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Gall bladder stones removed, elevated LFTs, persisting pain after surgery

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32 year old female, 120 pounds, 5 ft 3 in tall. No history of other diseases. Do not drink or smoke. I had my gallbladder removed approximately 2 months ago( I was also 6 weeks postpartum from second child born vaginally), found stones and chronic cholecystitis. LFTs were highly elevated when I was admitted. For the first two weeks after the surgery, had difficulty eating, nausea and some pain reminiscent of the gallbladder pain though not as severe. MRCP was normal and those symptoms have improved. LFTs have come down but AST and ALT are still slightly elevated. Not sure of the exact number but less than 2 times normal. CBC, celiac, hepatitis, anemia tests all normal. Also ruled out wilsons I believe. Currently experiencing moderate RUQ pain that is different from what I experienced with the gallbladder. Pain is more XXXXXXX tenderness and there is an area of tenderness when touched on my abdomen near the site of the gallbladder. This pain increases when the colon is full and gas feels like it gets trapped in the ascending colon for a period of time. No nausea, no fever, no vomiting. Alternate between normal bowel movements, a couple of days of constipation that ends with a day of normal bowel movement followed by diarrhea emptying everything out. GI doc suspects IBS and is more concerned about continuing LFT elevation. Surgeon suggests adhesions and seems totally unconcerned with liver numbers. Any other ideas or tests I should request?
Posted Wed, 18 Apr 2012 in Digestion and Bowels
Answered by Dr. Poorna Chandra K.S 34 hours later

Thanks for the query.

Pain in the Right Upper Quadrant following cholecystectomy (postcholecystectomy syndrome) is usually secondary to
1) Unrelated causes like Gastritis, Peptic Ulcer Disease

2) Retained Common Bile Duct stone - unlikely as MRCP is normal

3) Sphincter of Oddi dysfunction - The sphincter present at the junction of Common Bile Duct and duodenum is spastic and does not relax during meal causing symptoms. Diagnosis is difficult as a dilated CBD may be found only during the pain and is associated with liver enzyme elevation.

The elevated enzymes in your case may suggest the above or a condition called Nonalcoholic Steatohepatitis as all other common causes of enzyme elevation have been ruled out.

This may be evident on an Ultrasound of the abdomen and the pattern of enzyme elevation.

Hope your concern is addressed. In case of any doubts, I am available for the follow ups.

Above answer was peer-reviewed by
Follow-up: Gall bladder stones removed, elevated LFTs, persisting pain after surgery 31 hours later
I had an abdominal ultrasound when I was in the ER. Would you expect there to be some evidence of XXXXXXX there or do they need to be looking for it specifically? GI doc mentioned possibility of liver biopsy if elevations continue..would you? Would you recommend any other imaging or testing before invasive biopsy?
Answered by Dr. Poorna Chandra K.S 42 hours later

Thanks for writing again.

The ultrasound correlate of XXXXXXX (Non-alcoholic Steatohepatitis) is a bright liver.

Liver biopsy is a tool to look at the cause and extent of liver inflammation that is employed once the noninvasive tests have failed to point towards a source.

One has to test for autoimmune hepatitis markers like XXXXXXX (Anti Nuclear Antibody), SMA (Smooth muscle Antibody), LKM (Liver Kidney Microsome) and probable iron overload also.

It is also advisable to get a HBV DNA (Hepatitis B Virus- Deoxy Ribo Nucleic Acid) and HCV RNA (Hepatitis C Virus- Ribo Nucleic Acid) tested before going to liver biopsy.

I hope this answers your query.

Wish you good health.

Above answer was peer-reviewed by
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