Liver enzymes ALT 169 ALP 269

[needabetterlife]

Ive been emotionally on my knees for most of Jan & Feb after a routine blood test the first week of the year showed raised liver enzymes.
Feel able to post and get insight now Ive had most results back. Has anyone been through similar and have any advice?

Female age 42. No recent medication, antibiotics, herbal treatments or known illnesses or viruses. Bmi 37. Hba1c 32. Hardly drink - possibly 5 times annually. All clear from hep b & c, hiv. Autoimmune LKM, AMA & SMA. I cant see ANA on the blood results.

Initial results ALT 169 and ALP 269. Reduced now to 93 and 213. GGT 70, AST 82. Bili ok at 13.

EBV detected (unknown how long for IgM indeterminate).

Ultrasound showed multiple gallstones (I dont have any pain) bile ducts clear and no inflammation of liver or gallbladder.
liver showed: “Diffuse heterogeneous low echotexture of the liver related to parenchymal disease.” She never said a word to me in the scan about this.

Only symptom I have is fatigue which Ive struggled with chronically all my adult life since university.

Next stop hepatology clinic.

Can anyone help with their experience? Words of wisdom? Waiting for every blood test has been so worrying.

Thank you

Mine are raised too though not as high as yours. Looking at bmi I'm presuming you are overweight (as am I) and I would think if you aren't on meds or diabetic then it's likely they will check first for non alcoholic fatty liver (common with obesity) I'm not a doctor so can't interpret those but my GP has advised me to keep off any alcohol for 2 months , use milk thistle and retest in 2,months (im pre diabetic) with me it's likely to be a combination of pre diabetes, statins, beta blockers and being overweight. Has your GP explained the results?

My ALT and ALP were higher than yours (700 something and 500 something) but it was due to gallstones and inflamed gallbladder. Once the gallbladder was out they were normal within a month. I did have the typical wicked painful biliary colic though.

I also have fatty liver, need to work on my weightloss

Are you itchy, wee normal colour? I was very fatigued when my enzymes were bad

Thank you both so much for your replies. It has honestly been two very scary months waiting for results on awful tests.

@Crikeyalmighty yes I am very overweight around 6stones but I have lost 6stones so half way there. Nobody has mentioned NAFLD to me. I dont understand the scan results and whether this indicates this? GP seems to think levels could be the gallstones but without pain it doesn't seem sensible to me?

@Caramac555 no itching and wee fine. The only thing that came back on tests was EBV (glandular fever) but the gp didn't explain this very well. I think they're at their limit of any understanding now without a specialist. How was your fatty liver disease diagnosed?

Ultrasound diagnosed my fatty liver, but as an incidental finding to the gallstones which I'd been referred for.

My GP also contacted hepatology for advice,I think the liver tests must be a fairly complex thing to interpret.

Have you looked at the British liver Trust website? Livers do seem quite resilient and able to recover from quite a bit of damage unless disease is very progressed.

@needabetterlife well done on that weight loss- that's amazing!!!it's taken me 4 months so far to lose 1st and 5 lbs- but then I'm told.Beta blockers slow your metabolism as does being over 55 . Nuts really - I've been really good and walked a ton - 10,000 steps most days. I had my gallbladder out yearsago but I believe gallstones do have some implication on LFTs

Hi, just a quick post as I'm working.

Please have a look at what the 'AMA' positive result means. It stands for 'Antimitochondrial Antibody'. You might find it illuminating as it's fairly specific for one condition.

I have a positive AMA also.

Hi @ChocolateDeficitDisorder my AMA and all other auto immune antibodies were negative.

Bit late to the party here, but were you also tested for celiac disease? It is sometimes linked to elevated liver enzymes, and can also be linked to EBV.

@Anyonebut
Thank you for your reply. No I haven't been tested for this.
My lft were normal in 2017. Do you feel being tested would still be worthwhile? My abdomen was so gassy on the ultrasound they couldn't see my pancreas (it was a 6hr fast). I dont feel like I have digestive symptoms though?

@needabetterlife I am wheat intolerant but don't have gastric issues- for me it caused nervous system issues and came on at 60 out of the blue. If I occasionally have something with gluten in it ( I had a Sunday lunch out and forgot about gravy) I get wobbly legs , balance issues and migraines within 2 hours- but I don't get the digestive issues. I think they call it gluten ataxia

If you are not getting answers, I think it’s worth getting tested, as pp mentions, celiac doesn’t always present as GI issues. The initial test is a blood test and for some people that’s enough to confirm or rule it out, although eso Erin es an endoscopy is also necessary.

*sometimes, not eso Erin…

I'm also 42 and went through this at the end of last year. Still going through it to some extent. Mine were raised so they brought me back in for lots of different bloods. I had lost a lot of weight too in a short space of time and I had constant nausea. I was referred for CT from neck to groin and a gastroscopy. Nothing found.
I'm still losing weight though I eat a bit better now and the nausea is not as bad as it was.
I'm back to check liver and kidney function along with vit D on Monday as Vit D was also low.

Still no answers.

@Anyonebut @Crikeyalmighty

Thank you both. I never knew celiac could have non digestive symptoms or come out of the blue. I will definitely discuss this with my gp.

@Spokentruth gosh you poor thing! How frustrating still not knowing what is going on. Did you also have an ultrasound? Lfts are so strange and complex - up until two months ago I didn't know a single thing about them and the more I read the more I dont!

You google the numbers and hepatitis comes up scaring you to death but as you pick away and hear more real accounts you find that there are so many possibilities. Im glad the nausea is subsiding and you can eat more. Im have completely overhauled my entire diet since all this.

I also forgot to mention that hormones seem to also play a part (as with everything) do if you are on hormonal contraception it might be worth investigating if this is a known side effect.

Thanks needabetterlife. I too was tested for Hepatis. Nothing to see there. I've had diabetes, thyroid, coeliac, stool test for H pylori etc... checked. I did have an ultrasound booked but they said I didn't need it as CT would override it. It was all very odd because I felt so poorly for months. If I do keep losing weight though I'll have to go back as that's not normal for me.

Hepatitis even!

@needabetterlife Neither did I . I thought coeliac /wheat intolerance was one of these things you had from childhood etc. very very common apparently in over 55s, as is sudden lactose intolerance.

In the interests of full disclosure, I haven't been tested because the neurologist told me to trial it for my neurology issues I developed post covid. As soon as I did it helped. I don't now fancy the 3 months I would have to eat gluten to be officially tested and labelled - I've had the odd bit in error and as soon as I do, I get weird leg trembling and a migraine.

My last liver enzymes were up too, but only very slightly above normal. In my case doctor thinks it's statins and beta blockers- so medication related, plus being a few stone overweight and not having a hall bladder. Non alcoholic fatty liver is apparently very common if you are at least a couple of stone overweight, as is pre diabetes. Hence I'm on a diet combining gluten free, low cholesterol, and lowish carb - and I'm not a salad fan- it's a challenge as I love pasta and rice and good bread!!

I have similar, mine are a little higher but it's been going on a while. My GP was clueless and quite worried after doing what felt like a million tests. I'd been waiting for a hospital appointment for well over a year due to gallstones causing me a lot of pain so my GP wrote to them to ask about this too. I've since been seen and apparently it's likely to be bile duct stones - they don't always show up on US scan so I've been referred for an MRI to check and assuming they find them I'll need an endoscopy procedure to remove them prior to gallbladder surgery.