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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 34990
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I just recently visited with my new Doctor, My other Doctor

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I just recently visited with my new Doctor, My other Doctor left town so I had to see a new one, Im 25 years old and when I was 18 I was diagnosed with Fatty liver, I had several Ultrasounds and bloodwork every 6 months, When I just saw him, I had blood work done again, since it has been about a year since my last one. My last Blood Work showed my ALT was up to 79, a year later and about 20 punds heavier my ALT is now 112. What does this mean? Does this mean i am progressing to cirrhosis?? I have been on a diet since the begining of January and have lost about 15 pounds, I was about 290 when i got my last LFTs and then i went up to about 320 not I am down to 305 after dieting for for a few weeks, I am just worried that I am progressing, the Dr. said to stay away from alcohol and over the counter medicince and come back in 3 weeks. He felt my abdomen when I was in his office yesterday and said he did not feel my liver, so it wasnt swollen. Could I have cirhosis? The GI Dr. I saw in 2010 said there was no reason for a biopsy because it wouldnt change the method of treatment which was diet and excercise, of course i was about 260 lbs then and my ALT was around 66. What do you think I should do?

Greetings Brandon.

Hope the following points will clear the raise in your liver enzyme;

1) The liver function tests may be abnormal even in patients with a healthy liver.

2) Studies evaluating the clinical significance of these abnormalities have demonstrated that serious underlying liver disease is uncommon in many individuals.

3) Just this level of enzyme elevation is found in almost 10% of cases without any disease.

4) Only a persistent increase of two fold for three months will need further studies or invasive investigations like liver biopsy.

5) The other causes should be observed if there is no history of any medications, alcohol abuse and investigation for hepatitis B and C are normal and there are no medical evidence of the following diseases (which can elevate these enzymes); muscle disorders, thyroid disorders, celiac disease, and adrenal insufficiency).

Just this mild raise of ALT does not point to cirrhosis. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are intracellular liver enzymes with mitochondrial and cytoplasmic forms. Absolute levels of aminotransferases correlate poorly with the severity or extent of level damage and do not provide reliable prognostic information. In addition to hepatic injury, there are many other factors that may affect aminotransferase serum levels. Hyperthyroidism has been noted to raise both ALT and AST levels. Following causes should be considered in your case;

1) Non alcoholic fatty liver disease

2) Hepatitis A to E

3) Other virus; Epstein-Barr, cytomegalovirus, and HSV

4) Hyperthyroidism

In your case following approach would be done to control these raise of liver enzymes;

1) Weight reduction

2) Stopping alcohol if you do.

3) Exercises

Further investigations required would be (if not done earlier or rise persists after 6 months);

1) serum protein electrophoresis for autoimmune hepatitis

2) thyroid-stimulating hormone levels;

3) creatine kinase levels;

4) antibodies for celiac sprue;

5) alpha-1-antitrypsin phenotype and levels;

6) adrenocortical insufficiency (Addison's disease)

If these investigation do not reveal anything abnormal; I would not be worried in your age group and only a 6 monthly or yearly check up of liver functions would be advised.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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Customer: replied 4 years ago.
Thank you very much for your very informative answer, I have been nauseated for about 5 days now with some stomach pain and a lot of gurgling today. I have not vomited and I had diarrhea a couple of times, could this be related to the rise in ALT when all the other lfts were normal?
You are very welcome, Brandon.

Your present symptoms are absolutely unrelated with ALT. This is minor intestinal infection (bug / virus) and usually pass of spontaneously. Following may help;

1) PeptoBismol
2) Lomotil; may only be given if the diarrhea is vigorous.
3) Gatorade / Pedialyte
4) Plenty of fluids
5) BRAT diet; banana, rice, applesauce, toast. Vegetable broths / vegetable soups, coconut water also can help.
6) Probiotic

It is privilege assisting you.

Dr. Arun
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