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Having back pain. History of IBS. Concerned about elevated ALT, AST and bilirubin levels. Chances of cancer?

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Practicing since : 2002
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Wondering about cancer and statistics at my age
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?
Posted Mon, 21 May 2012 in Liver and Gall Bladder
Answered by Dr. Robert Galamaga 2 hours later
Hello and thank you for submitting your question.

Your question is a good one and I will work on providing you with some information and recommendations.

First of all I want to tell you that I am not concerned that we are dealing with any type of cancer at this point. You have very slight changes in your liver function tests which do not represent anything life-threatening.

The best way to approach the Laboratory findings in this setting would be to repeat the lab in about eight weeks. There are a few things which can cause mild elevations of these liver tests. This includes taking any excessive amounts of medications which contain Tylenol. In addition any significant consumption of alcohol on a daily or regular basis can also cause elevations of these liver tests.

One other possibility which may contribute to these findings would be if there was any evidence of gall stones. These tiny stones can sometimes cause a slight blockage of the flow of the bile through the liver and into the intestines. If you have symptoms of abdominal pain particularly on the right side this might be an indication to have an ultrasound performed to assess for any problems with your gallbladder. if that is not the case then I would simply follow this with a repeat laboratory test in about two months.

Thank you again for submitting your question. I hope you have found my response to be helpful and informative. If you have any additional concerns I would be happy to address them.


Dr. Robert
Above answer was peer-reviewed by
Follow-up: Having back pain. History of IBS. Concerned about elevated ALT, AST and bilirubin levels. Chances of cancer? 52 minutes later
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.
Answered by Dr. Robert Galamaga 21 hours later
Hello and thank you for your follow-up question any additional information you have provided.

Again I am not concerned if you have any type of worrisome problem or any type of cancer going on. There is actually a syndrome called Gilberts disease which is a benign and very common condition in the general population. In patients who have this particular type of syndrome the bilirubin level is often very mildly elevated. It does not put you at risk for anything worrisome at all in the future and it is something that will just be part of your medical record. No need to do any additional testing along the lines of the bilirubin outside of the normal schedule of screening laboratory tests.

The only other possible screening test that might be of benefit would be an ultrasound of the liver. Sometimes that particular enzyme the AST can be elevated if there is some fatty infiltration of the liver. This can sometimes happen if a patient is overweight or if a patient consumes a moderate or excessive amount of alcohol and in some patients there is no obvious cause. I think it would not be unreasonable for you to have an ultrasound of the liver as well just to complete the entire comprehensive workup which you have already performed.

Regarding the pain other than musculoskeletal causes such as a type muscle or possibly a bulging disc in your back the only other thing which comes to mind would be a tiny kidney stone. A kidney stone can often cause pain in the mid or low back. This pain tends to radiate also into the scrotum however. Sometimes it might cause some degree of blood in the urine. Your symptoms do not sound very suspicious for a kidney stone but it is just something else which I am considering on your behalf.

Once again it appears that you're very healthy and and I do not see anything significant that is threatening your general health. As far as the blood work I think another test in 6 to 12 months would be reasonable and possibly an ultrasound of the liver at some point. This is not something that needs to be done immediately.

I thank you again for submitting your question. If you have any additional points to discuss I would be happy to address those here with you.


Dr. Robert
Above answer was peer-reviewed by
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