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Vomiting, nausea. Done with liver enzyme test. What could be wrong?

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My daughter 's liver enzymes are 3,000 to 4,000. She went to the ER for vomiting and nausea and they have me a copy of her labs and told me to take her to her g.i. Doctor asap. I'm so worried. What could be wrong?
Posted Tue, 23 Apr 2013 in Liver and Gall Bladder
Answered by Dr. Charles S Narasi 44 minutes later

Thanks for your query.

Your daughter has acute Hepatitis, rather severe. I am somewhat concerned that she was not admitted to the hospital unless this was more like an urgent care facility.

The reasons for Hepatitis could be viral.

As you are probably aware there three main types of Hepatitis caused by Type-A, B or C.

Type -A is called the infectious hepatitis because it can be contracted by ingestion of contaminated food.

Nausea and vomiting could be part of the symptoms.

The level of the enzymes suggest that your daughter had been ill for atleast week to ten days when the levels peak. She is probably jaundiced as well.

Type-B can also be in acute form like A. Type-C can be completely asymptomatic and in most cases the acute phase is very mild like as a case of flu.

Acute Type-A hepatitis can in some cases go into liver failure and coma. This happens in only about 5-10% of cases. Most will recover to normalcy.

However Type-B & C hepatitis can go on to a chronic phase where the virus stays active in liver cells and make the liver enzymes to stay abnormal even after six months or more. Eventually this could lead to Cirrhosis and even liver cancer if untreated.

The only other thing that would make the liver enzymes to that high is drug overdose, caused by Acetaminophen or Paracetamol.

Occasional cases of mushroom poisoning can do that.

I hope you will get to take your daughter to the GI specialist who will do appropriate tests and take the necessary steps to prevent severe complications.

I wish her the very best.
Above answer was peer-reviewed by
Follow-up: Vomiting, nausea. Done with liver enzyme test. What could be wrong? 7 days later
Thank you so much for your help. I called her gi doc and she told me to take her to ucla hospital er. They admitted her. Her diagnosis was acute viral hepatitis of unknown etiology and pneumonia. She was very ill and hospitalized for a week. While in the hospital, her liver enzymes dropped significantly each day. However, her lipase creeped up to around 150. That dropped though so they released her and asked me to follow up with her gi doctor here at home in Bakersfield. She also has scphincter of oddi dysfunction (previously diagnosed) and had an ercp last July. She also has celiac disease. She has lost 30 lbs (which isn't terrible because she is very overweight. I'm still concerned because she is eating very little and vomited on the car ride home from hospital.
Answered by Dr. Charles S Narasi 26 minutes later
Hello, XXXXXX,
I am glad that the GI specialist did the right thing by admitting her to the hospital. So long as the liver function tests are improving, that is good news. She should recover completely. As for the elevated lipase levels, it could be part the viral infection which also probably caused pancreatitis.
I am not sure if this was related to sphincter of Oddi dysfunction.
You mention about celiac disease also. Weight loss is from the combination of infection and also perhaps not being on a strict gluten free diet and malabsorption.
She should be on a strict gluten free diet for life pretty much.
People have tried reintroducing small amounts of gluten containing products to see if the immune system can tolerate it, it usually does not work, and there will be flare-ups.
I am sure she will gradually improve. Keep her hydration good and she can have rice products.
I am sure her GI doctor will be sending her for follow-up blood work.
If she gets very frequent gallbladder attacks due to sphincter of Oddi dysfunction, which is documented, by HIDA and CCK scan, then she may benefit from gallbladder surgery, which can be done through laparoscopic approach.
I wish her well.
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