Pain and High ALT & AST for 2 years

[gra_05]

My question is I have been having pain on my upper right abdomen since my pregnancy with my second child in 2006.  After my daughter was born in 11/2006 my liver counts were up so they did a hepatitis panel which came out to be negative did a CT scan which noted fatty liver.  Then they did endoscopy and colonoscopy but did not find anything abnormal except unusual amount of bile in my stomach and they did a biopsy but it burned up so could not be tested.  I had my gallbladder out in 1/06 after giving birth to my first child in 10/05 due to gallstones and cholegnitus? not sure of spelling.  They ran me through a battery of tests but didn’t’ really find anything. I am only 31 years old.  I ended up having nerve problems and had triple nerve decompression on both legs and then carpal tunnel on both hands.  I have to have another nerve test because the ulnar nerve seems to be problematic now.  Back to the liver problems the counts have been high every 6 months they are retested.  In 11/07 since they doubled I went to a Gastro. specialist which did a test to check for antigens found in autoimmune and PBC, etc.  it came back negative so said to wait 6 mo. to retest. I have a blood panel done 5/08 and the counts have gone up 5-6 times my ALT was 294 and my AST was 232 my protein was high at 8.6 and albumin at 5.4 %MONO 14 Hemoglobin 16.1.  They did a hepatitis panel and all negative.  I go back to my Gastro. spec. this Friday and I know they will do the same blood panel as was done in 11/07 I am just wondering if anyone has any suggestions or if a liver biopsy should be done?  The pain is constant and dull for the most part but lately it has been more severe and almost debilitating at time.  

[Thomas D Schiano, MD]

ok.  keep me in the loop

[gra_05]

Thank you for the advice.  I just had the CT scan done which showed severe diminished density of the liver consistent with severe fatty infiltration.  The EUS with ultrasound come back normal though they did take a biopsy of the stomach.  I have a follow up appt. in two weeks on that and they are in the process of scheduling a liver biopsy.  

[aiMelissa]

I have a liver disease called Primary Sclerosing Cholangitis.  It is similar to PBC and AIH but more difficult to diagnose.  You should request and MRCP be done, it is a special MRI of your liver, pancreas, and the ducts involved.  

I also have continuous pain and it took me 11 doctors to find my diagnosis.

[Thomas D Schiano, MD]

i think this is reasonable.

[gra_05]

Thank you I went to the gastro. and they are having me do another CT scan with and without contrast of the abdomen and are having a EUS done.   They want to rule out biliary sludge or gallstone stuck in the duct.  Nothing showed up on the CT scan that was done two years ago but who knows.  Then depending on the results are going to do a liver biopsy.  Does that in your opinion sound like good practice?  Thank you for your feedback.

[Thomas D Schiano, MD]

good luck.

[gra_05]

Thank you for your response and I appreciate your feedback.  I will follow up with my Gastro. specialist Friday with this information.  

[Thomas D Schiano, MD]

if your liver tests have remained elevated to this degree for this length of time then a liver biopsy is warranted.  you need to make sure you do not have autoimmune hepatitis which can be associated with an elevated protein.  You are also the right age for this.