Patient's Query
Hello doctor,
My eight-year-old daughter continues to have strong abdominal pains. A couple of months before, it was really bad and was also coupled with mono and fifth disease.
At that time, her levels were crazy high. AST = 1312, ALT = 1692. These levels freaked out the doctors, so we went back the next week, still high but much lower AST = 394, ALT = 807, GGT = 84. We also did a sonogram at that point, which was inconclusive. We went back two weeks later, and it was not better AST = 532, ALT = 682, GGT = 71. Doctors have no answers and no idea about what was going on. The doctors seem to phone it in at that point.
My daughter started feeling better, so we did not push it for a couple of months and went back in, and the levels seem close to normal: AST = 57, ALT = 42, GGT = 12. We were given no comfort as to what caused it. My daughter does complain a couple of times a week about her stomach hurting, but she is not in the extreme pain she was in until this week.
She is back to waking up in pain, spending most of the school day in the nurse's office. So now we are heading back to the hospital for more blood, as we did not get any answers from the first 37 vials of blood they have taken. Any clues on what might be causing this?
Please advise.
Hello,
Welcome to icliniq.com.
I can understand your concerns.
This appears to be a case of obstructive jaundice. The main cause of obstructive jaundice is gallstones. Since GGT (gamma-glutamyl transferase) levels are raised more than 70 in the first report, it suggests an obstructive cause. AST (aspartate aminotransferase) and ALT (alanine aminotransferase) can increase in both hepatic and obstructive causes.
In obstructive jaundice, the level of direct bilirubin increases more than indirect bilirubin levels. Gallstones are easily visible on an abdominal ultrasound. It also causes severe acute abdominal pain. There are some syndromes, like rotor syndrome, which can also cause obstructive jaundice. Nevertheless, the enzyme levels are fallin,g and the child is improving now.
But I suggest you repeat the ultrasound to look for gallstones. Review the ultrasound report and liver function test report, especially bilirubin levels.
I hope this helps.
Thank you.
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Answered byDr. Deepak Patel
Medically reviewed byDr. Vinodhini J.
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