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Developed Heartburn, Back Pain And Vomiting. Related To ETOH, Hepatitis A Or Food Poisoning?

Posted on Mon, 29 Apr 2013

Question: I am a healthy 54 y.o. Female. Had labs one year ago.
AST and ALT were 14 & 15. Bilirubin 0.3. Last Wed. I developed exvruciating heartburn and back pain. Vomiting, too. I went to my PCP. Labs were AST 950. ALT 475. Bilirubin 1.4. I drink approx. 4 to 6 gkasses of wine in a week. Could this be ETOH related, Hepatitis A or food poisoning? I ama nurse and got my results before my PCP. What is the next step? PCP has not contacted me. I have had these results since Friday. XXXXXX

Answered by Dr. Grzegorz Stanko (26 minutes later)

Hello!

Thank you for the query.

Your symptoms seem to be caused by gallstones in the gallbladder or bile ducts. Especially if your urine is darker and stool is lighter, bile ducts obstruction seems very possible.
Acute pancreatitis caused by alcohol intake is also possible and symptoms usually are similar to gallstones symptoms. Some other tests should be done to either confirm or rule out this conditions.
You should visit your doctor(as soon as possible, as bile ducts obstruction or acute pancreatitis can be urgent) and have GGTP, AP, amylase, urine amylase checked and abdominal ultrasound performed.
If bile ducts are with stones, ERCP procedure should be done to cure it.
Hepatitis A or food poisoning would rather give nausea, vomiting and diarrhea at first.
If all this diseases will be ruled out, peptic ulcers should be also considered.

Hope this will help. Feel free to ask further questions.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Grzegorz Stanko (2 hours later)

Thank you. As far as pancreatitis: my Amylase and Lipase were normal, as was the Alk Phos. A GGTP was not done. If this is alcohol related, is it reversable by limiting or stopping alcohol altogether? I think I would miss my social wine, but could live without it, if I had to. If this was alcohol related, wouldn't my lab #'s have been high last year...can they just shoot up that high, if it is alcohol and the were "low normal" a year ago? I hope it is gallstones, that would be the better of all the other possibilities.
Thank you!

Answered by Dr. Grzegorz Stanko (12 hours later)

Hello!

In my opinion it is not alcohol related. Regular alcohol intake rather causes slow liver degeneration and liver tests would be rising slowly. So your lab tests from last year should be at least slightly above the norm.
Alcohol intake does not give acute pains, moreover it does not give pains at all (except pancreatitis).
So I`m almost sure you do suffer from gallstones. I suggest you to avoid alcohol as it irritates gallbladder until you wont get diagnosis. You should also avoid fatty foods and fried foods.
GGTP is very sensitive marker of bile ducts obstruction and should be done at your case. And so is ultrasound.

Hope this will help.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Grzegorz Stanko (2 days later)

Thank you, Dr. Stanko. I saw my PCP today. I am going for an Ultrasound of my GB on Monday, that's the earliest I can be scheduled! He is fairly sure it is gallstones, like you said. I hope it is nothing worse. I will let you know the outcome, if that's okay. Appreciate your help. XXXXXX

Answered by Dr. Grzegorz Stanko (6 hours later)

Hello!

Good to hear that. I`m looking forward to hearing from you.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Grzegorz Stanko (4 days later)

Hi Dr. Stanko. I had my US today. It shows, multiple gallstones, as you said. All my organs were WNL. Thank you for your help and good advice. I am seeing my PCP on Wednesday. Can these be managed by diet? Or is surgery inevitable?

Thanks again,
XXXXXX

Answered by Dr. Grzegorz Stanko (28 minutes later)

Hello!

Unfortunately it can not be treated with specific diet and surgery is the only option. Some doctors can advise you with Chenodeoxycholic acid supplementation (collected from bears liver in China) but this does not give desired effect.
Moreover, if the stones are small, migration to the bile ducts is possible what can cause acute pancreatitis.
That is why I suggest you to visit general surgeon and get scheduled for the surgery.
Gallbladder surgery is usually performed with laparoscopy. This surgery leaves only tiny scars, and does not cause many pain after it. Usually it takes up to 3 days in the hospital. So it does not sound bad at all.
And get vaccinated against HBV before this surgery.

Hope this will help.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Grzegorz Stanko (54 minutes later)

Thanks. I have had the HBV, years ago. Labs showed immunity, recently. Per US, the stones are "multiple, subcentimeter and mobile". I suspect my PCP will agree with you. I am in Philadelphia, PA. Are you able to make any suggestions, as far as surgeons? If not, I understand. You have been extremely helpful, already!

XXXXXX

Answered by Dr. Grzegorz Stanko (11 hours later)

Hello!

My suggestion is to do not wait with the surgery. The sooner the better. Before the surgery you should keep diet. Avoid spicy foods, fatty foods, fried foods and alcohol. Nothing else comes to my mind so far.

Hope this will help.
Regards.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar