Elevated Liver Enzymes

[Football10]

I posted on this website in 2011 regarding various health problems I was having and the unknown cause of elevated liver enzymes. I was essentially told to monitor and manage the problems and to report back if anything changes. Unfortunately 4 years have passed and the symptoms remain but recently things have begun to change.
The circular blotchy rash on my scalp, face and arms has now also spread to my armpits, palms of my hands, fingers and knuckles. I am also still experiencing discomfort in the bottom side of my right ribcage after eating heavy foods plus my bowel movements have become loose and float. I still have an anxiety problem that I manage and have been seeing a chiropractor to correct spinal and general joint pain believed to be caused by poor posture.

I have had some of the tests I had done previously repeated and all still show no problems. I did though manage to get a chart of previously taken blood tests over the last 4 years. I have listed the highest and lowest scores of some of the regularly performed tests below.

ALT: High 99 Low 56
ALP: High 258 Low 64
GGT: High 114 Low 71
C-reactive protein: High 6 Low 2
Albumin: High 53 Low 48
Globulin: High 34 Low 25
Total Protein High 85 Low 76
Inorganic Phosphate Levels: High 0.95 Low 0.5
Bilirubin: High 14 Low 7
Amylase: High 37 Low 35

Is it possible for someone to interpret what the various levels mean? I have noticed however that most of the numbers deceased in early 2014 although some have begun to rise again recently.

I am a 26 year old male in the UK, who is Teetotal and therefore a non-drinker and non-smoker.

Any suggestions as to what might be causing these problems would be greatly appreciated. Thanks

[fntn]

Sounds like you're keeping your doctors on their toes to figure this out, very good! Too many people are simply content to let our medical system plod along at its typical, lackadaisical pace. If you get more information, please let us know, if you need any help or just another pair of eyes on things.

Another procedure you can talk to your doctors about is a biliary specific MRI sequence technique. It's described as a MRI contrast-enhanced cholangiography procedure that uses a contrast that specifically peaks during the hepatobiliary phase (it's after the normal Arterial/Venous/Delay phases). So the contrast works by highlighting both: (1) the flow of bile throughout your liver and biliary tree and (2) the liver's bile formation/transport process starting from the lobules and excretion outward. This provides a way of seeing any problems or obstructions that are impeding bile flow, but also shows any issues in the "functional capabilities" of the hepatocytes (regionally based of course).

It's a relatively new MRI procedure and only a limited set of hospitals or medical centers can do it. It takes special hardware and it also takes a great deal more patient time (in the MRI machine) since the hepatobiliary phase is 30 to 90 minutes after the injection of the contrast.

Take care and hoping you can get it straightened out. I went through the same thing for a time, and had very confused doctors just staring at me.

[Football10]

Thanks for the reply. I have had stomach endoscopies, colonoscopies, ultrasounds, a barium follow through and a liver biopsy. All came back normal with the result of the liver biopsy coming through the post and quoted in the letter it reads that “essentially it shows some fatty infiltration in the liver, as we discussed in the clinic, but no other changes at this point”.

However the tone and wording of the letter did not seem to suggest a definitive diagnosis which is frustrating from my point of view.  

I also do not understand how a person of normal weight and body fat can have a non-alcoholic fatty liver? When the worst blood test scores were recorded I was actually at a reasonably healthy weight however I am much heavier now and the scores have decreased. I understand the body heals but surely the correlation would be the opposite and the fatter you are the more fat would be likely to build up in the liver thus worsening the blood score levels.

Do you know of any tests that can be performed to check bile flow?

Thanks for your continued help.

[fntn]

It seems you have a number of health issues that may not be linked to your liver problem. Looking at your numbers, I would guess you have some type of impeded bile flow, but please keep in mind that we are not doctors.

Have you have any imaging work done? If there is some bile flow problem, it isn't very large nor complete, so detection would be tricky. The back flow of bile into your liver can cause a mild elevation like you are seeing. Bile needs to be transported to your small intestines where it is meant to be. If it bathes your liver cells, then they are destroyed and your Alt rises.

Let us know how things are going and do keep pestering your doctors. This does need to get resolved.