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Elevated liver enzyme. Pressure at right of abdomen, dizzy. Ultrasound, hepatitis, blood tests done. Reason and is liver biopsy required?

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Gastroenterologist, Surgical
Practicing since : 1989
Answered : 883 Questions
Hi Doctor, I am a male of 32 years old. I have elevated liver enzymes for already some time (seen in the blood tests for more than 2 years ago and still present). The doctor at the hospital wants to do a liver biopsy if these elevations remain (By now ALT was around 200). He wanted me to lose weight, and then take a blood test again. I lost some weight and started to do more exercise, and the liver enzymes dropped. (ALT : around 100 u/L) Also I felt better and some symptoms disappeared. However I should take a new blood test after some time again which I did not do because I am rather afraid of this biopsy and wanted to see if I could improve my situation by living healthy and do some exercise. I also had an ultrasound, were all seemed normal. No signs of cholostasis (I think this is blockage of gallbladder ducts) However, lately I again get symptoms that indicate that something is wrong. Those symptoms are sometimes mild pressure at the right side of the abdomen, just under the lower ribs, as if something is blocked or inflamed. Sometimes I feel also a bit dizzy, and not clear in the head. Another thing is a bit darkened skin under the eyes. And a general feeling of not feeling very well. Another symptom is that I have often (dark) XXXXXXX stools, which are fluffy, or thin. I can give you also the results of the latest blood test. I was also tested for hepatitis at my normal physician, where it showed negative, but I don't know if this could be still the case. I would like to get some opinion or advice concerning what disease I might have, what to do about it and what the risks are of liver biopsy. I don't have an alcohol problem, I drink very little since already 2 years. I weigh around 86 kg and measure 1m81. Thanks in advance XXXXXXX Results latest blood test: Bilirubine total : 0,60 mg/dl Bilirubine direct: 0,21 mg/dl Bilirubine indirect : 0,39 mg/dl AST : 39,0 IU/l ALT: 110 IU/l Gamma-GT: 138 IU/l LDH : 384 IU/l Lipase: 44 IU/l Kidneys: Ureum: 38 mg/dl Creatinine: 1,21 mg/dl GFR: > 60 ml/min Total Protein: 7,6 g/dl CRP (inflamm. /auto-immune) : 0,11 mg/dl Lipides: Triglycerides 81 mg/dl Total cholesterol 194 mg/dl HDL-cholesterol 78 mg/dl LDL-cholesterol 99 mg/dl Ratio Tot. HDL chol. 2.48 mg/dl Results for hematology were normal
Posted Tue, 22 May 2012 in Liver and Gall Bladder
Answered by Dr. Ketan Vagholkar 12 hours later

From your history and reports you do not seem to be having any problem. I fail to understand why a liver biopsy is being considered in your case.

I would suggest you to just undergo a good USG (Ultrasonography) evaluation. If that is normal then a good balanced diet set by a dietician and regular exercise. Continue with this and then get a liver function test after 6 weeks.

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