HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

What Do My Liver Test Results Indicate?

Posted on Fri, 5 Jun 2015

Question: Dear Doctor,
I am 32 years old.I was diagnosed with Latent TB (lymphnodes in left side of the neck) last year and my medications started from XXXXXXX 2014.For first two month doctor prescriped R-Cines600, Combutol(1000) and Pyzin(750).Then after doctor I was taking R-Cinex(600) and Mitovit Gold. End of January 2015, my lab test report count showed Neutrophils(diff) 37, Eosinophils(diff) 10, Total bilirubin 4.1 , SGPT 250 and SGOT 218.So, doctor stopped R-Cinex and since past 3 months I am on Combutol, Isoniziad and Mitovit Gold.My latest SGPT and SGOT levels are 140 resp and Neutrophils and Eosinophils are in same range as above.Also, I still feel small Lymphnodes at my neck. Kindly advice what diet should I follow and if I am getting proper treatment and any other test need to be performed.
Thank You,
S.N.

Answered by Dr. Arun (3 hours later)

Brief Answer:
Current treatment are fine, TB PCR can help in better treatment...

Detailed Answer:
Hello XXXX,

Thank you for asking query to healthcare magic. I read and understand your query. I am Dr Arun Tank answering your concern.

Your current treatment are good and should be continued.

Usually TB treatment requires prolong treatment. TB treatment can go up to a year or more in some cases.

So do not discontinue the treatment, Discontinued treatment can cause resistant in the TB bacilli which makes him difficult to treat further.

If you feel that the treatment is not responding properly than you can go for TB PCR testing. This test will detect usual resistant pattern in the bacilli. Treatment taken as per the report will give a good result with treatment.

You can ask me further concern here or you can ask me personally on bit.ly/DrArun.

Thank you
Dr Arun Tank

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

Follow up: Dr. Arun (24 hours later)

Thank you Doctor for your response. I asked my doctor that why my SGOT and bilirubin levels are persistently high for last 3 months and he said that it could be due to Isoniziad.
He has not prescribed any medication to bring those levels down, although I am taking Liv-52 for past 1.5 months.
He adviced me to continue Combutol,Isoniziad and Mitovit gold for next1 month and then will stop their intake for couple months and observe the levels.

Will stopping aggravate TB again .
Do I need to consult a liver specialist? I am tensed.
Thanks, XXXXXXX

Answered by Dr. Arun (11 hours later)

Brief Answer:
Take the alternative drugs...

Detailed Answer:
Thank you for the reply dear.

Liver enzyme alteration are common with the Anti tuberculosis drug.

But it will never be the reason for the change in the drug. There are many alternative drugs available that can be replaced in place of the drugs that is causing the liver enzyme alteration.

Stopping the drug can cause resistance in the TB bacilli which makes the treatment further difficult.

There is no need to consult the liver specialist instead you can take the alternative drugs by asking to your doctor.

There is no need to tense, TB is curable and you can also be TB free with appropriate treatment so do not worry and take the proper treatment.

You can ask me for further concern here or personally on bit.ly/DrArun.

Thank you
Dr Arun Tank

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Arun (3 days later)

Thank you doctor for your advice

Answered by Dr. Arun (5 minutes later)

Brief Answer:
Most Welcome dear...

Detailed Answer:
You are most welcome dear...

You can ask me for further information on bit.ly/DrArun.

Thank you
Dr Arun Tank

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Arun (3 days later)

Hello doctor,
I had posted my case couple of days before and Dr. XXXXXXX had responded.I will summarize my case again.I am 32 years( male) and was on AKT(latent TB with R-Cinex and Mitivit Gold ) for past 10 months(i.e. from June2014). On 27Jan15 my LFT showed Bilirubin 4.1,SGPT 249 and SGOT 218.Doctor stopped medication for two weeks and my LFT results 16feb2015 were Bilirubin 2.9, SGPT 187 and SGOT 136. My Doctor then started medications again with Isoniziad,Combutol and Mitovit gold and on 23Apr15 LFT results were Bilirubin 1.5, SGPT 122 and SGOT 137.He then referred me to Gastroenterologist who asked me to stop TB medications immediately and asked me to do following test(results) as on 25Apr15 ANA-1:320, ceruloplasmin 21.6,ASMA- Negative,LKM1-Negative.He told me that I have AIM which is chronic and asked me to take steroid Tab Omnacortil 10 mg twice a day for 15 days and see him again with LFT results. I have still not taken the tablet and want to wait for 1 month and then check LFT results as I think it is due to Isoniziad. Kindly advice/suggest I am in lot of stress.

Thanks,
XXXX

Answered by Dr. Arun (41 hours later)

Brief Answer:
Start alternate drug therapy for TB..

Detailed Answer:
Hello swant,

Thank you for asking me query.

As I mentioned you in my previous answer. You should not withdraw the TB treatment instead you can take the alternate medication.

Once you withdraw the drug therapy, resistant strain will grow that will make the treatment difficult.

You can visit the nearby TB specialist as prescription of drugs can be given with your body profile. I can not prescribe you here direct without obvious examination.

You can ask me for further query here or you can ask me personally on bit.ly/DrArun.

Thank you
Dr Arun Tank

Above answer was peer-reviewed by : Dr. Pradeep Vitta

Follow up: Dr. Arun (16 hours later)

Thank you doctor for your response. I would definitely take second opinion from a TB specialist.But since my ESR has been normal(~9) for past 3 months, doctor asked to stop all TB medications.

Also,What is your opinion on ANA titer 1:320, do you think this is concern or due to isoniziad?

Kindly refer any TB specialist in XXXXXXX area.
Regards, XXXXXXX

Answered by Dr. Arun (28 hours later)

Brief Answer:
ESR is the nonspecific marker, detail clinical correlation requires.

Detailed Answer:
Thank you for your query dear,

Isoniazid can cause rise in ANA antibodies due to liver injury.

ESR is the nonspecific marker. For erythrocyte sedimentation in blood. Its value depend on many factors. It not only the TB which can cause rise in ESR.

So in my view second opinion of TB specialist can help decide whether you have TB right now and whether the TB treatment is required or not.

Yes rise in ANA antibodies is because of the isoniazid treatment. It is a hepatotoxic drug so it can cause rise in ANA levels. But once you withdraw the drugs it will automatically come to base levels.

You can ask me for further information here or you can ask me on bit.ly/DrArun.

Thank you
Dr Arun Tank
Infectious diseases specialist.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Arun (2 days later)

Hello doctor,

I consulted another TB specialist and through his examination he concurred "STOP AKT". His opinion was different than the Gastroenterologist who said that I have Auto immune hepatitis(AIH) looking at ANA(1:320 homogeneous and nuclealor) reading.

However, he concluded that I have drug induced hepatitis which is Asymptomatic at present.I also asked him that for past 3 month my AST/ALT levels were persistently elevated and if that is a concern.He said that it should reduce after withdrawal of drug and asked me to exericise regularly and check LFT (AST/ALT/Creatinine/Bilirubin) levels after 10 days.Although, Doctor has not given me any medications to reduce these AST/ALT levels.

I hope and pray that these levels return back to normal alongwith ANA readings.

Knndly advice if any further follow up is required.

Thanks,
XXXX

Answered by Dr. Arun (15 minutes later)

Brief Answer:
Stop the drug and do exercise regularly...

Detailed Answer:
Hello XXXX,

Good to see you again.

As your direct examination reveals that you are not suffering from the TB you do not requires any further treatment. You can stop the TB treatment now.

Yes your AST, ALT levles will reduce once you stop the TB treatment.

This are the liver enzymes which released due to liver injury by drugs. Which will reduce after the stoppage of the drug.

In fact there is no drugs that can reduce the enzyme level and it can be reduced with stoppage of the drugs only.

Some ayurvedik preparation available in the market can help you like Liv 52 you can take this under your doctors guidance.

Continue exercise as it can be helpful for the health and liver as well.

You can ask me for further clarification here or personally on bit.ly/DrArun

Thank you.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Arun (7 days later)

Dear Doctor,
Following up with my case, After 20 days of stopping TB medications, I did LFT tests today and results are SGPT 104 and SGOT 86 , Alkaline Phosphatase 196, Bilirubin 1 (direct - 0.6) rest are normal.Recollect that my ANA was 1:320 on 25April2015.

The levels have not returned to baseline, does this confirm that I have AIH as suggested by Gastroenterologist.

I am scared now, as I know that it is chronic disease.

Please advice.

Regards,
XXXX

Answered by Dr. Arun (17 hours later)

Brief Answer:
Please follow gastroenterologists guidance...

Detailed Answer:
Hi dear good to hear you,

Yes, the level of ANA, SGOT, SGPT etc. are worry some.

After the stoppage of the antibiotics for the 20 days it must be reduced.

So we can't deny the possibility of autoimmune hepatitis, you should visit the gastroenterologist and follow their guidance.

You can ask me for further clarification here or on bit.ly/DrArun.

Thank you,

Dr Arun Tank

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

Follow up: Dr. Arun (59 minutes later)

Hi Doctor,
Should I consult a Heptologist or Gastroenterologist?

Thanks, XXXXXXX

Answered by Dr. Arun (21 hours later)

Brief Answer:
Hepatologist is first choice and gastroenterologist is second choice...

Detailed Answer:
Hi XXXXXXX

You can ask to any one of the above specialist.

But preferably you can consult the hepatologist and in second option you can choose gastroenterologist.

You can ask me your further queries.

Thank you
Dr Arun Tank.

Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Shanthi.E