Why are my liver enzymes and gamma GT elevated?

Hello,

Welcome to icliniq.com.

Well, you are right, and I have reviewed the reports (attachment removed to protect patient identity). Let us just sort out things one by one.

First of all, your weight is slightly overweight. Your current body mass index (BMI), which is the proportion of your weight to your height, is 28.3, which is just 3.2 above the normal value of 25. So it is possible that fatty liver is partially contributing to your problem. But I doubt if it is the only explanation for your deranged liver enzymes unless we exclude the other potential causes of such elevation of your liver enzymes.

The potential causes of the elevated liver enzymes are alcohol-related liver dysfunction. Please mention if you take any alcohol and its quantity in a week's time. Autoimmune hepatitis, which is another common entity, is reasonable to think in your case, given your past history of seronegative RA (rheumatoid arthritis). I would write some blood tests to exclude that.

Lastly, there is another set of disorders with an elevation of the liver enzymes, namely Wilson disease (often has a family history of liver disease), alpha-antitrypsin deficiency (with accompanying cough, asthma, sputum, and family history positive for the same), and iron overload called hemochromatosis.

Please do not get frightened reading all these unique and aberrant diagnoses. It is possible that you might have nothing except fatty liver disease, but I will write down a panel of investigation below to exclude all the above possibilities, to be on the safe side. There are no special clinical or examination findings that can justify the above diagnosis, except the blood test, which I wrote down below. HbsAg negative is a good sign, and it suggests against the diagnosis of acute or chronic hepatitis B infection. So it is unlikely that you have hepatitis B infection. HbCore total suggests that you have prior exposure to the hepatitis B virus, possibly cured with treatment or spontaneously. HAV IgG (antibody to hepatitis A virus) suggests an old infection. There is a specific test, i.e., IgM, to detect the hepatitis B infection currently. I will suggest that you do some more investigation to be sure that you do not have an active hepatitis B infection.

• Complete blood count and ESR (erythrocyte sedimentation rate).
• ANA (antinuclear antibody), ASMA (anti-smooth muscle antibody), Anti-LKM-1 (liver kidney microsome)antibody.
• Serum ceruloplasmin.
• Alpha antitrypsin 1 levels. Serum ferritin, serum iron, and transferrin saturation.
• Hepatitis B DNA quantitative, HAV (hepatitis A virus) IgM, HEV (hepatitis E virus) IgM.
• Ultrasound abdomen with color doppler of liver vessels.
• Fibroscan of the liver (transient elastography).

So to summarize, there are some more tests required to establish the reason for elevated liver enzymes. I can understand that you must be anxious, that you are supposed to get another cycle of investigations, but this is how we can establish the cause of this, and can then guide you to an optimal plan of action.

Kindly stop taking vitamin D and vitamin E if there are no significant deficiencies in the blood tests. You can carry on fish oil.

Let me know some more information as well. Did you use any herbal medications, contraceptives, steroids, or antibiotics in the last couple of weeks or months? Are any painkillers or steroids used for controlling your seronegative RA? Or current or past use of Methotrexate?

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.

Hello,

Welcome back to icliniq.com.

I reviewed all tests you uploaded (attachment removed to protect patient identity).

It was expected to have raised liver enzymes when one has an operation in the vicinity. But they usually come within normal in subsequent weeks. This would not be the cause of your current liver enzyme derangements. You do not need to rush anywhere with this liver enzyme pattern; you just need to get the relevant workup, and things are going to be fine very soon once we make a diagnosis and start you on some targeted treatment.

Since it is very difficult to establish a diagnosis just based on liver function tests, it requires more than that; that is why I am unable to offer you any specific treatment right now. But anyway, these are not an alarming elevation of liver enzymes, which are usually those in the range of thousands, which are the ones that require urgent hospital referral and potential admission.

I hope this helps.

Thank you.