Raised ALT liver function - gallbladder / bile duct related?

[BambinoBoo]

I had a CT scan a month ago for an ongoing gallbladder problem (inflamed). The consultant couldn't see any stones but my bile duct is dilated to 18mm and gallbladder wall slightly thickened. He has now ordered an MRCP (MRI scan) before he decides whether I have a ERCP or something else. In the meantime, my GP had my liver function and blood tested and it has come back today with raised ALT. He wants to repeat the blood test on Thursday. I am worried and not seeing him till tomorrow. Does anyone know please if a raised ALT is typical with problems with the bile duct or gallbladder - the latter of which I am still waiting to have out; although it seems that the bile duct is now the primary issue. Have googled and it keeps saying raised ALP for bile duct and ALT for alcohol use - not touched a drop in months and I wasn't a heavy drinker before that.

Many thanks

Have zero knowledge in this area other than the fact that I had raised ALT when pregnant with my son and it wasn't a gallbladder issue because I had mine removed 4 years before. It also wasn't an alcohol issue with me - I barely drink. There must be some other cause besides gallbladder/drink although that doesn't mean gallbladder/drink is not a cause.

The thing normalised after birth. Hope you get some answers soon.

A raised ALT is a marker of inflammation in the liver. If you have a liver related problem then the ALT will be up. Whether to be concerned depends on how high it is; if its more than a couple hundred this will be significant. (normal values approx less than 40, depends on the lab your hospital uses).

Have you been checked for other causes of liver disease to rule them out?

GGT is more of a marker for high regular alcohol intake, but this isn't entirely specific .

ALP is a marker of congestion, which happens when gallstones block bile that is produced in the liver getting into the gallbladder. This congestion can cause inflammation which will put the ALT up.

Let us know how you get on

Thanks margo and purple. I got my exact numbers today and I swear the GP said ALP rather than ALT but I am so tired with doctors and tests i need to ask again.. Anyway it was 186. My gamma GT was 238!!!! I am having another test tomorrow. I'm wondering when he might show concern over it. Sounds high to me but he told me not to panic.

Its high enough to indicate there is a problem that needs fixing, but you know that already! Numbers aren't high enough for the specialist team to get overly worried about, (although your GP may if he/she hasn't had much hep-billiary experience before becoming a GP, but don't let that bother you).

Your GTT will be up because you have a bile duct problem.

GGT isn't specific for alcohol, in otherwords it can be raised for other reasons e.g bile duct probs, diabetes,, but if someone is drinking a weeks worth of units in a day then it probably will be raised. Some people swear blind they don't touch a drop, have a GGT of a few hundred but nothing else wrong with them at all. Those we tend not to believe!

Is there a specialist nurse at your hosp you can talk to? If you phone your consultant's secretary they will be able to tell you.

Thank purple. As you say, I know something is up with my bile duct and am waiting for an MRCP, but the blood numbers really alarmed me so your post was very reassuring. I know my GP has let the consultant's secretary know the figures and they haven't contacted me so they probably see much worse. I had another blood test today and I asked the nurse if they were alarming. She said that if they were an issue, the doctor would have "had me in by now".

Thanks again though. By the way, are your a doc yourself?

Bambino - Nurse.
Don't want to out myself though!

My ALP and ALT levels raised dramatically as well but my biliruben figures dropped (so eyes are not as yellow) and doctor kept saying everything OK. Then today they found my liver is enlarged and had loads of scans, cameras and tests today to see cause. As of yet, they havent come to a conclusion as to what is causing problem (because I am not following an expected pattern) and it is so frustrating. I have kept asking about my liver and feel really anxious that the doctors kept ignoring me. (figures around 400+). Now waiting for CT scan as well. Blocked vile duct has been mentioned but other symptons dont fit.

stars Poor you as well!

Its horrible not knowing what is going on but t sounds like everything is being done to look for the answer.

People aren't textbooks so not everyone follows general patterns. If you only had those investigations yesterday the senior docs may not have had a chance to see all the results and review them yet, but it won't take long

Thanks Purple. I am in hospital and they reviewed everything straight away. The hve also been comparing all the other scans to see if they can see differences. The conclusion seems to be its a reaction to all the drugs I am on, but the side effects that I have got are are not common withthe drugs I am taking. Difficult times.

stars there are some very rare and unusual drug reactions. No consolation when you are that 1:10 000 person. Definitely difficult times for you.

Hang in there and lets hope for good news today. I am sure lots of others MNs will be thinking of you too!

Let us know how you get on

Bambino, maybe it's a clue for you, but raised ALT (and abnormal liver enzymes) are often a symptom of problems related to gluten. There are loads of medical papers published linking this to celiac, but I found with my ds that it also goes for gluten sensitivity. In some papers there is conclusion to try diet before any invasive treatments.
With my ds, whose blood tests for celiac were inconclusive, I removed gluten to see if it would make any difference and it did. He was later found to have a gene for gluten sensitivity.

I have seen this topic often mentioned on celiac forum, where the enzymes improve on the diet. I also know someone whose alt was 400+ and he was told the cause in the liver couldn't be found and he didn't drink, he later was found to be celiac.

paper
another one

OP - just as a side note regarding the gall bladder problem.

Just worth keeping in mind that just because the consultant can't see any stones, doesn't actually mean that there aren't any there. My consultant said exactly the same thing, yet on my emergency op to remove my gall bladder, he found it was full of 'gravel' - many tiny stones which don't show up on an ultrasound.

Hope things improve for you soon.

Thanks again purple I get my next blood results tomorrow so we'll see what they hold. I got my outpatient appointment with the consultant surgeon for end feb so I am hoping that i get my mrcp before that. I imagine there is a drumbeat type process. God, stupid buzzword phrase there but couldn't think how to describe it.

stars my CT scan said "calculi not well seen" on gallbladder and in bile duct, and I read that a CT can't always pick up stones so imagine that is why he has ordered an MRI. This could be the case with you too, although, ultrasound picks up stones really well - have you had one?

nightcat many thanks for the info, and. I think you at right. I try to avoid bread etc as it has always made me feel bloated and sluggish and I do have quite a few food allergies anyway. At my worst a couple of months ago - oh, when my urine was orange and bilirubin in there and the nurse said I didn't need a blood test - the lowest fat thing I could eat was bread and jam and I had attacks every day. Gave it up and no more attacks whatsoever. It is something I will definitely take up with the consultant.

tapir thank you also. I am hoping that this mrcp comes up with some answers. It is apparently much more accurate than the tests I have had so far.

It's now nearly 6 months since I asked for the lap choke and feel like I'm walking through treacle. I went to a wedding reception on Friday and sat there like a right lemon drinking water as everyone ate their meal, there was nothing I could have had that wouldn't have set me off. All I want is to get back to normal.

I've had an MRCP to look for a stone stuck in my bile duct. Twas nice & easy, if a little noisy.

Keeping my fingers crossed for you.

Hi there,
sorry I have no helpful info for you but wondered if you would mind sharing your symptoms?
I am waiting for an endoscopy and ultrasound scan to check gallbladder and stomach inflamation.I'm interested to know if there is a connection with gluten sensitivity because I haven't been able to eat gluten for almost 1 year now.Tested negative for celiac(last year) but hadn't eaten any gluten for 7 weeks previously.
sorry,don't mean to highjack,I'll start another thread but you sound further along the road than me and I thought you may be able to advise.

Hope it all becomes clear for you soon,and that you are not suffering too much.

Hi 14k initially my symptoms started as a pain in the upper right hand side of my tummy, under the ribs, which ended up as a continuous throbbing in my back. It would come on around 8 hours after eating anything remotely fatty, so usually 4am ish and would wake me up. The bile duct pain is more central tummy area above the belly button and the only way I can describe it is like I am trying to breathe out fully with someone sitting on me. other symptoms for me included constipation and severe trapped wind which felt like a contraction. I never really suffered from vomiting like many do, just mainly the above. For me also, the lack of energy and lack of focus is probably the worst part. It feels like you a doing everything with one hand tied behind your back.

With regards to your gluten intolerance, I have read that it is best to be tested after a period of eating gluten to get a proper reading. I think the timescale was 2 weeks, so if you can stomach it, perhaps you could try that and then get re-tested. I certainly will be once my bile duct is sorted. I hope your scans go ok and at least come up with some answers for you.

Got my retest blood results today. ALT down to 73 from 168. But they didn't test my gamma gt despite it being requested which is odd. Doc wants to test again end if this week.

Also got my date for the MRCP and it's next week so - finally - things are moving along.

bambino - great news that your numbers are dropping
There may not have been enough blood to do a GGT as well, or maybe it was done but not reported - GP could ring the lab to find out if they have time to hang on the phone waiting for someone to answer

stars how are you doing today?

Thanks Bambino, and I hope you are feeling a bit better.
At least you haven't got long to wait for the mri.

How is everyone? I got my new latest blood results today and my ALT is now 27 and Gamma is down from 238 to 73 so much improved. I wonder if the doc thinks I've been necking cheeky vimtos all along. I wish!

Got my MRCP tomorrow. I am so fed up with it all now. I am finding work really hard going, and because I am on such a limited diet, I have no energy, particularly mental energy. I am so forgetful too. Hope the MRCP brings me some answers and solutions.

Good luck for tomorrow Is the test invasive?
Can't help with the blood results,sorry. Come back and let us know how you get on.

Thanks 14K. Had my MRCP (focused MRI scan so not invasive) and it wasn't half as traumatic as I thought it would be. The radiologist said that he got some good images, so while I know that he can't discuss the results with me, at least it sounds like he has identified what is causing my bile duct to be dilated. After 2 months of faffing, it would be great to finally know and to hear what their plans are regarding surgery. Roll on appointment with the consultant!

Bambino - that sounds good. Keeping my fingers crossed that it all turns out well for you.

Hi Purple. Thanks for asking

ALP and ALT still extremely high but doctors dont seem too concerned. They are happy that biliruben is within normal range. They feel it is probably due to medications and I have to wait and see. Being monitored every day though

I'm hoping PurpleWednesday is around. Just got my MRCP results from my GP, and they say that I have a 6mm gallstone in my distal bile duct (which I think is 8mm wide), but says the very distal duct isn't visualised but several views are suggestive of a centimetro stricture. So a stone with a stricture under it. Fuck. I didn't even know you could get a stone and a stricture at the same time. I'm panicking a bit as my outpatients appointment isn't until end Feb. GP wants me to take an LFT blood test tomorrow, and said if they're on the high side then we should call the consultant and ask to be seen sooner, if fairly normal then I can wait till my outpatients. I'm not even sure if the Consultant has seen the radiologist report yet as he normally writes a post-xray meeting conclusion which he sends to the GP, but the secretary only faxed the MRI results. I may hear something tomorrow as the review meetings are normally on a Monday. I don't know. I'm bloody fed up with all this now.

Sorry for banging on. How are you all?