Hello and thanks for your query.

Regarding these two medications, neither of them are notorious for causing this level of hepatitis. They have, however, been associated with some degree of pancreatitis,

It would be theoretically possible that you may have developed some degree of pancreatitis which led to the hepatitis.

In order to understand this completely, a thorough laboratory and imaging workup would need to be done and I am sure your physicians are working on that.

If you have a chance to scan your lab reports or imaging reports I would be happy to review them.

You have a feature to upload the reports / image by yourself at the right side of the query page, please utilize that so that I can answer your queries better.

With the AST and ALT elevated significantly it fits more of a picture of cellular injury to the liver. The liver is a very resilient organ so I am confident that yours will recover fine with no long term detriment.

I would be very interested to know what an ultrasound or CT scan of the abdomen would show in your case.

Withdrawing the medication is certainly indicated until the complete workup is finished.

I assume you had testing to rule out viral hepatitis as well such as Hepatitis A, B or C.

I also assume there is no history of alcohol abuse etc.

The increasing abdominal girth with nausea and fluid retention is quite concerning as well. I am interested to know who you will be seeing next to continue this workup.

I thank you again for submitting your qiery and I look forward to receiving more information from you regarding your tests and progress to this point.

I hope we will be able to provide you with an informative and helpful experience.

Regards,

Dr. Galamaga

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Thank you for submitting your follow-up question.

I am sorry to see that you are having a tough time maintaining compliance with the celiac diet. This is absolutely 100% something that you need to try to work on in the future. Maintaining the adequate diet for management of celiac disease will prevent significant progression and a lot of the medical problems which can develop from patient to have issues with this long term illness.

It is possible that maybe the celiac disease is contributing to some of the symptoms you are experiencing. I think there are a couple of specialists which would behoove you to visit in order to follow up on your current symptoms. The first specialist would be a gastroenterologist. This is a physician who deals with patient to have celiac disease on a regular basis. They also focused attention on the liver and can help you understand if there is any significant problem that needs to be addressed along those lines.

As far as the edema is concerned this could be addressed by either an XXXXXXX medicine specialist or a nephrologist. There are laboratory studies which can be performed to see if there is a concern regarding your kidney function and maintaining fluid balance.

It is certainly possible that some of your symptoms may be related to uncontrolled celiac disease. I encourage you strongly to consider adhering to a strict diet related to the celiac disease to see how this helps you in the next several days or several weeks. I'm confident that if you are able to maintain this diet you may in fact to see some good interval improvement.

I thank you again for submitting your question. I appreciate the follow up information you provided as well. If you have any additional concerns regarding this question please do not hesitate to ask.

Regards,

Dr. Galamaga

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