Elevated ALT & AST - (Capillary) - Aspartate AST AT (Capillary) & Albumin AT - Fatty Liver - Cirrhosis.

[Nelly2004]

Hi, I am a pretty healthy and active 55 Y.O White Male with a low BMI.

My mother passed away 5 years ago at the age of 74 with a pretty fast onset of non alcholic cirrhosis of the liver.

In 2022 after a CT scan I was informed I had a slightly fatty or scarred liver but with nothing to be concerned about, the same again a year later with another consultant with another CT Scan.

This July I started to get a dull ache or sensation of an inflated ball under my right rib with intermittent shooting pains so went for a blood test.

I had a high(er) readings of:

ALT (AT) 69

AST of 46

AT (albumim) 51

with an in range Biluribin of 8.

My doctor has told me to follow up in 6 months.

I wondered if anyone new whether any of this is of concern for me to go to see a faster follow up?

Are these readings something which can change and be down within months? and tips to eat healthily to make the liver less fat, or is it , due to my mother, something heredity?

Thanks a lot in advance.

[Kristian]

Hi Nelly, the results are only slightly out of range so I can see why your gp has suggested a follow up in 6 months. The readings can fluctuate and I suspect as you already have a diagnosis then the GP is happy to keep you routinely monitored. That pretty much standard as far as I can tell. NICE will have some guidance out there about actions GP's should take with regards to abnormal liver tests and also early stage Liver diseases like fatty liver, which are managed in primary care (i.e. by your gp).

For a bit of peace of mind, and just to quote my experience. My results were all more higher than that, usually in the low to mid hundreds, and whilst I was under secondary care (I.e. the local hospital) my monitoring was roughly every 6 months or so too. So even if you were referred you'd probably not been seen on any different time frame anyway.

Once liver disease is confirmed, it is in the main just a case of ongoing monitoring. The frequency can vary depending on activity or symptoms, but 6 months for fairly advanced disease is pretty normal, and less advanced disease then annually is also common.

I think the main take away really is, if you feel anything changes, I.e. you have a new symptom or you do feel markedly worse then it's always worth getting it checked out at that time irrespective of any ongoing monitoring that may be occurring.

Hope thats helpful.

[Nelly2004 in reply to Kristian]

Hi Kristian, thanks so much for taking the time to reply in such a thorough and understanding manner, it's appreciated. I guess, one of the main things for me, is for one, just to understand that these things can spike but to also understand the process and outcomes if I do have an issue. A fatty Liver, is at the moment just a phrase for myself, and one which I can hopefully address a little with lifestyle and food. It's the point or levels where I should worry I will look into. I think the fact that I have this ache in the same sort of space I know my mother complained about is what has made me have more concerns and the fact that two other levels have spiked since initial first spike. From good advice like yours I'll stay calm and look to have another test in 5 months or sooner if I feel worse or am more worried. Thanks for your time and advice. Nelly

[Kristian in reply to Nelly2004]

I think that's the correct approach. Being cautious is never a bad thing, and if something just "doesn't feel right" it is always worth getting it checked out.

Results will fluctuate, it's the general trends over time they tend to keep an eye on, although a big change does always tend to prompt a bit of follow up. But for minor changes they tend to just keep under review as part of the overall process.

Eating reasonably healthy and keeping reasonably active will both help in the long term too. So that's a pretty good plan you already have.

Good luck and always feel free to ask any questions if you're ever in doubt.

[Nelly2004 in reply to Kristian]

Hi Kristian, I hope you are well. Since we last liaised on this, I have had continued abdomen discomfort which lead me to take another blood test which now shows even more elevated readings, ALT 133 (from 69 i month ago), AST 54 (from 46), and GGT of 119 (from 57 previously ). I have just endeavoured to make an appt with a GP and also a Liver specialist for next week. I don't like the side discomfort most of all and with my history of the disease in my family want to stay on top of it. the readings are rising. What I'm trying to ascertain is , if it's fatty liver, is it just a case of keeping on top of it or will know more once seen specialist to see what exactly it could be.

[Chipschill]

You might also check to see if there is a genetic component contributing to your condition since your mother had cirrhosis.

[Readlots]

Hi, I can relate to your concerns. My Mum died of PBC aged 75. I also have PBC /AIH crossover and Alpha 1 antitrypsin deficiency. As Chipschill has suggested it might be worth asking your GP if they can check for any genetic link and autoimmune links if your results don’t improve. 6 monthly checks are quite normal, there often isn’t any need for more even if you are diagnosed with liver disease.

Often our livers react to something, flare up and then recover by themselves. It might be alcohol, medicine, a virus or bacterial infection or stress. That’s why GPs often say that they will retest after a period of time. And often they have returned to normal.

Sometimes there is something more going on e.g. fatty liver, and lifestyle changes can sort it out. Sometimes it’s autoimmune and you may need medication but you don’t necessarily need to be seen sooner for this.

I’ve had PBC/ AIH since 2012. I take Urso for the PBC and Azathioprine for the AIH. I don’t drink and I avoid medication (e.g painkillers) that might affect my liver. I try to eat healthily ( but I love cake 😱) and I walk the dog and garden for excercise. So far my LFTs are good.

I occasionally have a flare up with fatigue and brain fog getting worse but a month on steroids has always sorted me out.

If you are worried about your symptoms talk to your GP, they can investigate further if necessary or reassure you.

The main thing is to avoid alcohol, and Google!

[Nelly2004 in reply to Readlots]

Hi, thanks a lot for your patient response, appreciated. I've just assumed that I had a genetic link to the issue via my mother (who was unaware she had any issues at all until one year before she passed away with the problem). If the doctor is to clarify I have the same issue (auto immune issue) what exactly does it do to 'help' the situation? is it a case of being prescribed the drugs such as you are on , when and if the issue 'flared up' in any serious way? and what do they say is 'serious' ?

I eat pretty healthily (very rarely processed foods, only white meat, and lots of veg), drink a couple of nights a week to a low level and am active, with good weight, so I only have an issue with it, if I feel like I have symptoms, such as the ache I have (I also have shoulder issues and itching which I've read can be symptoms too).

What I'm basically trying to get my head around is, at what point does one have to act on it? and as you say, is it something we live with?

Sorry to be a little vague, it's just I'm trying to process it.

Thanks

[Readlots in reply to Nelly2004]

No need to apologise. It sounds like you’re like me in wanting to be prepared. Knowing whether you’ve got a liver condition helps because you can access treatment which stops the disease progressing, or at least slows it down. Lots of people with autoimmune liver conditions die with it rather than from it having lived a normal lifespan. The sooner you are diagnosed and start treatment the better the chance of living a normal and full life. I hope that helps.

[Nelly2004 in reply to Readlots]

Hi, I hope you are well. Since we last liaised on this, I have had continued abdomen discomfort which lead me to take another blood test which now shows even more elevated readings, ALT 133 (from 69 i month ago), AST 54 (from 46), and GGT of 119 (from 57 previously ). I have just endeavoured to make an appt with a GP and also a Liver specialist for next week. I don't like the side discomfort most of all and with my history of the disease in my family want to stay on top of it. the readings are rising. What I'm trying to ascertain is , if it's fatty liver, is it just a case of keeping on top of it or will know more once seen specialist to see what exactly it could be.

[Readlots in reply to Nelly2004]

I’m sorry your blood results aren’t going in the direction you want. If it’s fatty liver disease, lots of people on here have turned things around with diet and lifestyle changes. The BLT website has advice on diet for fatty liver disease. They also have a good section on questions to ask at medical appoinyments