Brief Answer:
Possible alcoholic hepatitis.

Detailed Answer:
Hello and welcome,

Yes, all of the symptoms you mentioned can be related to her liver being inflamed from alcohol. Those liver enzymes are quite high. The best way to detox her liver is for her to detox from alcohol, if that is what is causing the liver enzyme elevation. It may take a couple of months to see the liver enzymes decrease significantly once she has quit drinking.

An angry liver can cause nausea and abdominal pain, and can radiate pain to the right shoulder in particular.

It sounds as though she is rather ill, most likely with alcoholic hepatitis, and she should have further evaluation to assess the severity, such as with coagulation studies and bilirubin level. If these are abnormal, she may need corticosteroids to decrease the inflammation. If these and other blood tests are normal, and she can tolerate food, she should take a B vitamin complex. If her diarrhea or abdominal pain is severe, she may need to be off food right now, and have IV fluids plus certain vitamin Bs.

If she has drunk heavily for a long time, the issue won't be only how to detox her liver now, but how to stay off all alcohol to prevent further inflammation in the future. So a program for abstinence may be necessary.

I am basing my recommendations on that you wrote that she has been a heavy drinking. There are other causes for hepatitis too (pancreatic, viral), but if there has been alcohol abuse, usually there is no need to look further. A blood test called C-reactive protein is a good indicator of if alcohol is the cause of this problem.

I think if she is quite ill plus she has very high liver enzymes, further evaluation is needed right now.

If you would like more information, here is a good article that may help too: http://emedicine.medscape.com/article/170539-overview

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Brief Answer:
Can't rotate the uploaded lab reports to read them.

Detailed Answer:
Unfortunately the images came out upside down, and sideways. I don't have a mechanism to rotate these here. Could you please try to repost the labs?

Thanks.

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Brief Answer:
Further evaluation and recommendations.

Detailed Answer:
I took a look at the 2 sheets of lab reports.

From these it looks like we can rule out pancreatic causes for her elevated liver enzymes. I am saying this because the chemistry panel had a normal lipase level (so not a pancreatic cause).

Her potassium was very slightly decreased, and that might go with losses due to diarrhea.

The ration of AST to ALT is greater than 1, which strongly relates to alcohol abuse.

If she is obese, this can contribute to elevated liver enzymes. And any hepatotoxic medications such as Tylenol (acetaminophen can contribute to this too).

So here is what I would recommend for further evaluation and treatment:
1. Stop ALL use of alcohol. If she has been drinking heavily for a long time, she may need medication help for detox, such as with a benzodiazepine that is gradually decreased once the alcohol is detoxed from her body. This will help prevent agitation and other withdrawal symptoms. This requires medical supervision.

2. To make sure there is no other cause of the very high liver enzymes, the following tests are recommended:
C-reactive protein (elevation is seen in alcohol abuse)
Hepatitis B and C tests (to make sure it is not a viral hepatitis)
Ultrasound (if not absolutely sure the problem is from alcohol abuse, or if her current liver enzymes were a rapid rise from previous liver enzyme tests in the past)
If she has any bruising problems, then get coagulation blood tests

3. Take a B-vitamin complex, or Folate and Thiamine supplements daily.

4. No Tylenol or other medications that are hard on the liver.

5. Acute treatment with glucocorticoid medication (such as Prednisone) and close monitoring if her doctor thinks her general illness is due to alcoholic hepatitis. I cannot tell this without examining her and comparing her current liver enzymes with those of the past.

I think she needs to follow up with her doctor to discuss these recommendations and a plan, including a plan for helping her to detox from alcohol and for follow up with monitoring her symptoms and rechecking her liver enzymes.

I hope this information helps. Please let me know if I can provide further information. Also, I welcome hearing how she is doing after she and her doctor put a plan in place and she has further evaluation.

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