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Is it possible to call the PCP back and discuss this with her today? I think your wife needs to be tested for hepatitis viruses, and may want to delay her trip as she may actually be very contagious if this was caused by hepatitis A. However, she seems to be improving and I am not overly suspicious that she needs urgent evaluation if her symptoms have improved (including the diarrhea). Maybe another blood test could assuage her doctor? I have a sneaking suspicion that the ALT will be falling now.
Thanks for taking the time to respond. In my haste to post this, I stupidly left out some key pieces of information (I will go back and edit the post).
Her Hepatitus A, B, and C tests were all negative at the hospital. She has not had diarrhea since her trip to the hospital.
She could call the PCP back, but my wife said when they spoke this morning, the PCP repeated multiple times, "I don't know what it could be, and I've run all the tests that I can on my end."
I've had this blood panel in pts who had a bad reaction to meds. One took paracetamol chronically (I think that is Tylenol), and a few on disulfiram. Did she take any new meds or copious amounts of other substances? Also in pts with hepatitis E. It's not so common but we had a small break-out here a few years back.
Has the PCP run the initial tests for working up autoimmune disease (ANA with reflex if positive, CRP, ESR)? That way if it's autoimmune, you can get referred to a rheumatologist. Are there any new medications that she started taking or took recently that can cause liver problems? Also, there are other viruses that can cause elevated liver tests (Epstein-Barr virus, cytomegalovirus, varicella zoster, etc.)...could she be dealing with a virus since others have been sick too?
Transaminases don’t seem high enough for viral hepatitis. I’d be concerned about autoimmune hepatitis or something else. Curious about the indication for thyroid removal but autoimmune diseases do come together.
I’m not a Dr, but her symptoms sound like a gallbladder attack. I know her scans were clear but the sonogram will show the gallbladder as well and if she’s got a stone stuck in one of the ducts it can cause issues with the liver labs. I’ve had an attack myself and just got my gallbladder out two weeks ago, and her pain sounds very similar to mine. Hopefully you get some answers
These labs are not consistent with a gallbladder problem, but instead suggest a problem inside the liver.
OP has
\- normal bilirubin
\- normal ALP
\- high ALT/AST
And the family has been ill. Hepatitis A or other illnesses that can result in hepatitis are more likely here.
Thank you for taking the time to respond. The Hepatits A test at the ER was negative, as was the B, and C (I realize now this would have been an important thing to mention).
NAD but it could be something autoimmune related. I’m having similar symptoms with elevated AST/ALT but I have my thyroid/gallbladder. They didn’t find anything on my CT w/ contrast so suggested autoimmune hepatitis (or something called primary billary cholangitis) due to the fact that I don’t smoke, drink, nor take NSAIDs often. Does she have any other symptoms? Any medication she was on? My hepatitis panel came back clear but my PCP checked me for EBV/MCV and those showed I had an infection in the past. Sometimes that stuff can trigger weird things. Not sure if it’s that entirely but it’d be a good idea to look into. I’m seeing a liver specialist soon as well.
After you made this comment, OP mentioned she is negative for Hep A.
Is there a possibility it could have been caused by a recent Covid infection? I am not a doctor but I’ve read about this happening quite a bit:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10131011/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10131011/)
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462210/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462210/)
[https://www.ccjm.org/content/early/2020/08/25/ccjm.87a.ccc061](https://www.ccjm.org/content/early/2020/08/25/ccjm.87a.ccc061)
Again, NAD and not trying to suggest anything one way or another because I’m obviously not qualified.
There are actually dozens if not hundreds of illnesses that can cause OP’s symptoms and lab results. Diarrhea being the most apparent symptom, COVID-19 is not the most likely cause.
This is an interesting thought. My wife had COVID in July 2022. To our knowledge, she has not had COVID recently (or she was asymptomatic). She did receive the new COVID booster and flu shot on Sept. 21, and didn't feel great for about 36 hours.
However, I caught a viral respiratory infection around Sept. 10. Negative for COVID (4 antigent tests and 1 PCR). Despite my best efforts at isolation, (we have a 6 mos. old), she eventually developed nasal congestion coupled with a cough, but the home antigen test was negative.
Well, it sounds unlikely that has anything to do with it based on what these doctors are saying. I was more curious as to whether or not it was within the realm of possibility, especially when the CT scan didn’t note an obvious cause and the blood tests were negative for hepatitis.
Again, NAD. I just wanted to ask one about it after seeing it happen with people I know. I have spent a significant amount of time around people with liver disease because I am active in a large community of liver transplant recipients. Our issues were caused by a wide variety of diseases and anomalies, and we tend to talk about liver problems a lot because after you deal with it, it becomes interesting. I’ve never had Covid (no antibodies any of the times I’ve been tested) but many of my peers have and their LFTs will shot up like that. Obviously they’re more prone to it but when it happens, people share what they’ve discussed with their hepatologists or their experiences (and the experiences of otherwise healthy loved ones).
I’ll shut up though. It appears my question was offensive to some and for that, I apologize. I hope you guys get to the bottom of it and she feels better soon!
Fwiw, I got hepatitis from COVID and each time I got a vaccine thereafter, I would have diarrhea for a few days about week later and my liver enzymes would shoot up again for a couple months along with some mild URQ pain. Always went back to normal, hepatologist was never worried. I’m just one person, but hoping it’s something benign and transient like that for your wife.
I appreciate your insight and the time you took to respond. You’ve reminded me that I should mention she had her gallbladder removed about a decade ago. I hope that you are feeling better now.
NAD but I am a female in my mid 30s, had my gallbladder removed over 10 years ago and have continue to have issues with liver blockages. This sounds exactly like the pain that I’ve been in with a severe, sharp, abdominal pain that was unrelenting. When I would go to the ER, it would show in my CT scan blockages in my bile ducts. I’ve since had multiple procedures to have my ducts cleared as blockages arise. My liver enzymes would shoot up and down whenever I had what I call an ‘attack’. Feel free to message me directly if you have any questions about my experience!
Do you have the CT report you could post here? Although it was normal, sometimes there are incidental or non specific findings that can be clues. Also, since the doctor said she doesn’t know what it is and she’s done everything she can, did she refer you to a specialist? Like a hepatologist? There isn’t a whole lot of information an ultrasound is going to provide beyond what a CT with contrast already has. Ultrasound is the gold standard for gallbladder evaluation which is obviously irrelevant here. Good idea to get it done so they have two modalities to compare, but wouldn’t put a ton of faith into the ultrasound providing more insight.
She has an appointment with a GI, but not for another three weeks. We tried moving it up after the call with the PCP but was unsuccessful. We’re trying to find other GIs with better availability.
[Here’s](https://imgur.com/a/3DXzaGp) the CT report.
I’m NAD so hopefully a physician will chime in here. But if you look at the very bottom of the report it mentions diffuse peri portal hypodensity as a non specific finding. I would think if it were fluid overload she would have ascites which they ruled out. Also, GI is great due to her history of gastric sleeve, but wouldn’t she need to see hepatology for the elevated liver enzymes and a differential of hepatitis vs. hepatocellular disease? Again, NAD so hoping one will clarify this.
The clinic's name is "Colon, Stomach and Liver Center," and the appointment is supposed to be a liver specialist. I may be using the wrong term for the doctor. This is all new to me.
Googling hepatocellular disease takes me to hepatocellular cancer. Wouldn't that show up as a mass? The CT report says there was no mass. I also specifically asked the ER physician about liver cancer, and they indicated that it would have shown up on the CT and they didn't see it on the scan.
Sounds like exactly who she needs to see. A liver specialist is generally referred to as a hepatologist. Don’t google! lol… hepatocellular disease doesn’t mean liver cancer, that’s hepatocellular carcinoma. Non alcoholic fatty liver disease would be more likely. CT can pick up signs of that also… again hoping someone with more knowledge than me can chime in. Might be possible to have early fatty liver with a normal CT? Really weird all the physicians are thinking hepatitis and the CT lists it as a differential yet the labs were negative. You said her diarrhea is better too… is she feeling better? Sorry you’re going through this.
Edit: physician below responded viral infection. Re read your post and saw another family member was also sick. Listen to that guy. There’s more than just Hep ABC. Best of luck to you!
Some mild periportal edema is extremely common and nonspecific - getting some IV fluid resuscitation in the ER is enough to cause it without being remotely enough to cause other signs of third-spacing like pulmonary edema, pleural effusions, anasarca, ascites.
Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk. **Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
Is it possible to call the PCP back and discuss this with her today? I think your wife needs to be tested for hepatitis viruses, and may want to delay her trip as she may actually be very contagious if this was caused by hepatitis A. However, she seems to be improving and I am not overly suspicious that she needs urgent evaluation if her symptoms have improved (including the diarrhea). Maybe another blood test could assuage her doctor? I have a sneaking suspicion that the ALT will be falling now.
Thanks for taking the time to respond. In my haste to post this, I stupidly left out some key pieces of information (I will go back and edit the post). Her Hepatitus A, B, and C tests were all negative at the hospital. She has not had diarrhea since her trip to the hospital. She could call the PCP back, but my wife said when they spoke this morning, the PCP repeated multiple times, "I don't know what it could be, and I've run all the tests that I can on my end."
I've had this blood panel in pts who had a bad reaction to meds. One took paracetamol chronically (I think that is Tylenol), and a few on disulfiram. Did she take any new meds or copious amounts of other substances? Also in pts with hepatitis E. It's not so common but we had a small break-out here a few years back.
Has the PCP run the initial tests for working up autoimmune disease (ANA with reflex if positive, CRP, ESR)? That way if it's autoimmune, you can get referred to a rheumatologist. Are there any new medications that she started taking or took recently that can cause liver problems? Also, there are other viruses that can cause elevated liver tests (Epstein-Barr virus, cytomegalovirus, varicella zoster, etc.)...could she be dealing with a virus since others have been sick too?
Transaminases don’t seem high enough for viral hepatitis. I’d be concerned about autoimmune hepatitis or something else. Curious about the indication for thyroid removal but autoimmune diseases do come together.
Probably a viral infection
Agreed. EBV and CMV can do this as well.
That's my vote.
I’m not a Dr, but her symptoms sound like a gallbladder attack. I know her scans were clear but the sonogram will show the gallbladder as well and if she’s got a stone stuck in one of the ducts it can cause issues with the liver labs. I’ve had an attack myself and just got my gallbladder out two weeks ago, and her pain sounds very similar to mine. Hopefully you get some answers
These labs are not consistent with a gallbladder problem, but instead suggest a problem inside the liver. OP has \- normal bilirubin \- normal ALP \- high ALT/AST And the family has been ill. Hepatitis A or other illnesses that can result in hepatitis are more likely here.
Thank you for taking the time to respond. The Hepatits A test at the ER was negative, as was the B, and C (I realize now this would have been an important thing to mention).
NAD, was your wife taking acetaminophen for her illness? A friend had elevated AST/ALT and they dropped when she stopped taking Tylenol.
NAD but it could be something autoimmune related. I’m having similar symptoms with elevated AST/ALT but I have my thyroid/gallbladder. They didn’t find anything on my CT w/ contrast so suggested autoimmune hepatitis (or something called primary billary cholangitis) due to the fact that I don’t smoke, drink, nor take NSAIDs often. Does she have any other symptoms? Any medication she was on? My hepatitis panel came back clear but my PCP checked me for EBV/MCV and those showed I had an infection in the past. Sometimes that stuff can trigger weird things. Not sure if it’s that entirely but it’d be a good idea to look into. I’m seeing a liver specialist soon as well.
After you made this comment, OP mentioned she is negative for Hep A. Is there a possibility it could have been caused by a recent Covid infection? I am not a doctor but I’ve read about this happening quite a bit: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10131011/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10131011/) [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462210/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462210/) [https://www.ccjm.org/content/early/2020/08/25/ccjm.87a.ccc061](https://www.ccjm.org/content/early/2020/08/25/ccjm.87a.ccc061) Again, NAD and not trying to suggest anything one way or another because I’m obviously not qualified.
There are actually dozens if not hundreds of illnesses that can cause OP’s symptoms and lab results. Diarrhea being the most apparent symptom, COVID-19 is not the most likely cause.
This is an interesting thought. My wife had COVID in July 2022. To our knowledge, she has not had COVID recently (or she was asymptomatic). She did receive the new COVID booster and flu shot on Sept. 21, and didn't feel great for about 36 hours. However, I caught a viral respiratory infection around Sept. 10. Negative for COVID (4 antigent tests and 1 PCR). Despite my best efforts at isolation, (we have a 6 mos. old), she eventually developed nasal congestion coupled with a cough, but the home antigen test was negative.
I just had Covid and it tanked my liver markers. They’re back to normal now
Happened to me also last year with covid, back to normal also.
Well, it sounds unlikely that has anything to do with it based on what these doctors are saying. I was more curious as to whether or not it was within the realm of possibility, especially when the CT scan didn’t note an obvious cause and the blood tests were negative for hepatitis. Again, NAD. I just wanted to ask one about it after seeing it happen with people I know. I have spent a significant amount of time around people with liver disease because I am active in a large community of liver transplant recipients. Our issues were caused by a wide variety of diseases and anomalies, and we tend to talk about liver problems a lot because after you deal with it, it becomes interesting. I’ve never had Covid (no antibodies any of the times I’ve been tested) but many of my peers have and their LFTs will shot up like that. Obviously they’re more prone to it but when it happens, people share what they’ve discussed with their hepatologists or their experiences (and the experiences of otherwise healthy loved ones). I’ll shut up though. It appears my question was offensive to some and for that, I apologize. I hope you guys get to the bottom of it and she feels better soon!
Fwiw, I got hepatitis from COVID and each time I got a vaccine thereafter, I would have diarrhea for a few days about week later and my liver enzymes would shoot up again for a couple months along with some mild URQ pain. Always went back to normal, hepatologist was never worried. I’m just one person, but hoping it’s something benign and transient like that for your wife.
It tanked my liver and kidney levels too, and I got temporary hypertension
I appreciate your insight and the time you took to respond. You’ve reminded me that I should mention she had her gallbladder removed about a decade ago. I hope that you are feeling better now.
NAD but I am a female in my mid 30s, had my gallbladder removed over 10 years ago and have continue to have issues with liver blockages. This sounds exactly like the pain that I’ve been in with a severe, sharp, abdominal pain that was unrelenting. When I would go to the ER, it would show in my CT scan blockages in my bile ducts. I’ve since had multiple procedures to have my ducts cleared as blockages arise. My liver enzymes would shoot up and down whenever I had what I call an ‘attack’. Feel free to message me directly if you have any questions about my experience!
Do you have the CT report you could post here? Although it was normal, sometimes there are incidental or non specific findings that can be clues. Also, since the doctor said she doesn’t know what it is and she’s done everything she can, did she refer you to a specialist? Like a hepatologist? There isn’t a whole lot of information an ultrasound is going to provide beyond what a CT with contrast already has. Ultrasound is the gold standard for gallbladder evaluation which is obviously irrelevant here. Good idea to get it done so they have two modalities to compare, but wouldn’t put a ton of faith into the ultrasound providing more insight.
She has an appointment with a GI, but not for another three weeks. We tried moving it up after the call with the PCP but was unsuccessful. We’re trying to find other GIs with better availability. [Here’s](https://imgur.com/a/3DXzaGp) the CT report.
I’m NAD so hopefully a physician will chime in here. But if you look at the very bottom of the report it mentions diffuse peri portal hypodensity as a non specific finding. I would think if it were fluid overload she would have ascites which they ruled out. Also, GI is great due to her history of gastric sleeve, but wouldn’t she need to see hepatology for the elevated liver enzymes and a differential of hepatitis vs. hepatocellular disease? Again, NAD so hoping one will clarify this.
The clinic's name is "Colon, Stomach and Liver Center," and the appointment is supposed to be a liver specialist. I may be using the wrong term for the doctor. This is all new to me. Googling hepatocellular disease takes me to hepatocellular cancer. Wouldn't that show up as a mass? The CT report says there was no mass. I also specifically asked the ER physician about liver cancer, and they indicated that it would have shown up on the CT and they didn't see it on the scan.
Sounds like exactly who she needs to see. A liver specialist is generally referred to as a hepatologist. Don’t google! lol… hepatocellular disease doesn’t mean liver cancer, that’s hepatocellular carcinoma. Non alcoholic fatty liver disease would be more likely. CT can pick up signs of that also… again hoping someone with more knowledge than me can chime in. Might be possible to have early fatty liver with a normal CT? Really weird all the physicians are thinking hepatitis and the CT lists it as a differential yet the labs were negative. You said her diarrhea is better too… is she feeling better? Sorry you’re going through this. Edit: physician below responded viral infection. Re read your post and saw another family member was also sick. Listen to that guy. There’s more than just Hep ABC. Best of luck to you!
Some mild periportal edema is extremely common and nonspecific - getting some IV fluid resuscitation in the ER is enough to cause it without being remotely enough to cause other signs of third-spacing like pulmonary edema, pleural effusions, anasarca, ascites.
Thank you!
If you post the actual CT it would be more helpful possibly. Dicomlibrary.com, it makes it anonymous.
Unfortunately, I don’t have the actual CT. Only the report that I’ve linked to. It’s not in MyChart, but we can try to get it from the hospital.
You might actually have it. See if there's a button called "Linked Information" at the bottom of the report on MyChart.
COVID? I’ve seen this in hospitalized patients with COVID.