NHS test results - what would you do?

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TW: Bit Graphic and long (apologies!)

Earlier this year, I became very unwell. One morning, I woke up and was violently sick—both ends (I know, yuck). Initially, I thought it was just a stomach bug. However, my symptoms quickly became concerning:

•	My stools turned white—not pale, but completely white like chalk.
•	This progressed to diarrhea that was unlike anything I’d ever experienced: clear liquid, like water, with absolutely no substance.
•	This went on for four days.

I felt terrible, looked deathly pale, and visibly aged. A pregnancy test came back negative.

I contacted my GP and got an appointment with the paramedic at my practice. It was actually the most thorough check-up I’ve ever had. During the consultation, I shared my family’s cancer history, which includes multiple cancers. Most recently, my mother passed away. Her diagnosis came so late that cancer had spread throughout her body (stomach, liver, pancreas, and more), making treatment impossible. We don't know where the primary cancer was located.

The paramedic ordered a range of tests:

•	Bloodwork: Full blood count, liver function tests, CA125, celiac, and diabetes tests.
•	Urine and stool samples (stool collection was particularly challenging).
• FIT test (for blood in the stool) 

When the results came back, everything was within normal ranges except for:

•	ALT (liver enzyme): 105 u/L (normal range: 0.0–35.0).
•	Serum total protein: 78 u/L (close to the upper limit of 80.0 but still within range).

I'm in my early 30s, and given my healthy lifestyle (occasional wine, good diet, regular exercise, normal weight), the high ALT result alarmed me.

At my follow-up, the GP initially said my results were normal. I pointed out that I've seen my results in the NHS app, and I know I have elevated ALT, I expressed my concerns given my family history. Only then did the GP perform a physical exam, finding:

•	Extremely tender stomach
•	Back pain

The GP ordered repeat liver function tests, adding AST this time. Results:

•	ALT: 60 u/L (improved but still above normal).
•	AST: 31 u/L (normal range: 0.0–35.0).

The GP told me everything was fine because the ALT had decreased. By this point, my gastrointestinal symptoms had subsided, but I still didn’t feel reassured. I pushed for further investigation and was referred for an ultrasound (internal and external).

The scan showed no issues with my liver, stomach, or pancreas. However, they found a 3cm hemorrhaging ovarian cyst.

When I returned to the GP (was seen by different doctor this time), I was told the cyst was “normal” and to come back only if I experienced pain.

Although my symptoms have improved, I can’t shake the feeling that something was missed. Every time I have abdominal pain or a change in bowel movements, my anxiety flares up. I admit my mother’s illness has made me hyperaware of missed opportunities. She was twice sent home from A&E and told to wait for the letter for the CT scan, despite already having sepsis, which ultimately caused her death. I nursed her at the end of her life in my 20s. Watching her go through that left me terrified of missed diagnoses.

AIBU to think something was overlooked earlier this year? Should I push for more investigations, or is it truly a “wait and see” situation now?

Wait and see

I’m sorry you’re going through all this worry, how horrible for you. Keep pushing with your GP, you know your own body best and if something isn’t right, trust your instincts. Wishing you all the best.

Can you afford a private scan ?

@Msmoonpie Yes. I have private insurance and access to a private GP, so I can pursue further investigations if needed. I’m just unsure what the next step should be—would it make sense to request another abdominal scan, or is there something else I should be asking for?

I had a very similar bug in May. I have never felt so ill in my life. D&V for about 36 hours and was totally wiped out for 2 days after it subsided. I didn’t feel well again until about 2 weeks later as I had stomach pain afterwards. I also had a tender stomach and back pain.My doctor diagnosed me with post gastrointestinal infection IBS. I altered my diet to include kefir yogurt etc and I would say I was fully recovered after about 8 weeks. However I had no blood tests.

Could it be the same virus? I realise you are worried because of your family history.

Sounds like health anxiety to me. Perfectly understandable given what you went through with your mum, but those blood results wouldn't concern me. A virus could have raised your ALT, among many many other reasons. You say your symptoms have improved, so what would you want investigated? You might be better asking for help managing anxiety.

I agree, that could explain the gastrointestinal symptoms. I had it a few weeks ago and described it as "weeing out of my bum" after the worst of it had past 🤢 I had all sorts of weird pains and remember having really bad shooting pains down my legs. DH is still having a lot of stomach pain now.

Maybe it was something similar along with the cyst?

@owlexpress that's why I wonder if anything is as missed. I felt, at the time, that ALT 105 u/L is very very high. I avoid reading dr Google, but I know that ALT is linked to the liver. And yes, like I said I am more anxious about my health due to what happened. Although, I wouldn't say I feel anxious all the time, give then symptoms at the time I did.

ALT can rise during illness and the reduce to normal levels as you get better. The high end of normal is 56 so you are not far off. If you have private health insurance go ask for a second opinion and try to see a gastro doctor.

I have exactly your symptoms and the doc told me I was fine also.
Convinced I have gallstones. Not had a scan.

Did you see the full report of the scan? If not can the GP print it off first you? To give an indication of the wording about the cyst.
It doesn't sound like they did a hepatitis screen, could be something they could have considered .
Do you have any nausea etc?

It may not be reassuring but common things are common. A gastroenteritis that resulted in fleeting raised ALT is most likely culprit. There's nothing else that is a red flag.
You infer you've had a negative FIT test and ca125 too which is reassuring and makes both bowel and ovarian cancer vanishingly unlikely. It sounds like you've been over investigated already to be honest and the cyst was an incidental finding.

What more tests do you want?

An ALT of 105 is also not 'very very high', it's mildly raised. Some hepatitis patients run in the thousands.

You had a few days of GI symptoms and a mildly raised ALT which is resolving. Everything else has come back normal.

More scans aren't going to reassure your health anxiety. They will either rust pick up more incidental findings or nothing at all.

I understand your concerns based on your family history. However, it sounds to me like you had a pretty bad gastro bug, leading to a bumch of impacts on your digestive system which are now resolving and returning to normal. And with any severe gastrointestinal issue, it's pretty normal to not feel completely right for a while - I would strongly recommend you take a probiotic and aim to eat a diet that's as as varied as you can get away with, definitely ensure you're eating some fermented foods, yoghurtand avoid high fat foods for a while.

Also, white stool is usually a sign of infection - not necessarily int he gut, just any infection.

@coffeeandteav I have had gallstones. My main symptom was extreme, and I do mean extreme, pain witha s trong feeling of nausea and feeling unwell when eating. Not what the OP is desribing.

Dr here- there are a wide range of causes for raised ALT. One of which includes viral infection. Whilst your ALT was raised, I would not say it was “very, very high”- it was mildly elevated, and has begun to normalise fairly quickly. Your scan showed nothing concerning in the liver. The only other thing they arguably should do is repeat in another few weeks to ensure that the trend is downwards/ ALT normalises. I would not be concerned, on the basis of what you have said, that anything more needs done in regard to your liver function tests.

Haemorrhagic ovarian cysts are quite common and rarely a cause for concern- they can be uncomfortable or painful though. They are usually self-resolving and do not need treatment. Our local protocol is for repeat scan (no sooner than 6 weeks- typically 6-12) to check for resolution but that is cautious.

I hope that reassured you, OP.

Agree with this. I think you have been fairly thoroughly investigated to date (arguably more than would be entirely necessary, given the most likely cause for your symptoms and test results) and should take some reassurance from this.

Wait and see.

With a settling ALT and normal liver scan? A hepatitis screen is not warranted, based on info given.

I think it was more indicated at that time is what I meant -

Sorry you've been through this OP. You've been given very sensible advice above- ALT can run much higher (I think the labs stop measuring the exact number when it hits above 6000) and yours is coming back down which is the most important thing. It also sounds as though your practice has been very thorough and gone above and beyond. Hope this thread provides some reassurance but can understand your worry after what happened to your mum

Viral illnesses can cause transiently elevated liver function tests

Yes, well. My mother died because her GP thought she was a hypochondriac, so when it comes to persistent symptoms and feeling like you aren't being taken seriously enough, then my view is to keep going back and badgering them until you get to the bottom of it. Don't be fobbed off.

My DD is a GP and says that unfortunately patients having access to results often causes much more worry than is ever necessary, because out of context an abnormal result will cause panic, when it's a completely tiny blip due to temporary illness. Worrying results are rechecked and reported on and dealt with but meantime patients get stressed.

You've had tests, you've had scans and you aren't unwell now. I don't think going privately is going to give you more reassurance!

Sometime infection can cause a raised ALT, the fact it was high when you were unwell and then improving when you were better indicates that this could be the cause.