Question: I had an MRCP/MRI performed two days ago for complaints of nausea, vomiting, severe epigastric pain, and weight loss (10 lbs in one week). symptoms began abruptly more than two weeks ago. The worse of the symptoms have gotten better and aren't constant anymore (severe n/v and worst epigastric pain for three days consistent, with ZERO relief. I wasn't even able to walk around much without retching and or vomiting); now, I will have smaller "episodes" that do eventually get better, only to return. I have some yellowing in my eyes, though it hasn't gotten any worse.
My bloodwork last week reveled elevated liver funtion tests (ALT = 962 u/l; AST = 887 u/l; ALP 209 u/l, Total Bilirubin 2.7 mg/dl; Lipase 69 u/l) all other blood work was 'within normal limits', all test results on CBC were 'within normal limits', as well. I have never had levels anywhere near that high on CMP ever. This is highly unusual for me. An abdominal ultrasound performed that same day revealed a constricted gallbladder and no other findings. I had fasted. The problem was thought to be my gallbladder because of the symptoms; An MRCP was ordered the following week to better confirm theory. The symptoms remained.
Two days ago, the MRCP report came back normal, gallbladder unremarkable. The only thing the MRCP revealed is as follows:
"there is a relative distention of the descending and transverse limbs of the duodenum to the level of the superior mesenteric artery, distal to which the duodenum is decompressed."
"IMPRESSION:
1) unremarkable biliary tree and gallbladder
2) Findings raising the possibility of superior mesenteric artery syndrome. "

Yesterday, my doctor wasn't in clinic so he had his nurse call me. She told me the MRCP was "normal" but the doctor wanted to rerun the CMP bloodwork. She mentioned nothing about the SMAS. I went and had blood drawn yesterday; however, I haven't received those results yet; today is now Saturday and Monday is a holiday. I assume if there was something clinically significant, there is emergency protocol in place to contact the patient, regardless of whether or not the ordering doctor is available. I avoid visiting the ER at all costs and probably should have gone several times. My question is, given the elevated LFT's, MRCP findings, symptoms, etc., do you feel this warrants immediate attention? physically, I feel terrible and I'm so hungry all the time; though, I'm uneasy about eating. My urine started being dark last week and has remained dark each time I urinate, and the UA revealed 2+ bilirubin and high specific gravity. Should I go to the ER, although I HATE the ER and have many anxieties about going to the ER? Does this require immediate attention?

I don't feel the elevated lft is due to medications or hep. I'm not on any new meds or dose increases, and I was immunized with the exception of HEPC. The CBC was normal; no white blood cells. I have routine blood work every few months and nothing like this has ever presented. I should have my latest CMP results by Tuesday. Can I wait until Tuesday? How urgent i the SMAS? Again, I DO NOT like the Emergency Room; but, I obviously don't want to die. . .also, the abdonimal ultrasound showed liver was normal, and MRCP showed normal liver, as well.
is there a possibility that a gallbladder obstruction may have passed through to my bile duct and now appears as SMAS, or aggravates the SMAS?
I also have a gastric ulcer, as seen on endoscopy.