My ALT and AST have been elevated for decades. For second time in a row now, my AST has becomevhigher than ALT ; they are currently in 60ish range. A very nice article i read on the DiRitiis ratio from around 2013 says my new current ratio of 1.1 suggests fibrosis and ir bad prognosis to cirrhosis
but heres the thing and herein lies the question. Does this apply if I do not know the cause of my decades elevation?
The article discusses the doom and gloom of the ratio within the context of specific known disease processes How should i think about the sudden change of ratio in an unknown context?
I do not drink and i sm under weight. Ovrr the decades have been tested for hepatitis and hiv, both negative. Ultrasound did not find any evidence of fatty liver or gallstone issues Hemangioma only thing that shows up. Am in poor health generally.
Could a change in ratio to only 1.1 have any innocent cause? Weight loss? Protein deficiency? Is there a blood test that can help diagnose fibrosis ? (I wont have the fibrosure scan) I recentky had a ct scan of abdomen for other reasons but without contrast. Can fibrosis or at least cirrhosis be seen on scan? Am wondering if there is a chsnge in liver thats related to some other gi symptoms. Then again perhaps the other gi symptomd sonehow messed withbratio
input on my questions greatly appreciated.
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SkinNBones
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Could you potentially have an ELF test? (Enhanced Liver Fibrosis test) which is a set of blood tests that can indicate whether you have fibrosis. I would imagine your CT scan would be sufficient to identify if there are changes to your liver.
It's possible to have fatty liver even if you are slim and it is actually quite common in those with anorexia or people who are severely underweight & might not always be picked up on ultrasound.
As this has been going on for some years and they haven't as yet identified a cause what is their next plan of action? The ratio normally only comes into play if one or both AST and ALT are hugely out of range unless it's in a patient with known cirrhosis and can be used as a potential indicator of the underlying cause of cirrhosis.
Are you under the care of gastroenterology/hepatology? Have any auto immune antibody tests been done? Have you ever had a liver biopsy?
Sounds like they need to be getting serious in establishing your diagnosis.
On the blood panel will look up and see if its the one i saw years back but could not remember the name. The one i had found i remember was only relevant in cases of known fatty liver and wasn't super helpful in my case and measured things not an issue for me like ldl cholesterol
On fatty liver, I know it can occur in thin people (and even resukt from malnikutrition), but when the ultrasounds have been normal, I thought that was sufficient to rule it out. If sometimes ultrasounds cannot detect it, is there a different way to detect it? I’m gonna have somebody else look at the CT scan. Since I wasn’t there for liver in the hospital. And they were busybmay well have overlooked that They also commented on the liver “lesion” which I know has been stable for years and believed just to be a hemangioma but it’s possible that for them that was the most noticeable thing about the liver and they didn’t bother with other liver changes but I will definitely ask
years back, I refused a biopsy. They didn’t think it would give much information anywayb they predicted there might be some nonspecific peri portal inflammation, when I first started getting liver enzyme abnormalities, I went to the mayo clinic saw a liver expert, who iwas a jerk by the way, but that’s another story
I have in the past had tests for anti-mitochondrial antibodies, and I forget what are the other ones for auto immune liver disorders. Only once the anti-mitochondrial antibody was borderline high. But never agagiven my normal ALP and bilirubins PBC does not seem to be what’s going on but of course there is auto immune hepatitis which can be hard tondiagnose
another question, for you if you can - that’s interesting when you say that the ratio is only relevant when the liver enzymes are extremely elevated. So do you think that elevations around the 60 something Mark are not high enough for the ASTALT ratio to be meaningful? If nothing else, the change in ratio is definitely new for me and new stuff lands on the radar.
doctors are mostly ignoring stuff. I won’t even bring up the ratio because I’m known for bringing up with a considered to be subtle things. For the weight loss, my moron doctors tell me to eat more calories. I’m trying to avoid catastrophes, but doctor seem to be determined to let me go to such a point that I have catastrophes and then will pay attention. I once had a liver specialist, but he left and I never got a but when I told him that I can’t tolerate the Phibro scan, they won’t work around my constraints. Thanks again.
Your enzymes being only in their 60's are only in what they would describe as mildly elevated. Doctors don't get excited unless figures are into the range of 3 to 4 times upper limit of normal (or higher).
AMA being high may well point to something auto immune. (My hubby has cirrhosis due to auto immune liver disease / AIH / prescription drug induced ??)
Can I ask why you don't want a fibroscan or feel you can't tolerate it? It is not that different to an abdominal ultrasound the just take 10 readings across your liver using the probe - it's completely non-invasive. From the 10 readings they can give you a CAP (fatty change score) and a kPa (liver density score) and that would be a good pointer as to whether indeed there is a potential liver issue.
my liver enzymes have gone uo ton3-5 times but usually during an infection and then they go back to my usual 1.5-2 x state. Ggt is often 3-5 times but its not a trst included on routine testing anymore
Sounds like still an open question of whether a ratio chenge means anything for mildly elevated alt and ast
Ultrasounds give me loads of long last inflammation; pelvis and abdomen are the two worst. Fibroscan uses an even higher intensity sound waves than a regukar abdominal ultrasound.
Just looked up the blood test. Looks useful to ne. need to check on whether anyone will order in those who have not been diagnosed with advanced fibrosis (and i shoukd look up how bodyvsize effects it tonsvoid sny false negatives
Ill also google blood test to diagnose fibrosis (Or ask chst got)
Thanks. I try to squeeze as much info out of tests as i can since can be hard for me to get them. Certaibly true have more important things to stress about- in part trying to figure out if recent gi symptoms and weight loss (posted on it yesterday) may have something to do with a silently worsening liver
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