Liver Biopsy Question and Concern

[RDM2001]

Hi. My ALT number was slightly elevated in November 2013 (57) and when retested a month later it was 97. My PCP referred me onto a liver specialist and I had a slew of bloodwork done and a Ultrasound. This was in late February. My ALT number is now 103.

My ultrasound was fine and showed nothing abnormal and the rest of my bloodwork was all within the ranges. All Hep tests were negative. The nurse practitioner stated I was the “picture of health”.

I drink about 0-5 drink a month, don’t smoke. I’m 5’8 and 187 pounds.

Next week I am have a biopsy of my liver done.

While on one level I am grateful my test results were good minus the AKT number I am terrified that there is some ticking time bomb that is causing my ALT numbers to be high.

In this scenario what would the Biopsy being looking for? Thanks.

[Dorset123]

Hi,

Doesn't sound like you are drinking much, but why not stop completely for a few months & see if that improves your ALT. Ibrufen can also make the liver worse.

good luck

[Bolly]

Who ordered the biopsy, was it the liver specialist? Sometimes it's difficult in clinic to ask questions, but it really is the best time to get answers from those who know! Next time your liver specialist orders blood tests, scans or procedures, ask them before you leave the clinic what they are for. In the meantime, my guess is the biopsy will look at the tissue they extract to diagnose the cause of the inflammation in your liver. Can I ask what symptoms led to your PCP running a liver panel, and what levels were the other elements of the liver panel, ie Albumin, Bilrubin, ALP, AST (if taken). Your ALT is certainly rising, which suggests whatever is causing the levels to rise may still be happening. Did your PCP go through your medical history, diet high in carbs etc and pinpoint anything, ie long term medication for something non liver related, diabetes, etc etc,.

[RDM2001]

Thanks for the responses.

@ Dorset123: I figured since I drink so little that wasn;t really impacting the number but I think I may just cut it out for the next few months to see what happens. I have been taking Ibuprofen a few times a week since the fall due to soreness from work.

@Bolly. My PCP referred me to a Liver Specialist and he is the one who wants the biopsy. I know the biopsy is being done because my numbers otherwise look good.

So could it be fatty liver without it looking like fatty liver on the ultrasound if that makes sense?

I originally went into see my PCP in November for a physical plus I was having some "Male performance issues" if you know what I mean.

Component Standard Range Your Value

WBC 4.2 - 9.1 THOU/uL 7.1

RBC 4.6 - 6.1 MIL/uL 5.2

Hemoglobin 13.7 - 17.5 g/dL 14.6

Hematocrit 40 - 51 % 41

MCV 79 - 92 fL 80

RDW 11.6 - 14.4 % 14.1

Platelets 150 - 330 THOU/uL 303

Seg Neut % 34.0 - 67.9 % 66.4

Lymphocyte % 21.8 - 53.1 % 23.9

Monocyte % 5.3 - 12.2 % 7.5

Eosinophil % 0.8 - 7.0 % 1.8

Basophil % 0.2 - 1.2 % 0.4

Neut # K/uL 1.8 - 5.4 THOU/uL 4.7

Lymph # K/uL 1.3 - 3.6 THOU/uL 1.7

Mono # K/uL 0 .3 - 0.8 THOU/uL 0.5

Eos # K/uL 0.0 - 0.5 THOU/uL 0.1

Baso # K/uL 0.0 - 0.1 THOU/uL 0.0

Sodium 133 - 145 mmol/L 137

Potassium 3.3 - 5.1 mmol/L 4.1

Chloride 96 - 108 mmol/L 103

CO2 20 - 28 mmol/L 28

Anion Gap 7 - 16 6

UN 6 - 20 mg/dL 17

Creatinine 0.67 - 1.17 mg/dL 0.76

GFR,Caucasian 115

GFR,Black 133

*UNITS=mL/min/1.73 square meters

Glucose 60 - 99 mg/dL 103

Reference Ranges apply only to FASTING samples.

ADA Guidelines Blood Sugar Levels for Diagnosing Diabetes & Pre-diabetes

Normal: < 100 mg/dL

Impaired Fasting Glucose (IFG): 100-125 mg/dL

Diabetes: > 126 mg/dL on two different occasions

Calcium 9.0 - 10.3 mg/dL 9.3

Total Protein 6.3 - 7.7 g/dL 6.7

Albumin 3.5 - 5.2 g/dL 4.0

Bilirubin,Total 0.0 - 1.2 mg/dL 0.6

AST 0 - 50 U/L 42

ALT 0 - 50 U/L 105

Alk Phos 40 - 130 U/L 83

And from my ultrasound:

RIGHT UPPER QUADRANT ABDOMINAL ULTRASOUND ORDERING CLINICAL INFORMATION: Elevated LFTs.ADDITIONAL

CLINICAL INFORMATION: None.

COMPARISON: None.

FINDINGS: Liver: The parenchyma is of normal echogenicity. No focal lesions are identified. Gallbladder: No stones or wall thickening. Common Bile Duct: 0.3 cm Pancreas: Poorly visualized secondary to bowel gas. Right Kidney: No hydronephrosis. There is a upper pole cyst measuring 2 x 1.3 x 1.8 cm.

Impression

IMPRESSION: Unremarkable right upper quadrant ultrasound. No evidence of focal liver lesions, cholelithiasis, or biliary ductal dilatation.

END OF IMPRESSION.The consultation was reviewed and approved by an attending radiologistafter exam interpretation with a radiologist in training or PA.

I don't take medications but Vitamin. D. .

Thanks again.

[Bolly]

Hi again RDM.. Are you outside the UK, as these don't look like UK blood tests, also we tend to use the abbreviation GP rather than PCP for our doctor.

I don't know much about diabetes, but your diabetes bloods look like you are in the pre-diabetes range? This may account for the elevated ALT? Diabetes with adult onset can be due to diet, genetics or insulin resistance I believe. According to some research in clinical diabetes journals.. "Individuals with type 2 diabetes have a higher incidence of liver function test abnormalities than individuals who do not have diabetes"

Not sure what an 'upper pole cyst' is but it could be related to your kidneys.

[florrie505]

Hi, I too was told that i could continu drinking if i wanted when I was diagnosed with Pbc. 4 years later had an emergency transplant. Recovery has been very slow for me.

Good luck and make vhanges now or repent for life xxx

[RDM2001]

@GBolly...yes I am outside of the UK. In US. This forum seemed to be a nice place to post from what I was reading. That's why I joined. I'll have to ask about the Diabetes number. I'm pretty sure I didn't fast before the blood work as there was no instruction to do so. I just checked my paperwork from when I had it done and there was no mention of doing this. So I think the skewed the numbers.

Thanks again for you replies. It has been helpful.