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Dr. Anil Kumar
Dr. Anil Kumar, General Physician
Category: Health
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Experience:  M.D. with over 30 years of experience in practice.
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I recently got strep throat and am currently on antibiotics.

Resolved Question:

I recently got strep throat and am currently on antibiotics. However, I got blood work done twice and in both cases my liver enzymes were extremely high (this was before I started the antibiotic treatment). I was tested for Hepatitis A, B, and C, mono, HIV etc and all were negative. I was told that I have mild fatty liver, though. Am I still at risk of developing Hepatitis? And how can I get my liver enzymes to go down?
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Anil Kumar replied 1 year ago.

Hello,

Can you provide the liver function test report?

Which liver enzymes are elevated?

Alcohol and smoking history?

What is your occupation?

Since how long have you been suffering from?

Have you undergone Ultrasound/CT scan whole abdomen?

Are you frequently taking pain killers or other medication/supplement?

Pain abdomen?

 

 

Thanks.

Customer: replied 1 year ago.

I believe this is what you're asking for:


 


Exam- NM HEPATO IMAG INCL GB: [copied exactly from results provided at hospital] Patient was administered 8.2 mCi of technetium 90 9M Choletec intravenously. Scintigraphic images were acquired at one minute acquisition per frame for a total of 56 frames. There is normal distribution of CCK within the liver. The gallbladder fills and the CCK is seen passing into the small bowel. At that 0.1 mcg of CCK was produced intravenously. Ejection fraction was calculated after region of interest was generated around gallbladder. Ejection fraction is 40% at 11.5 minutes. At that point the gallbladder slowly fills an ejection fraction 25% at 30 minutes. IMPRESSION: Abnormal exam. Ejection fraction is 25% at 30 minutes. Normal is greater than 40%. These findings are consistent with gallbladder dysfunction or chronic cholecystitis. There is no evidence of obstruction or acute cholecystitis.


 


Liver Enzymes from Blood Work on 8/4/13- ALP 297/ AST 305/ ALT 459


Liver Enzymes from Blood Work on 8/7/13- ALP 294/ AST 233/ ALT 454


 


I've been a regular smoker for about 4 or 5 years. I generally stayed around 5 cigarettes a day. For about 6-9 months I was smoking around 10-15 cigarettes a day. I quit for about 3 months at the beginning of this year, but I did start again and average between 1-5 cigarettes a day, going days at a time without smoking at all. As far as alcohol use, I drink socially. I do have anywhere from 2-5 drinks (varying from liquor to beer) when I do go out, which varies from once a week to once every 2 or 3 weeks.


 


I work for an internet t-shirt company. I often do moderate to extensive manual labor and some work online. It has a generally mild to moderate stress level involved, and on occasion can get very stressful. However, I, in general, have a high stress level.


 


I was only diagnosed with the strep throat last week. It all started with a fever around July 25 or 26. Aside from the fever and fatigue, I had no other symptoms indicating strep throat. The fever would only go away temporarily with use of ibuprofen, and on August 4 despite taking the ibuprofen it persisted so I went to the emergency room. By this point, my appetite had begun to decrease and I was getting bouts of nausea. It was only a day after my visit to the ER that my throat started hurting very badly, and the fever still continued. On August 6 I went to my primary care for a follow up and that's when it was noticed I had white patches on my tonsils, and a throat culture was done (and later proved I had strep). He did order more labs which I did the following day (as noted above).


 


I did have a full CT scan of the abdomen and pelvis. I'll include the conclusion but let me know if you need the full findings. Also, please note that this was done prior to the other exam listed above: Conclusion #1- Moderate amount of free fluid in the pelvis uncertain etiology. Increased endometrium is noted but no definite focal lesion or mass identified. #2- Some thickening of gallbladder wall. Small amount of pericholecystic fluid, acute cholecystitis cannot be excluded. #3 No focal hepatic abnormalities and relatively normal enhancement, except for some low density in the portal triad regions on the arterial phase.


 


I also had a sonogram of the gallbladder (this too was done before the exam listed at the beginning). Conclusion- Partially contracted gallbladder without definite evidence for cholelithiasis or acute cholecystitis. No evidence of biliary obstruction. Diffuse abnormalities of the liver suggests the possibility of an inflammatory process without definite focal lesions.


 


I had been taking 600mg-800mg ibuprofen every 8-12 hours for over a week straight. I haven't taken any since August 7 though. I do take Xanax (0.25mg-1.5mg) for frequent panic attacks and social anxiety. I take a daily low dose aspirin (81mg, though I was not taking it while on the ibuprofen). I do take a daily multi-vitamin, and ranitidine (150mg 1-2 time a day). Less frequently I take Promethazine, Pepto, Bentyl, and Claritin.


 


There is not any persistent pain in my abdomen. If I press down on my upper right abdomen, right below the rib cage, it does hurt a bit but it's not excruciating or anything, and only happens when I press down.


 


 


 

Expert:  Dr. Anil Kumar replied 1 year ago.
Hello,
Thanks for providing more information.
Well an elevation of just ALT/AST suggests several different possibilities including viral hepatitis (which you said was negative), alcohol intake/alcohol liver disease, 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 your liver is healthy, just experiencing some inflammation that may be temporary.
So you should avoid alcohol and even continue to limit your smoking consumption.
Avoid pain killers as much as possible.
Also avoid fat free diet,spicy food.
Xanax has cause elevated liver enzymes so it can be another possible cause.
However, this is reported in less than 1% of people using it.
You should discuss it with your doctor and if required discontinue it.
And repeat liver function test should be advised quarterly.

I suggest you to consult a gastroenterologist for further evaluation and management.




I hope this helps.
If you have any further query then feel free to ask.
Positive feedback and bonus are highly appreciated.
Thank you.
Customer: replied 1 year ago.

So is there a chance that I can still develop Hepatitis because of this? Should I look into getting the vaccines for A and B? And I was reading that milk thistle can also help in reducing liver enzymes. Is that true, and would you recommend trying it?

Expert:  Dr. Anil Kumar replied 1 year ago.
Hello,
You should also undergo Anti Hepatitis E IgG/IgM to rule out Hepatitis E.
Usually Hepatitis A and B vaccination have been given in childhood.
So you should check your vaccination record.

It takes 3-6 months to reverse fatty liver changes in most cases.
Milk thistle can help with fatty liver disease however their benefits are not proven scientifically yet.

I hope this helps.
If you have any further query then feel free to ask.
Positive feedback and bonus are highly appreciated.
Thank you.



Dr. Anil Kumar, General Physician
Category: Health
Satisfied Customers: 6552
Experience: M.D. with over 30 years of experience in practice.
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