Slightly vague lft question sorry

[farranccc]

Hi all, I’m just back from a Dr appointment about my ongoing pain just under my right rib. He said that all of my lft results were well within range (he read them out and all were pretty much low to mid-range) and ultrasound scan showed a normal shape, size and texture liver.

He then went on to tell me that the lft that I had a few years ago (when I was drinking a lot) showed one mildly elevated test of 67, (ALT I think) against a limit of 40. This sounds pretty bad to me and 50% higher than it should be but he said it is normal and not to worry about it - probably alcohol related. He has agreed to do another lft tomorrow but I am freaking! He is also checking for h.pylori and b12 and folate

Any thoughts?

By the way, 6 weeks off the booze for me but I would like to be able to have the occasional glass of wine once this is sorted.

[Identity75]

The liver is superb at taking care of itself most of the time and repairing a lot of damage. From the sound of it you don’t have to worry just yet. Your LFTs are good according to your doctor. It may have just been a blip before.

You can still enjoy the odd glass of wine just take this as a bit of a warning and don’t go over the top.

Am sure everything will be fine.

[Hidden]

ALT levels can be raised by recent infections such as colds etc. Your raised ALT is really not something to worry about, as my husband had something of this order after a blood test and he was absolutely fine. To give you an idea of dire ALT levels, when I was diagnosed with auto-immune liver disease, my ALT was around 1000 and I was jaundiced. I hope this puts your mind at rest. Everybody would be delighted with your ultrasound

[farranccc in reply to Hidden]

Thanks for the replies both - very kind of you to take the time.

I wonder if it is not my liver causing the pain under the rib then. Just strange that alcohol and coffee seem to irritate it - although an Indian takeaway seemed to bring it on the other night.

I wish I could find out and put it straight (and out of my mind).

[Hidden in reply to farranccc]

I had pain under my rib after an exercise class! So it could be muscular. The liver itself does not have any pain receptors, so pain is not being generated by the liver. If it was swollen (which it isn't from the u/s), then surrounding tissue would feel the pain. I think you can probably relax, take a deep breath and just let your doctor do their stuff. Good luck

[J3ff24 in reply to Hidden]

Hi MC, how was your LFT’s as of late? Still in 1000’s? Did it get better? (Which i hope you did) what are your symptoms before you were diagnosed?

[Hidden in reply to J3ff24]

I was diagnosed approx 9 years ago. It took them about 9 months to get me stabilised and I have been managed by aza ever since. As my condition has got worse over the last 2 years, they have added in pred (5mg), amongst other things and that is keeping things normal at the moment- mostly. My LFTs are normal, but have been affected by food poisoning (about 12 months ago).

Before I relate any symptoms, may I ask why you would like to know? Are you concerned that this is what you or someone you know may have?

Auto-immune liver disease is managed with meds and for most people this means azathioprine. The usual protocol now is to add in pred for the first 12 months. I am referring to treatment here in the UK.

[J3ff24 in reply to Hidden]

Hi again, appreciate the response. That’s good to know that you able to manage it and keep it normal by meds. Reason i asked is because i had elevated ALT myself slighlt on AST. I am on my 3rd liver enzyme bloodtest in Sept. ultrasound last April seen nothing in my liver and negative 2 months ago for Hepatitis from my hepatitis test. Does autonimmune included already on a hepatitis bloodtest?

[Hidden in reply to J3ff24]

Auto-immune is diagnosed from ruling out other causes first, so excluding viral hepatitis, then non-alcoholic fatty liver disease, alcoholism and drug usage and Wilson's disease (and probably other things too). Once these have been ruled out (and you would be asked about alcohol usage and drug usage- I was), then bloods will provide clues that are suggestive of auto-immune disease.

So from the bloods they will look at ALT (AST is less useful for AIH) and immunoglobulins and also look for the presence of autoantibodies. If the blood results have the right indicators (I'm afraid I can't tell you fully what these are), then an ultrasound will be carried out to look at the size of the liver. If all these things taken together suggest auto-immune, then a biopsy will be ordered. SInce a biopsy carries a risk, then it will only be ordered if absolutely necessary to confirm previous findings, since the cell tissue will look different from the type of hepatitis caused by alcoholism for instance (and presumably others- although not being medically qualified, I can't say for sure)

How I know that this is the case, is from meetings I have attended for AIH with the leading consultants in the UK. I hope this answers your question?

[GrandmaDylan in reply to farranccc]

I had right sided pain which radiated into my back between the shoulder blades. It was due to gallstones for which I had my gallbladder out.

[Julie8]

Do t leave it to chance. You could have cased scarring back when you had raised Lfts and drinking. That’s what happened to me. Lfts can go back to in range but the scarring may still be there. Get a scan.

[farranccc in reply to Julie8]

Hi Julie8, thanks for your message. I did already have an ultrasound scan and it all appeared ok. Would an ultrasound not show scarring? Is there something else I should be asking for?

Thanks

[Julie8 in reply to farranccc]

Hi there. A fibroscan reveals scarring but if you’ve had an ultra sound scan, that would show any enlargement or lumps or bumps or fatty liver and they said yours was fine, so I would keep an eye on your lfts and get your go to keep an eye on it

[farranccc]

Just a brief update: I called the Doctors surgery today and they’d had all my blood tests back (thyroid, kidney, h.pylori, folate, b12, etc etc) and liver enzymes bit not ggt as mentioned in my parallel post.

Everything was clear and like the last set I had a few months ago they were almost in the middle of the reference range.

Great news I think but the pain I have been having in the stomach / liver area seems to be getting worse even though I haven’t had a drink for 6+ weeks. Today, after I had finished my lunch (egg salad) I felt it as bad as ever

I have a follow-up appointment with the Dr next Wednesday but what do I say / ask for? He was convinced it wasn’t my liver (based on u/s and bloods) and the latest result will compound that view I presume.

Any ideas warmly welcomed.