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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 34693
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I'm a 44 year old female, historically active and fit but

Customer Question

I'm a 44 year old female, historically active and fit but les lately. Ulcerative colitis for 25 years. Recently gained 10 lbs in 2 weeks. Upper right abdomen discomfort. ALT 90 AST 110. Doc just ordered abdominal ultrasound. What are the likely causes?
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: Yes, doc found elevated liver enzymes and ordered ultrasound. I'm on Lialda (5+ yrs), Welbutrin (18 yrs) and Viibryd (6 mos)
JA: Anything else in your medical history you think the doctor should know?
Customer: no
Submitted: 8 months ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 8 months ago.

Hello! My name is***** to JustAnswer. I'm reviewing your question now, and will post back with the reply momentarily.

Customer: replied 8 months ago.
Couple of other symptoms that may/may not be related: Near time of weight gain, began falling asleep immediately after eating, literally cant keep my eyes open. Also have cramps in my calves at night that wake me, but has been happening for a couple of months.
Expert:  Dr. Arun Phophalia replied 8 months ago.

Few common causes would be looked for the abnormal liver enzymes:

1) Medications.

2) Autoimmune hepatitis, which is not uncommon with the ulcerative colitis (which too is an autoimmune disease).

3) Transient rise due to some virus which resolves on its own.

SGOT and SGPT; Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are intracellular liver enzymes with mitochondrial and cytoplasmic forms. Hyperthyroidism has been noted to raise both SGOT and SGPT levels. Following causes should be ruled out;

1) Non alcoholic fatty liver disease

2) Hepatitis A to E

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

4) Hyperthyroidism

Following approach would be done to control these raise of liver enzymes;

1) Weight reduction, if you are overweight.

2) Stopping alcohol, if you drink.

Further investigations required would be;

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)

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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Expert:  Dr. Arun Phophalia replied 8 months ago.

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

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 (tests repeated at monthly interval) 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, adrenal insufficiency and anorexia nervosa.

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Expert:  Dr. Arun Phophalia replied 8 months ago.

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Expert:  Dr. Arun Phophalia replied 8 months ago.

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Expert:  Dr. Arun Phophalia replied 8 months ago.

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