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Detected with gall stones. Blood test done. What are the cause for the high levels?

DOCTOR OF THE MONTH - Jan 2013
Jan 2013
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Internal Medicine Specialist
Practicing since : 2003
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My husband has been detected with Gall Stones (multiple) of aroung 8-13 mm. Also his Toatal bilirubin is 14.5, his SGPT is 1174 IU/L, SGOT is 833 IU/L, Alkaline phosphatase is 221 IU/L. Please let me know what to do in this case as levels are very high. He is a HbD Beta Thal minor. He had jaundice in his childhood 5-6 times. His eyes are always yellowish.
Posted Wed, 25 Jul 2012 in Liver and Gall Bladder
 
 
Answered by Dr. Mayank Bhargava 1 hour later
Hi XXXXXXX

Thanks for posting your query,

1) Your husband is suffering from yellowness of sclera & urine (Jaundice) and now the diagnostic dilemma is whether your husband has jaundice due to HbD beta thallassemia minor or because of liver disease.

2) Kindly mention the following details:
a) Presence / absence of anemia
b) Itching in body
c) Colour of stool
d) Associated symptoms such as fever, vomiting, abdominal pain (Jaundice may
be a part of Cholecystitis)
e) Enlargement of spleen/ liver.

3) Hemoglobin D/beta-thalassemia disease is a more serious disease than hemoglobin D disease (DD). Children/ adults with hemoglobin D/beta-thalassemia inherit one gene for hemoglobin D from one parent and one beta-thalassemia gene from the other parent. The beta-thalassemia gene causes the body to make less than the normal amount of hemoglobin.

4) Hemoglobin D/beta-thalassemia disease causes moderate destruction of the red blood cells. Persons who are affected may have a more severe anemia and the spleen may be enlarged.

5) In hemolytic jaundice (jaundice occurring due to destruction of red blood cells, as in your husband case), serum bilirubin is generally not more than 5mg% and SGOT/ SGPT are <500. While in your case, SGOT/ SGPT are in thousands range with serum bilirubin 14.5 mg%.

6) There is high possibility of gall stones in hemolytic jaundice and Cholelithiasis/ Cholecystitis (inflammation of gall bladder) may cause rise in alkaline phosphatase (normal 20-140 IU/L, in your case it is 221 IU/L). But serum bilirubin wont rise up to 14.5 level and if rise then patient may have fever, itching and white colour stool (kindly mention other features also). In obstructive jaundice, SGOT/ SGPT will not rise up to thousand level and if rise then patient must have history of severe abdominal pain.

7) SGOT/ SGPT rise in thousand level only in 4 condition (schiff liver book):
a) Acute Viral Hepatitis A/ B/ C/ D/ E,
b) Durg induced liver injury,
c) Ischemic Liver disease,
d) Passgae of gall stone in Common bile duct (Possibility in your case, but
associated with severe pain).

8) So there must be some Hepatocellular injury along with the primary disease ( HbD beta thallassemia minor) . As the SGOT/ SGPT are in thousands and serum bilirubin is in 14.5 range then there is high possibility of liver disease also.

9) It may be possible that HbD beta thallassemia minor & liver disease both are contributing the present scenario.

10) You should go for the following blood test: HbsAg, IgM Anti HBc, IgM Anti HAV, IgM Anti HEV, serum cerruloplasmin level, Iron profile to rule out hemochromatosis, liver biopsy, CT/ MRI scan of abdomen.

11) You should also consult with physician/ hematologist & gastroenterologist.

Hope this will solve your query

With wishes of rspid recovery,

Best Regards,

Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
Follow-up: Detected with gall stones. Blood test done. What are the cause for the high levels? 23 hours later

Hi,

Thanks a ton for your reply. He has been tested for Hepatitis C, which was negative. Also, he has been tested for Hepatitis B & C (reports are yet to come).
For your queries, here are the details:

a) Presence / absence of anemia - No (Haemoglocin = 13)
b) Itching in body - No
c) Colour of stool - Normal
d) Associated symptoms such as fever, vomiting, abdominal pain (Jaundice may be a part of Cholecystitis) - No such symptoms, just had some abdominal pain 2 days back. But it is normal now.
e) Enlargement of spleen/ liver - Spleen is enlaged mildly - 124 mm. Liver is not enlarged but shows grade 1 fatty infilteration.

Also I would like to know what are the symptoms related to a) Acute Viral Hepatitis A/ B/ C/ D/ E, b) Durg induced liver injury, c) Ischemic Liver disease, d) Passgae of gall stone in Common bile duct. He does not have any such symptoms in his case. Just a bit fatigued sometimes and 2-3 days back he had some abdominal pain which is fine now.

Also, can the Gall Bladder operation be done with these reports or first these have to come to normal ?
 
 
Answered by Dr. Mayank Bhargava 19 minutes later
Hi XXXXXXX

Thanks for posting details.

1) Normal hemoglobin with almost normal size spleen indicates absence of hemolytic anemia.

2) Absence of fever, itching, normal colour stool indicate absence of obstructive jaundice.

3) Symptoms of A) acute viral hepatitis A/ B/ C/ D/ E, B) Drug induced liver injury, C) Ischemic Liver disease: All these pathology involves liver and patient may have fatigue, weakness, loss of appetite, muscle ache, abdominal pain apart from jaundice.

4) As your husband is suffering from jaundice, his body should be given time to recover little bit, until unless there is some emergency for operation such as Abscess in gall bladder or emphsematous gall bladder. So surgery is not required at this point of time rather try to find out the cause.

Best regards,

Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
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