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What Causes Elevated Liver Enzymes?

Posted on Sat, 18 Oct 2014

Question: hello, my daughter went to ER with fever 103.1, severe headache, mild stomach pains and very weak. did blood workup (said everything was normal), treated for dehydration, hydrocodone 250mg for headache and offered but, my daughter refused, lorazepam. Their diagnosis was stress? Returned to ER 3 1/2 days later with same symptoms and throwing up. They did a blood workup. treated her for dehydration and fever. Lab results showed her liver enzymes had increased since first ER visit. Her d-dimer was positive. They did a CT of brain and chest, it showed nothing. They did an ultrasound of her abdomen and another CT. both showed nothing. Tested for Hep (got no results) and sent her home and she was told to have labs done again and see her primary doctor in 2 days. With no primary doctor, her results were sent to her OB which set her up with internal medicine. 5 days later she was seen by internal medicine, still having a headache, stomach pains but not throwing up and fever hovering at about 101.2. She was told that her liver enzymes were 6 to 7 times higher than normal. Internal med's sent her for to labs for repeats and additional workups, and another CT from top of her head to her pelvic bone, she was told to come back again in 7 days. 4 days later she got a letter in the mail stating her liver enzymes had come down a bit, she was now 4 & 5 times higher than normal, She now has blood in her urine, Her HEP test's were negative and she is to return on that 7th day to discuss treatment options? Her fever is still going up and down with Ibuprofen to treat it. she is very tired and her stomach is still bothering her from rib cage to pelvic bone. This whole time her WBC was only slightly elevated. Could you tell me what is causing all of this? What could they be talking about when they say treatment options?

Answered by Dr. Divakara (4 hours later)

Brief Answer:
Mostly its Infection of Liver

Detailed Answer:
Hi

Greetings from Dr.Divakara.P
Thanks for posting your query.

All her symptoms points towards Infection of liver (Hepatitis) . But what causes Hepatitis needs to be evaluated. Hepatitis is most commonly caused due to Viral infection or Bacterial infection. I know tests have come negative but I don't think they have done all the test. So I want you to upload the reports of all the test done so that I can go through it and advise what other investigation needs to be done.
Regarding treatment options your doctors may provide Antibiotics , Anti virals , Hepatoprotective medications. If there was continued deterioration then even Liver transplant was an option but you have said her liver enzymes have improved a little. So she doesn't need any transplant but certain medications is required.

Kindly revert back with reports.

Regards.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Divakara (2 days later)

Hello,

I am trying to get the medical reports uploaded. the system is not working. If i have to i will attempt to enter all the information manually. The doctor has suggested my daughter see a general surgeon. They want to take out her spleen and appendix?

Answered by Dr. Divakara (39 minutes later)

Brief Answer:
No thats not rational.

Detailed Answer:
Hi

I dont think Appendix can cause her Liver enzymes to raise. So no way Appendix is related here.

Spleen can be involved secondary to liver problem but removing spleen will not make her any better.

What possibility is there may be pus collection in or near the liver which needs to be drained out . This drainage is usually done by the surgeons so they might have referred to surgeon. Don't worry. Take Surgeon's consult and revert back to me.

In the mean time try to upload the reports.

Any clarification feel free to ask.
Happy to help you.

Regards.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Divakara (2 days later)

Hello,

I have attempted to upload photos of the medical/lab reports. Are you able to see them?

Answered by Dr. Divakara (5 hours later)

Brief Answer:
NO

Detailed Answer:
Hi

Very sorry , no reports seen .

If you find difficulties with uploading reports, you can mail it to YYYY@YYYY with subject as "Attn: Dr. Divakara"

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Divakara (22 hours later)

I was able to send the photos in an email tonight. I hope you are able to know which files are for this case. They do say XXXXXXX XXXXXX on them. My email is YYYY@YYYY

Answered by Dr. Divakara (4 hours later)

Brief Answer:
Got your mail.

Detailed Answer:
HI

Thanks for the follow up .

I got your mail . Went through the attachment .

The findings noted in the reports are :

1. Splenic Enlargement .
2. Several Enlarged Lymph nodes in the Right Lower quadrant-- Probable Mesenteric Lymphadenitis.

First I will tell you what does Mesenteric Lymphadenitis mean . There are certain node like structures called Lymph nodes in body , everybody has them . Their function is to clean the blood . But whenever there is some infection near their area they become swollen . That Swelling is called Lymphadenitis. Lymphadenitis occuring in the abdomen is called Mesenteric Lymphadenitis.

So Mesenteric Lymphadenitis along with Splenic Enlargement means there is some infection in the abdomen and that infection needs to be found out . The reason why they are referring to Surgeon is they might be planning to do a biopsy of those Lymph nodes enlarged . That biopsy has to be done by Surgeon . Once biopsy is done and analysed it shall give a clue to what is causing all these problems . They will not take out spleen . Don't worry .

Hope this answers your query .

If any clarifications feel free to ask .
Happy to answer .

Regards.

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Yogesh D