Liver Enzymes with elevated bilirubin

[ajosbor]

Hi, recently i had some liver tests done and when i got the results back they told me i should contact my doctor with the results since a few came back a little high. the following are my results.

Complete Metabolic              Reading Unit               Result                           Reference Range
ALT (SGPT) 140.0 U/L High                11.0 - 66.0
AST (SGOT) 70.0 U/L                  Borderline high                 15.0 - 46.0
Bilirubin Total 2.3 mg/dL                                Borderline high                             0.2 - 1.3
Total Cholesterol 222.0 mg/dL Borderline high less than 200.0
Triglyceride 220.0 mg/dL High less than 150.0
Hemoglobin 17.7 g/dL              Borderline high 11.0 - 17.3
Red Blood Count 5.81 x10E6/uL   High   3.7 - 5.1

I have since gone to my doctor, they ran a few tests and called it gilberts disease, i still wasn't feeling the greatest so i went to a liver specialist and he said wasn't gilberts disease but he couldn't find anything wrong either besides elevated tests. I had 3-4 liver tests done with pretty much the same results everytime, dropped a little by the end but were still high. I pretty much stopped going since they weren't doing anything about it, any ideas what could be causing these high test results? I am a healthy 22 year old, try to work out on a semi regular basis, don't drink a lot, and i have been getting upper abdominal pains everyonce in a while. I also have a family history of liver disease, that's what has me looking into this a little more. Grandma had liver cancer, aunt had crowns disease, and another aunt had a liver tumor. Any help would be great.

Thanks

[ajosbor]

just a quick question to all, was wondering about the ratio of ALT to AST. Every where i read it says if your AST is 2:1 of ALT it indicates most likely alcoholic liver disease. How about the other way around, as in my case, it's 2:1 but ALT to AST (ALT=140/AST=70) does this indicate anything about liver disease? i obviously know it indicates a possible liver issue but since all i'm showing is fatty liver through ultrasound i didn't know if it was a possible indication of just high trig's like i have, hep c (which i do NOT have) or just actual liver disease. Can you have alcoholic liver disease with a 2:1 ratio of ALT to AST or is this rare?

[ajosbor]

Well they did and ultrasound and took more blood. they decided that i have Fatty Liver and Gilberts Disease. They said that Fatty Liver should not be causing me stomach pains though. I have to go back and do more blood work to test my triglyceride levels again (last time they were high at 220) and then he'll put me on meds for them and see how that helps.

[ajosbor]

been having upper right and upper center abdominal pain and has been also hurting my right side of my back a little. had this pain for the last 4 days so i have a dr appointment later today, will let you know if they find anything else out. Thanks for the advice so far, been a lot of help.

Anthony

[mikesimon]

Autoimmune diseases should not me overlooked.
Mike

[auditor0007]

Normal for Ferritin is normally under 300.  At your age, it is not likely that your liver issues would be related to hemochromatosis, but it was still worth a shot.  I would still ask for a serum iron and TIBC test if you did not have these done yet.  They will give you a true picture on your iron.  If they tested your Ferritin, there is a good chance they already did these tests also, but check to make certain.  When you get the results of your serum iron and TIBC, divide the number for your serum iron by the number for your TIBC (serum iron/TIBC).  This will give you your iron saturation, which tells how much iron is in your blood.  Your blood can only carry a certain amount of iron.  Once you reach or get close to the maximum, then iron begins to deposit into the liver.  The result of your iron saturation should be low if your iron metabolism is normal, somewhere under 35%.  If by chance it is over 50%, then you could still have an issue.

It does seem unlikely though that hemochromatosis is the culprit in your case.  

No matter, once you have ruled it out completely, don't give up.  Something is driving your liver issues.  You don't just get high liver test results for no reason, so finding out what is driving your numbers is an absolute necessity.  Once you determine the root cause, then you can address the problem before it becomes serious.  As for genetic diseases, Wilson's Disease is another possibility, although it's prevalence is much lower than that of hemochromatosis.  While 1 in every 10 carry a mutated gene for hemochromatosis, only 1 in 100 carry a mutated gene for Wilson's Disease.  Wilson's Disease is attributed to an overabundance of copper in the liver as the body absorbs too much copper, and the complications tend to show up earlier in life than with Hemochromatosis.  Good luck.  I do hope you find out what is going on.

[ajosbor]

oops forgot to mention that she didn't give me any levels of either just said they were normal.

[ajosbor]

i talked with the nurse today and she said they did do a Ferritin test and at that time it came back normal and so did the hemoglobin test. i did make an appointment to discuss it more with my dr though.

[mikesimon]

That is an astute observation.
Mike

[ajosbor]

Thanks Everyone for the great Feedback, and to auditor0007, i will try to get to my dr to get the iron tests done. after reading up on the Hemochromatosis i feel i do have most of the symptoms, even though they say they can be confused with other disease since they are common sypmtoms. I was very interested when reading it that it said chances to develop liver cancer can become x200 fold since my grandma developed it with no signs until it was too late. I will keep you informed as to what the results are.

Thanks again,
Anthony

[auditor0007]

Oops, last post was meant for you.

[auditor0007]

The one test that interested me the most was your hemoglobin.  You should have your iron levels tested as high hemoglobin could be due to excess iron which can be caused by Hemochromatosis.  Hemochromatosis is a genetic disease where the body absorbs too much iron.  In turn, the excess iron is deposted in the liver.  If it is not removed, you will eventually develop cirhossis of the liver as I did.  

Since you are still very young, if this is the cause of your high liver test results, the iron can be removed before any significant damage is done.  If you wait though, the damage will become permanent.  To remove the iron, they just have you go through routing phlebotomies (blood removal) of one pint at at time.  With each pint they remove, excess iron is removed until your iron levels become normal again.

Obviously, your test results could well be do to something else, but you should definitely have the following tests done.

Serum Iron
TIBC
Ferritin

If these come back high, then they will do a genetic test for hemochromatosis.  If they come back normal, you will have ruled out hemochromatosis.  FYI, hemochromatosis is the most prevalent of all genetic diseases.  1 out of every 200 to 250 Americans has hemochromatosis, but not everyone with it loads iron as quickly as some.

[mikesimon]

Direct or conjugated bilirubin is associated with the liver whereas indirect or unconjugated bilirubin is not.
What we usually see on our labs results is: Total Bilirubin

Total Bilirubin = Direct Bilirubin + Indirect Bilirubin ---- it is the sum of the two

When we see an elevation in Total Bilirubin it is often prudent to see which of the two components is elevated. If the Direct Bilirubin is elevated it points to a liver issue. If the indirect bilirubin is elevated it does not point to a liver issue. It may be due to Gilbert"s Syndrome or some other issue such as hemolytic anemia, for example. With hemolytic anemia the red blood cells are destroyed prematurely. When red blood cells are broken down they are eventually turned into unconjugated bilirubin (not indicative of a liver issue) and cause the Total Bilirubin to become elevated.

So basically, a person concerned with liver disease usually does not want to see an elevated Direct Bilirubin.

Mike

[kellly2019]

so had a question my direct billrubin is 8.1 mg/dl ( high )  it shows in labwork, but my doctors don't know what wrong with my liver ?

[ZEEBEE2469]

mikesimon or others --  could someone clarify when it is said in these posts "direct bilirubin elevated" is that in relation to indirect -- i.e. it's # is higher than the indirect or are we looking at the # elevated in itself higher than then normal range?  Thanks.

[mikesimon]

Gilbert's Syndrome is relatively easy to rule out.
You get a fractionalized bilirubin test which separates indirect from direct bilirubin.
If your direct or conjugated bilirubin  is elevated it points to a liver disorder and excludes Gilbert's Syndrome..
If your indirect or unconjugated bilirubin is elevated Gilbert's Syndrome is a possibility
That test should have been done already.
Mike