Elevated ALT all other numbers are normal

Additional information: I have had one MRI while I was hospitalized a CT and ultrasound all of which were clean only visualizing a small bike duct dilation. In between now and then I've had weird liver poops that have resolved and look normal now. Should I ask for another MRI? What would they be looking for? The MRI said my liver was unremarkable. Before the hospitalization my ALT was normal I'd just had my physical. Just slightly elevated cholesterol very slightly like 2 points elevated.

Hello there @leonorleans,

I know everyone’s situation is different, but my particular case presented somewhat like yours in regards to the MRI. I had bloodwork (currently my ALT is just one point outside the normal range, but it was on the high end of normal the test before this) and the numbers were perplexing with some in the high range and others in the middle of the normal range.

Because of my elevated numbers, they ordered an MRI, further bloodwork, and genetic testing (due to family history and grandmother’s passing with liver cancer).

My first MRI showed a slight dilation, but upon having another one done at the time I had a liver biopsy, it did not show a dilation. The results came back “near-normal histological appearance. Features suspicious for focal perioductal concentric fibrosis. Features suspicious for mild periportal fibrosis on trichrome stain.”

My bloodwork showed I had a positive FANA (checking for autoimmune disease), I hurt all over and had some unexpected symptoms that were not the norm. The doctors said they were looking to rule out autoimmune hepatitis which was also the reason they wanted a biopsy. They informed me there are some conditions that do not show on an MRI that require a biopsy to diagnose/rule out. In my particular case I ended up diagnosing with primary sclerosing cholangitis (PSC) of the small ducts. I was told the large duct version can show with imaging, but small duct can only be confirmed with a biopsy.

I’ve been referred to many different specialties while they were trying to determine the root cause of my elevated numbers which also included a dietitian (a second referral following my liver disease diagnosis). The strangest part, to me, was my blood sugar level would drop after eating certain foods. My PGP actually sent me to begin this journey via digestive clinic because I was having stomach pain and thought I had non diabetic hypoglycemia. It was the digestive clinic that ran the first set of tests (my hepatic specialist is in their offices so I’m lucky).

My symptoms only appeared when my numbers were at their peak of elevation, joint pain, itching, stomach pain, brain fog, fatigue, altered stools, etc. The endocrinologist suggested a “green Mediterranean diet “ which is more plant forward and I try to stay at 30 grams of fat or less per day which helps keep my symptoms from popping up again.

I am by no means saying you should do anything in particular, but perhaps ask your doctor about other possible liver diseases that could cause an elevated ALT number while others are in the normal range. Again, mine have returned to the upper level of normal for the most part aside from this last visit where it was one point above normal. My hepatic specialist was very helpful and told me what he was hoping to rule out and why (it’s a process for sure).

I wish you the best,

Marissa

I would definitely get the HIDA scan. It shows how well your gall bladder is functioning. Mine was not functioning at all, so I had it removed. Scans that I’ve had done since removal show dilation of bile duct but they have no concerns as this appears to be from removal.
My husband had extremely elevated enzymes after a blood clot, and it ended up being caused by a supplement he was taking for his cholesterol (red yeast rice ). I had done a ton of research and that was the only new thing he had introduced.

Eliminate any supplements and acetaminophen and ibuprofen and retest. Also, there are supplements that you can take to detox your liver. I took one by first phorm (contained lions mane and a few other things) and my enzymes returned to normal.

I'm on vitamin D, low iron, a joint supplement, a collagen supplement, methylated B12, and Lmethylfolate I take these supplements because I also have Pernicious anemia. I don't know if I should just stop them I can't make my own B12. I will ask about the HIDA scan any tips for getting it done or how long it takes?

I should have clarified, I didn’t stop taking everything I normally took, just ones that potentially impact the liver. I take many of those same supplements because I don’t absorb B vitamins and folate.

The HIDA scan can be ordered by your GI or PCP. The scan itself is probably around an hour total. They scan you multiple times over that time period, and then i heft some type of contrast and observe how long it takes your gall bladder to process jr and to what extent it is absorbed. That helps them determine functioning.
Have you had any gall bladder symptoms? I had a lot (nausea, pain in between shoulder blades, general feeling of being unwell, and eventually, couldn’t eat meats or any foods with fat without feeling sick.

On April 28th I was discharged from the hospital after a few days of being admitted. I was admitted because they show the dilation of my bile duct but they couldn't find the stone and as soon as they started giving me antibiotics my number to return to normal. I had my physical a week before that and my liver was functioning beautifully and all my numbers were great except 2pt elevated cholesterol. My nutritionist and I came up with a plan the next day and that was that. On April 25th I went to the hospital after 3 days of on and off mild pain RUQ day 3 it didn't stop and the only symptom I had was pain no fever no nausea no vomiting nothing just a little pain. I was discharged with an ALT of 52. In the last 20smth days my ALT has significantly risen while the rest of my numbers have gone down. It started rising after they put me on augmentin at discharge. NAFLD doesn't develop in that short a period of time. My guess is liver injury or maybe bile is backing up but I think maybe additional tests and scans are needed. I had cancer markers and stuff done bc of the pernicious anemia and it came back petty negative. I'm a carrier and affected by the MTHFR mutation though which hilariously named but it causes me to go through awful stuff. As far a diet goes I have been gluten free and low fat for 2 years. I'll definitely follow up with a doctor but yk it doesn't make sense. My other liver numbers have all returned to perfect. So my ALT is still funky for reasons unknown. No pain no nausea no bloating no constipation appetite is starving because they have me eating 4 small meals a day and I'm always hungry, water intake is 80-100oz of water a day, tiny bit of fatigue, stools have returned to normal, no jaundice, no bloating. It's a mystery to me why my ALT would be acting so funky if I feel what I can only really describe as great minus slight fatigue.

I did on the 25th I went to the ER but was discharged the 28th the MRI showed slight dilation of the bile duct the gallbladder and the liver looked completely normal on all 3 scans ct with contrast, ultrasound, and MRI with contrast. They immediately suggested I get it taken out and I was like feeling way better so I said let me follow up with my doctor's and return home before we do any cutting. As per the pernicious anemia I didn't want to risk infection or slow recovery just yet. I've consistently followed a gallbladder diet for the last 20 something days. I can say right now I never had my pain return. I feel incredible. A lot of my liver symptoms resolved but my ALT is still elevated probably more than it was in the hospital. Otherwise I feel great. I don't take nsaids, and only Tylenol if indicated by my doctor. I did have some flank pain but it turned out to be an injury to the serratus anterior I did get that checked out. My suspicions are liver injury due to the augmentin they put me on, bile is backing up into my liver, or potentially just a continuation of why I went to the hospital and things are still healing. NAFLD doesn't develop this quickly. But I am still following my gluten-free low fat diet which I was already on and exercising every day. Not much else I can do until I can see a gastroenterologist. I'm currently waiting for that appointment and I see a surgeon may 31st to follow up. My biggest concerned about getting surgery is having read other people's stories here and having heard stories from my friends is that a lot of people develop non-alcoholic fatty liver disease after they have their gallbladder removed. I don't want to develop a disease like that. And although maybe it's unlikely. I just want to follow up with all my doctors first to make sure that I'm not high risk or something like that and that getting my gallbladder out is the safest move. I otherwise feel amazing and can't figure out why my liver is being like this. I've had some beef since being discharged but I don't really eat meat. I'm 95% vegetarian. The only reason I don't go completely vegetarian is because the pernicious anemia does not allow me to absorb B12 or iron so sometimes despite eating tons of vegetables beef is the most bioavailable. I receive iron infusions but the numbers have to be really really low. I'm on the low end of normal potentially in the toilet soon but not enough to get an infusion.

Augmentin is such a harsh antibiotic. I always had issues when taking it and flagyl. I’m hoping yours resolves. Our livers are so sensitive. My platelets always go crazy high when I’m inflamed too.

I agree and I recently found out that only a few brands of amoxicillin are actually gluten-free and I'm wondering if the amoxicillin part of the augmentin that I was taking was not gluten-free because immediately after I took it I started getting really sick and we stopped three days early because I contacted my doctor because I was so sick on it. My platelets actually look really good and my white count is really good too. So I'm not sure what's going on right now. I don't think I have another infection. I just think maybe it's either a liver injury from the medicine or my gallbladder still isn't happy, but perhaps that HIDA scan can show more! Thank you so much for all of your advice.

My heart goes out to you. I’ve had some of those issues (I take vitamin B complex and have to take D3 but otherwise that it other than a daily allergy pill for allergic asthma), and I can attest to the fact it takes a while to get a diagnosis when there are comorbidities that complicate your diagnosis. I’m hoping they can find the cause of your symptoms, and truly help you’re able to eat more than what you’re currently able to consume…hangry isn’t any fun :/

Speaking of fun(ny), I like the clever reference to your mutation! Gotta love genetic testing and the acronyms and initials that come from them.

Wishing you a speedy diagnosis and good health!
M