Wife Had Intermittent Jaundice For A Year. Blood Results Show Elevated ALT, AST, GGT. Any Advice

Posted on Mon, 2 Jul 2012

Question: Hello, My wife is from Nepal and has had intermittent jaundice for at least the last year. This presents as only yellowing of the eyes and no changes in skin colour have been noticed. She has no pain or sensitivity anywhere in the abdomen but the edge of her liver can be felt when examined. She has had no fever, no nausea and no other symptoms we have noted at all.

We have had a full blood count, liver function test and c reactive protein results come today but we will not be able to see the doctor now for review for around 2 and a half weeks so seeking this advice.

The blood results which are abnormal are as follows.

AST 32 U/L (Normal<30)
ALT 34 U/L (Normal<30)
GGT 36 U/L (Normal<30)
Alkaline Phosphatase 211 U/L (Normal20-105)

All other results fall within normal limits.

My wife has had hepatitis B and C screening both of which were Negative.

Thanks in advance,
XXXXXXX

Answered by Dr. Ketan Vagholkar (1 hour later)

Dear XXXXXXX

Thanks for the query.

From your history all the liver function tests appear to be normal.

I would like to know if the bilirubin levels are normal. I would also wish to know whether or not an ultrasound abdomen was done. If not, I would suggest you to get an it done just to rule out gall stone disease and evaluate the status of other abdominal organs like the liver and pancreas.

1. If the bilirubin level happens to be normal, then it is might be a case of xanthochromia wherein the sclera appears to be yellow simulating jaundice.
2. If the ultrasound abdomen happens to be normal then it can be related to your diet. If she is consuming too much of flavinoids in the diet then it can cause yellowish pigmentation.

I hope my explanation serves as a road map for the treatment of your wife. Let me know if there is any other concern.

With Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ketan Vagholkar (4 hours later)

XXXXXXX Dr Vagholkar.
Thank you for your initial response, the bilirubin levels were

11 (Normal<15)

but on the day of the test the yellow in the eyes was not visible.

you said the liver values were normal? is the elevated alkaline phosphatase nothing to worry about?

Also she does experience some pain or discomfort in her eyes when the yellow colour is present.

She has never drunk alcohol or taken an drugs.

No we have not yet done an ultrasound as my wife is not eligible for any free healthcare in Australia so already just to have the initial consultation and blood work done has cost us $400...an ultrasound is around another $300 and then a specialist free to review the report etc etc.

Answered by Dr. Ketan Vagholkar (2 hours later)

Hi XXXXXXX
I can understand your problem. Since the alkaline phosphatase is raised I have advised your wife to undergo ultrasound examination. This is for stones because stones can cause raised alkaline phospatase as well as cause waxing and waning of jaundice. The other information which USG can give is the status of the liver.
Since the bilirubin is within normal limits now, you need not worry .
If everything is normal, watch out for thyroid dysfunction which can give rise to such problems. Since your wife hails from Nepal which is endemic for thyroid and RBC problems (polycythaemia) get TSH (thuroid stimulating hormone leels), thyroxine levels (T4 levels) and tri-iodothyronine levels done. Get her eyes checked by a ophthalmologist to be on the safer side,

With Regards

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Above answer was peer-reviewed by : Dr. Aparna Kohli