My boyfriend has elevated liver enzymes - 60 ast/250 alt. He found out because of tests from driven by gout attacks since November ''07. The Dr. took him off all meds with the exception of his blood pressure medication. Two weeks later the numbers dropped to near normal, but he continues to have gout attacks. A total of four weeks later, his liver enzymes were checked again, the result being the numbers in the beginning of this questions. The Dr. is sending him to a liver specialist. He was also checked, with a negative result, for all hepititis. An ultra sound was done, good results. He has a mild case of fatty liver and is controlling his diet appropriately. He never drank much, and hasn''t touched a drop since the onset of the gout in November. Any cause for worry?
Optional Information: Female, Age: 53, MichiganAlready Tried: Tons of research with no solid answer.
DearCustomer
Does your boyfriend have any other medical problems (besides gout and high blood pressure)? How old is he? What meds was he taking? Any travel? History of blood transfusion? Travel? Where was he born?
Any heart problems? Lung problems? Anyone in his family with heart or lung problems?
DrS
Reply to DoctorS's Post: Only med problems are gout and borderline high blood pressure. He is 53. He was taking colchicine, ibuprofen and/or tylenol. No travel. No history of blood transfusion. He was born in Michigan. No heart or lung problems himself, his father died from heart problems, but he was in his 70s. His Mother is still living a healthy life.
That is very helpful - and a couple other questions, do you know if the Bilirubin was elevated or normal and if his coagulation studies (prothrombin time) were normal?
He has been extremely thorough in relaying Dr.'s information and test results because, by nature, he worries. Having said that, he said his Dr. said that every other test result has been right on the money... and she is a great Dr. and extremely thorough. I guess what I'm trying to say is that even though he has not specifically pointed to those tests, I'm sure a bilirubin and coagulation was completed and is normal.
An elevation of just ALT/AST suggests several different possibilities including viral hepatitis (which you said was negative), alcohol intake/alcohol liver disease (unlikely given what you mentioned about how little he drinks), hepatitis from medications like tylenol, auto-immune hepatitis (which can be checked by antibodies in the blood and would often run in the family), fatty liver which can just happen from a fatty diet or obesity, or chronic or inherited liver disease (often associated with family members who has history of liver disease and heart or lung problems at a young age). A workup for all of these things may leave us with a diagnosis of non-alcoholic steatohepatitis or NASH which can be totally harmless and have no symptoms. The fact that the other tests are normal suggests that overall his liver is healthy and functioning well, just experiencing some inflammation that may be temporary.
I am attaching information for you to read about:
http://patients.uptodate.com/topic.asp?file=livr_dis/5305
Please let me know what other information I can provide for you.
Experience: MD, 30 years of medical practice
Hi, Doctor S. Help again, we had another new development of raised alkaline phosphatase. To recap: He's been having gout attacks for about 15 years. Sometimes a year will pass in between. However, he experienced a gout attack which affected his right ankle and foot. The Dr. prescribed indocin, and he was taking ibuprofen at the time also. He asked for a complete physical when he had the gout. EKG,chest x-ray, PST, complete physical. Dr.'s exam found no problems. Blood tests were taken. Liver enzymes were 60/187 when he had gout in his entire right foot. Dr. waited 10 days and retested liver enzymes. Suffered no gout attacks and urich acid was in normal range 7.3. Tests came back 25/81 for AST/ALT enzymes. Alkaline phosphatase was 88. He was gout free at this point and she wanted to retest his blood after 10 days. During ten day period he had another gout attack in entire right foot. He took motrin, ibuprofen and aspirin for pain. He was retested and AST was 60, ALT was 255. Everything else was in normal range. Dr. wanted to check again in another 10 days. Stopped all meds during that period. Still suffered gout in right foot and now in the knee. Didn't take any drugs at all for pain or inflammation. After that ten days ALT came down 35 points, AST stayed at 60. However,alakaline phosphatase went to 200. He is currently gout free and has not been retested since his severe gout attack subsided. Can all the intense inflammation be causing his liver enzymes to remain elevated and be responsible for his raised alkaline phosphatase? Suffers no fatigue, no weight loss, no night sweats, everything is perfect. Can the severe gout attacks affect his system to affect these three elevated enzymes. If not, what could it be indicitive of?