Ongoing liver derangement in 21yo

[rusty_sim]

Hi

I would greatly appreciate some perspective on my liver.  I have been seeing

gastroenterologists every few months regarding my ongoing liver derangement.  Just

a bit of background, they picked it up early last year.  I am 21 yo (turned 21

yesterday), 62 kg (BMI around 22) non-alcoholic.

April 2012 - ALT - 85
June 2013 - ALT - 103
September 2013 - ALT - 116
November 2013 - ALT - 166

My latest LFT (November 2013) read
ALK PHOS - 201
AST - 75
GGT - 260

A little bit more about me
-MRI shows fatty liver
-Fibroscans show no significant liver damage
-Eat healthy, go to gym, taking egg protein since july (all advised by doctors)
-Do not drink heavily or often
-Do not smoke, do drugs, take any medication (paracetamol etc.)
-No hepatitis

The specialists have refused a biopsy and just 'want to see what happens'.  My GP

has not been particularly helpful or caring.  I just feel a little bit down :(

Look forward to any help or advice

[fntn]

Hi Rusty -

Your numbers do favor some type of chronic and progressive type of hepatitis occurring. Changing up a few things as requested and rechecking is a good idea.

You mention hair loss. Is it unusual or even patchy with involvement of both head and body hair? Any other odd things like rashes, raynaud's, joint pain, etc, GI issues? You also mention finasteride. Is there some on-going concern wrt your prostate, cancer?

Certainly progression of your known fatty liver to NASH maybe happening but your BMI is reasonable and you don't indicate any other metabolic activity you're doing that is unusual. That's why I mentioned the other symptoms. Possible an auto-immune process in play here?

[rusty_sim]

Hi guys

I saw my gastroenterologist again a few weeks ago and have been advised to stop all protein supplements, vitamins and medication.  He said my latest results are that of a hepatitic liver, and believes that even if the supplements aren't the cause of the liver derangement that they will worsen it.

So I am following his orders and will get a blood test in a few weeks

@me_just34, I think you are making good choices with exercise and food.  Keep it up :)  I consume a fair amount of tuna as well but have reduced intake because of fear of heavy metal accumulation, perhaps try switching to salmon?

Regards

[me_just34]

maybe stress is causing elevated enzymes.
try to find good experts.
good luck and do not worry if there is no liver damage.
i have fatty liver or nash (do not kno which one).
in october 2012 my ast was 96 and alt was 186. after exercising and diet, they returned to: ast 28 and alt 44. however,  they raised this januray
to ast: 51 and alt 101  (maybe it was due to excess consumption of tuna fish) and  again after exercising and weight loss they became: ast :33 and alt 37. however, i have pain in right quadrant and do not know the reason and doctors also said no idea. ct scan  one year was okay.

[rusty_sim]

Edit: I am now weighing in at 71 kg (BMI 25) after working out for 4 months

[rusty_sim]

Hi

Just an update

February 2014:
ALK PHOS 113
AST 51
ALT 129
GGT 238

March 2014:
ALK Phos - 130
AST - 160
ALT - 310
GGT - 295

I'm getting pretty scared now.  I saw my GP today, who said it's beyond her knowledge level and has referred me to a specialist again.

Gym supplements: egg protein
Hair: minoxidil and finasteride (started Dec2013)

Unfortunately I'm trying to balance my liver, hair loss and working out.  They appear to be mutually exclusive so I'm stressed.

Last year's ultrasound, mri and fibroscan showed no immediate liver scarring or enlargement

I will post my latest billirubin and others once I get them.

Thanks guys

[ceanothus]

I agree with Mike! I would ask the doctors to carefully evaluate the ducts associated with the liver, gallbladder and pancreas. Do you have copies of the reports generated from the MRI and fibroscan? (Its always a good idea to ask for and retain copies of such reports for your own files.) Have they also done ultrasound studies? Do any of these studies note any enlarged or otherwise abnormal ducts?  Don't let them wait too long without more effort at discovering the cause of these elevated enzymes - if they wait until you are really sick then it can be more difficult to treat some problems. Good luck on getting to the bottom of this, and keep us posted.

[mikesimon]

"...Liver function tests: Alkaline phosphatase and GGT

Another of the liver's key functions is the production of bile, which helps digest fat. Bile flows through the liver in a system of small tubes (ducts), and is eventually stored in the gall bladder, under the liver.

When bile flow is slow or blocked, blood levels of certain liver enzymes may rise:

    Alkaline phosphatase
    Gamma-glutamyl transpeptidase (GGT)

Liver function tests may check for any or both of these enzymes in the blood.

If alkaline phosphatase and GGT are elevated, a problem with bile flow is most likely present. Bile flow problems can be due to a problem in the liver, the gall bladder or the tubes connecting them..."

http://www.webmd.boots.com/a-to-z-guides/liver-function-tests

First I want to make it clear that I am not a doctor or in the medical profession in any capacity. What little I know I came by as a patient who had hepatitis c which necessitated a liver transplant in 2000.

I really have no idea what is wrong with your liver but I do know for sure that something is wrong and I strongly advise against the "watch and see" approach your specialist has recommended. In my opinion that approach is much too cavalier. It has been my experience that these types of situations do not usually resolve on their own. Perhaps it is possible that all of your blood levels are the result of Fatty Liver Disease but I would not be comfortable assuming that is the case. Your ALT has gotten progressively worse  since April 2012 and I see no reason to expect that will change without some type of intervention. The excerpt I posted from webmd.com raises the possibility of a bile duct problem and I would want to have that ruled out. You haven't posted your bilirubin which, if elevated, might further suggest a biliary problem. If you cannot prevail upon your current specialist to conduct further tests then I would advise finding another doctor who will. As stated above by Dee, a hepatologist would be my first choice but if one is unavailable then I would find another gastroenterologist who will pursue your situation more aggressively. I certainly don't intend on alarming you unnecessarily and I do not feel there is reason to panic. But, I do believe you need to find a doctor who will embark on an aggressive plan to diagnose the cause of your enzyme elevations.

Good luck,
Mike

[NT77]

If everything is as you say, this shouldn't be happening at your age. Well, everything is possible, but still...

Can you please list all the things you've been putting in your mouth, eyes, nose, or on the skin, that would of not been available, say, a thousand years ago? Everything that you can remember?

Just a few examples: swallowing any amount of toothpaste is a bad idea. Deodorants, perfumes... Do you chew gum every day? What's this egg protein you mention?

If the cause of these numbers is not external, then unfortunately, it's internal, meaning that something (or couple of things), for some reason, is not functioning the way it should.

[rusty_sim]

Hi Dee

Thank you for your reply.  I have seen 3 gastroenterologists but no hepatologists.  We don't really have heptatologists here in NZ.

I am not overweight, I was considered underweight.  Since starting bodybuilding a couple months ago I have got my BMI up to about 24.  However I have had abnormal LFT for the past 2 years.

I have not been on any medications.  My doctors are pretty stumped too, they don't know what's going on.  I just don't want it to turn into cirrhosis so I am trying to eat clean, exercise etc. but I just can't seem to get my ALT levels down.

Regards
Sim

[Dee1956]

Oh, sorry I see you have seen a GI, sorry.

Are you on any medications?  There are medications that can cause inflamation of the liver

[Dee1956]

Hello have you gone to a GI/Hepatologist?  That would be the type of doctor to go see.  I apologize if you have done that.

When you say they want to see what happens, does that mean they have asked you to change your diet?

My friend has NASH a non alcoholic liver disorder and she has been told that she needs to better control her diabetes and lose weight as she is nearing cirrhosis.
If you are not happy with your doctor you can always get a second opinion.
Please let us know how  you are doing.
Take Care