/18/2012 8:00 PM (GMT -7)   
Zanne, hello, and welcome to the Hepatitis forum. I can understand your shock at having such high liver enzymes, seemingly out of nowhere.

I have a few thoughts: Have you added any new medication recently? Are you taking a lot of ibuprofen? What do you do for the aching joints? If so, it could have a toxic effect on your liver. It's also possible that you may have AIH (autoimmune hepatitis) where the liver turns against itself, viewing it as a foreign body and attacking it. The original blood test may have been a fluke or gotten mixed up with someone else's. When will you be having repeat liver enzymes drawn?

If your enzymes continue to be extremely high, I think you should ask your doctor for a referral to a hepatologist (liver specialist) so that you can get to the bottom of what is causing this.

Hugs,
Connie
hep93
Forum moderator - Hepatitis


"But that was yesterday, and I was a different person then."

Lewis Carroll, Alice in Wonderland

Liver transplant recipient, Oct. 27, 2011, at Mayo Hospital, Jacksonville, FL

MamaLama
Forum Moderator


Date Joined Oct 2010
Total Posts : 4806
   Posted 4/18/2012 8:01 PM (GMT -7)   
Hi Zanne,

There are some forms of poisoning that can cause way high liver functions...tylenol for example, and maybe copper, though not sure of that one. And Iron I think. Have you taken a bunch of tylenol for some reason? Likley not with chrones. But maybe one of your meds?

Good they are running lots of tests.

Or auto immune hepatitis?

We'll be anxious to hear what this is all about.

Hugs,

Carol
Mike received liver transplant May 1, 2011, Jackson Memorial, Miami, FL

DGinSD
Forum Moderator


Date Joined Apr 2007
Total Posts : 846
   Posted 4/18/2012 10:03 PM (GMT -7)   
Zanne,
 
I agree with Connie and Carol about the AIH possibility but seeing as CD is an autoimmune disorder, it could very well be that you have developed AIH (autoimmune hepatitis) as well.  Joint pain can also be the result AIH.  You are already on pred and 6MP so it could have taken the obstruction to make it hard enough on your liver that your enzymes shot up.  AIH can totally cause enzymes to be that high and higher.  Definitely ask to see a hepatologist or ask your GI to run your SMA, LKM-1 & SLA.  A hepatologist will probably also request a biopsy.  When will you have new ALT/AST results?  I hate to focus on AIH but I would suspect that first because of your history...
Also, as Carol suggested, maybe have your copper and iron levels run.
 
Dany
Co-Moderator - Hepatitis
___________________________________________________
AIH Jan 2007
CMV June 2008
Raynaud's February 2010
Meds: Azathioprine 100mg & Ursodiol 250mg BID

Zanne
Veteran Member


Date Joined Apr 2005
Total Posts : 3763
   Posted 4/19/2012 5:14 AM (GMT -7)   
I haven't taken any new medications or in any new amounts, so I don't think its from a toxicity from something I took. I have wondered about AIH too. I will be having my new blood work this morning, should have results this afternoon, so I will have a bit more information.Would my levels be 30 times normal with AIH. That is what is concerning to me. I can find no reference on the internet to anyone who's levels were that high and the end diagnosis. I will ask about these other tests and a referral to a hepatologist. Thanks.

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 4/19/2012 9:38 AM (GMT -7)   
"AIH can totally cause enzymes to be that high and higher. Definitely ask to see a hepatologist or ask your GI to run your SMA, LKM-1 & SLA."

This is from Dany's post.

Hugs,
Connie
hep93
Forum moderator - Hepatitis


"But that was yesterday, and I was a different person then."

Lewis Carroll, Alice in Wonderland

Liver transplant recipient, Oct. 27, 2011, at Mayo Hospital, Jacksonville, FL

Zanne
Veteran Member


Date Joined Apr 2005
Total Posts : 3763
   Posted 4/19/2012 4:12 PM (GMT -7)   
Had repeat blood work today. AST is back to normal. ALT is back down to 400ish, so down 1000. My GI ran ASM but the results aren't in yet. Also my Ferritin level is fine. At this point he is stumped. Has ruled out AIH. Repeat bloods next Thursday. We are still waiting on a few other blood tests that aren't in yet too. I will get all of those after next Thursdays tests. If he is still stumped after that, I will be seeking a Hepatologist's opinion. I am almost more freaked out that the numbers are just jumping around and the doctors are all just confused.

Thank you all for your help.
Suzanne

CD 22 years officially, 32 unofficially. 4 resections '93, '95 '97 '11
Managing with strict low residue diet, keeping symptoms to a minimum. Hoping last resection took care of all adhesions and blockages will be a thing of the past! Still have a great time with my 2 daughters and husband!


Prednisone, 6MP,Prevacid, B12 shots, Bentyl, Xifaxan.....

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 4/19/2012 4:38 PM (GMT -7)   
Suzanne, it may just be a fluke. Try not to stress over it too much.

Hugs,
Connie
hep93
Forum moderator - Hepatitis


"But that was yesterday, and I was a different person then."

Lewis Carroll, Alice in Wonderland

Liver transplant recipient, Oct. 27, 2011, at Mayo Hospital, Jacksonville, FL

DGinSD
Forum Moderator


Date Joined Apr 2007
Total Posts : 846
   Posted 4/19/2012 8:44 PM (GMT -7)   
Zanne,
 
I know of a couple of people whose ALT/AST were in the 5000 range and one who was in the 10000 range...so yes, 30 times is quite possible.
On what result did your doctor "rule out AIH"?  You should try to not stress out too much but AIH is a serious illness if left untreated.  Luckily, you are on the meds you would need to be on if you are diagnosed with AIH but they'd have to increase your pred till your numbers are stable and normal.  I would request a referral to a hepatologist.  At this point, I can't imagine anyone ruling out AIH without a biopsy or, at minimum, further antibody tests (which are negative in some AIHers - that's why the biopsy is most important).  Your ALT is still too high.  What's your bilirubin level?
Dany
Co-Moderator - Hepatitis
___________________________________________________
AIH Jan 2007
CMV June 2008
Raynaud's February 2010
Meds: Azathioprine 100mg & Ursodiol 250mg BID
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