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Blood work showed high ALT and AST levels. How concerning is this? Have back pain and history of IBS, GERD and hiatal hernia

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Gastroenterologist, Surgical
Practicing since : 1984
Answered : 922 Questions
I have had a recent blood work up and had some concerns. My ALT was 93 U/L and my AST 28 U/L. My Alkaline Phosphate is 122 U/L. My Total bilirubin is 2.1 mg/dL and direct bilirubin 0.4

Wondering how concerning this is and if it deserves immediate attention?

I also have been having back pain recent and got me reading about kidney, pancreatic, liver cancer, etc. The pain is not super bad just started about 3 weeks ago. Its on the left side under my rib cage and some times will radiate down into the top of my left glute. So I related this with my blood work got me worried. But I also heard if it was any bad cancer that the pain would be emergency room type pain. Not sure how true that is. Plus someone said I am 34 and young for a lot of types that I mentioned. And that a lot of those levels I mentioned would be extremely high if I had anything bad going on. You would know about that more then me.

I also have a history of IBS-had an upper GI about 5 years ago and said I had a hital hernia and GERD.

I have had 4 sets of blood work over the last 4 years and the bilirubin levels have always been total of 2.1 or 2.2 and direct was 0.4. So over the last 4 years it has been about the same. But the ALT was raised just in the last blood test last August.
Posted Mon, 21 May 2012 in Liver and Gall Bladder
Answered by Dr. Ajit Naniksingh Kukreja 9 hours later

Thanks for posting your query

The details you have provided are appreciable, What I gather from your information is :

1] Your concern for raised S.Bilirubin
2] Recent Rise in S Alkaline Phosphatase
3] Your concern for any major illness
4] IBS
5] Hiatus Hernia & GERD

Let us consider them :

1] Raised Bilirubin for constant four years without any clinical symptoms of liver disease is not alarming for an emergency treatment, but if the Gallbladder ejection is slow it may keep high

Had I been your doctor I would recommend : Avoid fatty and spicy meals, avoid alcohol and take some liver tonic

2] Raised levels of alkaline phospatase suggest obstruction in biliary system, yet I would recommend you get it repeated as it is already 7 months old

3] All these lab reports though on a higher side, do not alarm an emergency treatment nor do they point to any cancers. Your pain in the left side could be more of intestinal origin than a liver origin

4] IBS - This is best managed by taking care of your stress levels and diet management

5] GERD - Take small frequent meals, Wear loose clothes, avoid stooping, do not lift heavy weights, take small frequent meals, and do not eat anything atleast four hours before you go to bed.

Raising the head end of your bed will also help in hiatus hernia
A dose of Proton pump inhibitor with domperidone will help control your GERD Symptoms

Hope this helps
Am available for followup queries
If there are no more doubts do accept my reply and rate it
Get Well Soon
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