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Gastric pain after delivery. Found multiple gb calculi, elevated SGPT and SGOT level. Surgery needed?

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My wife had severe pain&gas trouble on the 04th, and took her to the hospital. Lft test showed high sgot&sgpt values(sgot 700,sgpt 550) all other values were normal. The ultrasoundscan on the same day reported multiple GB caculi. Antibiotic started and We moved to the next better hospital next day. The endoscopy on 06th showed no stones in bile duct, and reported cholithiasis and no ercp was done, but doct advised keyhole surgery for gall bladder removal. We got worried and requested to postpone the surgery. On 08th doc advices for repeat LFT and this time SGOT came down to 74 and SGPT came down little to be at 500, all other values remained normal(even bilirubin) . Doct also adviced to take hepatites a&e tests. Now we are stuck on further steps.

Is gallstone causing high values of sgpt/sgot?
How did sgot came down drastic and sgpt very little?
Should we proceed with surgery?
Wife is 60 days after delivery, can we postpone the surgery for 1 more month?
Is liver having different issue than galstone?
I have attached my reports for doctor review
Posted Sun, 3 Mar 2013 in Liver and Gall Bladder
Answered by Dr. Abhijit Deshmukh 1 hour later
Well, there are 2 possibilities
1) Gall stone which has passed from CBD
2) Viral hepatitis
SGOT > SGPT and very rapid reduction of SGOT does not favor viral hepatitis while persistent elevation of SGPT goes against passed stone.
Worthwhile getting a Doppler of hepatic veins done to look for blockages.
Also get hepatitis A and E viruses tested.
Do not rush in for surgery before the cause is ascertained and SGPT has settled.
Exclude Budd Chiari syndrome (though unlikely ) by Doppler as mentioned above.
Hope this answers your query.
Wish her a speedy recovery.
Above answer was peer-reviewed by
Follow-up: Gastric pain after delivery. Found multiple gb calculi, elevated SGPT and SGOT level. Surgery needed? 8 hours later
Thanks doctor.

Now, few more clarification/updates

1) hearing from others that the ultrasound scan should say about the size of stones in GB, but our report does not say anything about it. Should we ask for repeat test?

2) wife had all tests before delivery , and we could see that her LFT was normal in last November. During pregnancy she had itching and doc said possibility of liver issues, but tests did not revelead anything.

3) while results has some reasons to rule out hepatitis or stone passage in CBD, could drugs used during pregnancy or after delivery a cause? She took lactation medicines after delivery and the delivery was induced pain.

4) if we delay the surgery, what diet is suggested for better functioning? Hearing XXXXXXX juice is good ....

5) should we repeat LFT / Scan at regular intervals before the surgery to know about the progress?

We are waiting for hepatitis a&e tests results which will come tomorrow. We will also check with doctor for Doppler test. Other than this should we ask our doctor any specific questions?
Answered by Dr. Abhijit Deshmukh 9 hours later
Thank you for the query,

1) No generally size of stone does not matter.
2) Unlikely that the present problem is related to the pregnancy problem
3) Unlikely that the past medications could have caused it. Is she currently taking any of medications? But pain at onset of symptoms, is unusual in drug induced liver disease
4) No specific instruction. Only that avoid high fatty meals. XXXXXXX juice I am not sure but I really don't think.
5) LFT can be repeated. But scan is not needed.
6) Well doppler is likely to be normal (as she has no water in stomach ). But just to rule out a rare cause.

Wish her a speedy recovery...
Above answer was peer-reviewed by
Follow-up: Gastric pain after delivery. Found multiple gb calculi, elevated SGPT and SGOT level. Surgery needed? 3 hours later
Thanks doctor.

No, she currently stopped all her medicines. She had taken Ayurvedic medicine in addition to allopathy for lactation. But for few days.

Meanwhile her hepatitis A E test results came and is negative.

One point missing in my uploaded reports was the normal ranges in LFT; those are different because done at 2 labs. In the latest report, Alkaline Phosphatase=135(range:30-120) is outside the range(30-120). The previous value of the same was 228 but the range then was 80-306. An increasing alkaline Phosphatase a concern?

Since doctor might want to compare each values in report, I am uploading the LFT reports again with normal ranges as in the report. We do not know if bile/ protien is increasing / decreasing.

When do u suggest a repeat LFT test?

If an endoscopy repeat is suggested , is it harmful taking within 2 weeks time?

Removing gall blader may be the final solution of stone presence, but what are its after effects in future? Will digestion be normal? Will have to avoid fatty foods ?

How severe her liver damage is? Is it curable if stone is not the cause? Is gastro the department for liver disease diagnosis? Should we consult a different specialist?

Thank you very much for your time.

Answered by Dr. Abhijit Deshmukh 3 hours later
thank you for the query,
1) Alkaline phosphate reports are normal minor variation in its level is not to worry
2) All the reports uploaded by you are EUS reports only, dont worry about bile or protein variation
3) i think she should take an weekly LFT
4) No point taking a repeat endoscopy if in doubt or if asked to repeat better to do an mrcp this time
5) dont have any specific side effects of cholecystectomy on digestion, it will be normal no dietary restriction post that
6) her liver is having inflammation no permanant damage (look like). Curability depends on cause next LFT report will definitely tell us the improvement / worsening. Gastro is correct department. Looks like you can continue your follow up with a medical gastroenterologist
Hope this answers your queries.
Best wishes
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