What Does This Liver Function Test Result Indicate?

Question : I just got back my blood work and my ALT is 202 as of 6/2- on 4/8 it was 132.. BOTH well above the average of 0-40..

I am experiencing extreme diarrhea, fatigue, and nausea for the last 10 days, and historically, in the last 6 months, have had 3 other "attacks".. (which is why I had repeated bloodwork)

I have a colonoscopy and endoscopy scheduled for next Friday- my personal opinion is that neither are going to show or address my problems. It seems that my liver is the problem and that I need to stop drinking- currently, the only thing that "dulls" my symptoms is a drink- which my gastro specialist has told me is OK to continue drinking ( I am not sure why this would be his suggestion, I thought for sure that he would say STOP drinking).. My question is should I change gastro specialists and what is my next steps to getting better? Based on my blood tests, it seems- to me- I need to stop drinking, and that a colonoscopy and endo is not going to find anything- except put money in the pocket of my gastro..
i have access to my HEPATIC FUNCTION PANEL results, let me know if you want me to send them to you.

Hello Dr.R.K!

Thanks for your help and assistance. I will stop drinking! I will upload my hepatic function panel results, which include the past results of the test.
I have had a bunch of other blood work completed on 6/2, basically the same tests as on 4/8, and the only thing that are also above normal are results from my Lipid Panel (which I have listed below the results) and on 6/2- Ferritin- 529 (normal range of 30 - 400 ng/mL). I have also had stool samples taken, but not gotten back results yet.

LIPID PANEL RESULTS FROM 4/8/2015
Cholesterol 295 (100 - 199 mg/dL normal range)      
Triglycerides            245 (30 - 150 mg/dL normal)
HDL      40 - 59 mg/dL      54
CHOL/HDL RATIO            5.5
LDL Calculated            192
Non HDL Chol. (LDL+VLDL) 241

In response to your other questions:

1. How many episodes of diarrhea per day?- approx. 5-6, sometimes more, sometimes less-In the morning I start with 2-3 episodes, usually occurring within first two hours of awakening. I do not eat breakfast, and usually don't eat lunch, because I usually have extreme diarrhea within an hour of eating anything. Sometimes though, in the evening, I feel better after eating and don't have a bowel movement- until later that night (see your question 4)

2. Small quantity or large quantity stool? small quantity of stool usually. If I have a big meal I usually have 3 or more trips to the bathroom (I am not eating every much though, as I am tired of the diarrhea and would rather be hungry then constantly in the bathroom.)

3. Blood or mucus in stool? No blood in stool, but mucus is present

4. Does diarrhea wake you up fro sleep? Yes, I usually wake up to extreme cramps and need to evacuate around 3 am, especially if I have a big meal and haven't had a bowel movement. In the last 10 days this has occurred 5 or 6 times

5. Any weight loss? Actually no. I am thinking that is (was) because of alcohol consumption. Also- I weighed 195lbs on 1/15 of this year, then gained 30 lbs in the month of February and March- the only time I did not have any symptoms. It appeared that I was back to normal in terms of symptoms pretty much gone, and I had regained my appetite (but in a big way..) . I will confess that I do not weigh myself regularly, but I have been trying to loose the extra 30 lbs since April, but have not really lost any weight.. Again, I contribute it to drinking alcohol- and have not really cut back on it as it seemed to slow my symptoms.

6. Any other medical illness? None. Prior to this condition, I rarely went to the doctor- usually for a Sinus infection or a Cold, but am pretty healthy otherwise.


I am also going to upload a timeline of my "issues" and an overview of my symptoms. I created this prior to my gastro appointment on 6/2, so it does reflect events after the visit, but none of the issues have stopped.
So, Hopefully this information helps.. But here are my questions:

1. should I keep the colonoscopy and endoscopy appointment for this Friday?
2. The only thing that has helped with my symptoms has been alcohol- and to your point, I need to stop drinking. The only other thing I have been taking has been pepto bismol, but I was told to stop that because of my upcoming colonoscopy.. I am afraid I will be very sick this week- AND not sure if I will have answers after Friday, so I will have been dealing with this for the last 10 days, now longer. What should I do? Is their some medication(s) that will help?

Thank you for your insights, it corresponds to what I am also thinking!

I have stopped all drinking. Regarding your advice:



1. Yes go ahead with upper GI endoscopy and colonoscopy. Insist your gastro doc to do a biopsy if relevant.

I will be going ahead with these tests. Today is the Prep day. Fun!! LOL

2. Get tested for common malabsorption sydromes and also get a stool test done.

I did get back results for malabsorption syndromes- It showed that I had a lot of allergies,but I went to an allergest who did the prick testing and said that my food allergies were not the issue.. I also got back results from stool tests- I think I had like 4 done- all came back as negative/normal..

Take probiotics.
I am currently (well, not today..) taking Align Probiotic- have been for a couple weeks- not really noticed any improvement, but am told it could take 4-6 weeks..

Take a course of the antibiotic Rifaxamin.
I googled Rifaxamin; it sounds interesting and will speak to the gastro doing my endoscopy and colonoscopy about it. thanks for the advice.

Lets wait for the endoscopy reports.

Ok! Will do!

Hello!

I am uploading my endo and colonoscopy results from Friday. Briefly- I had one polyp removed from colon, and one from esophagus- both biopsied. Also, from EGD, he found erythematous mucosa in the antrum, so he requested I repeat EGD in 8 weeks.

He prescribed 3 drugs:
omeprazole 40 mg -daily
hyoscyamine .125 - 1-2 tabs SL q 4 hrs PRN
Xifaxan 550 mg- 3x day for 2 weeks

I have picked and begun taking 2 of the 3 prescriptions. I have not picked up the Xifaxan- Even with a coupon for $500 off, it has a copay of $682. I know you recommended it too- I have an email into my Gastro who I have visited to ask if the Xifaxan is worth spending the money for- if it was more reasonably priced I wouldn't question it, but my (narrow) internet research says that it might be a good option if I have IBS-D, but I don't believe that I have been diagnosed with that yet from my gastro (I don't believe I have been diagnosed with ANYTHING by my gastro-) he has not said that I was, at least. None of the stool or blood results correlate to IBS-D.

But it maybe because I am not a doctor, and my gastro HAS NOT REVIEWED ANY of the test results with me.. YOU have been more helpful to date then him- so, thanks!

Also- this weekend I have continued to not drink, tried to eat per your directions- small meals through out the day. My stool has decreased in terms of frequency to 2-3 times a day and does NOT appear to me to be the definition of diarrhea (meaning, I have not had an urgent need to vacate), but stool is still loose and I still have fatigue and am still nauseous after eating. I have NOT been woken in the middle of the night for bowel movement either. I understand that it has only been 3 days, but am somewhat concerned that the next scheduled visit with my gastro is in 8 weeks- and isn't a Dr Visit, it's an EGD-

I will also admit that after my procedure on Friday, the doctor talked to me, and I appeared to be coherent, but I wasn't, as I don't remember the conversation- My support person thought I was coherent, so they unfortunately did not really listen to the conversation. : (

I am going to call the gastro's office next to see if I can get more information about Friday's conversation..

Let me know what you make of my reports and your opinion on the worthiness of Xifaxan, and if you have any insight as to how I can overcome the fatigue and nauseousness that I can't seem to overcome.

Thanks! Troy

Hi Dr. RK!

I combined all three stool test results and uploaded them. I should have biopsy reports back late this week or early next. Except for what I noted before, all other test came back negative or within normal ranges...

Thanks for your opinion about the Rifaximin- I am going to hold off, as you suggested. I am resigned to giving my system a little bit of time to "self correct"- I think the "not drinking" is going to really help; I just got into a spiral with self medicating with alcohol that I shouldn't have done.

I also went to my gastro's office today to talk to them. It turns out that my gastro s out of town until 7/1, but I am awaiting a call from his peer to discuss whatever I missed on Friday : ( So, again, thanks for your advice, it has been really helpful so far!!

Let me know if you have any other questions or insight!

Thanks again! Troy