Abnormal Liver Function Tests: When to Seek Urgent Care

Liver function index exceeds one thousand?

Hello, Doctor: I am a carrier of hepatitis B and have mild fatty liver and gallstones.
My long-term follow-up indices have been normal until the past two years, when they started fluctuating.
The most recent test on January 5 showed AST 342, ALT 357, AFP 1.82, and total bilirubin 0.8, with a normal ultrasound.
On January 13, when I reviewed the report, the doctor mentioned that my liver enzymes had risen again and advised me to immediately check the viral load and retest the other indices.
I have an appointment in two weeks to review the results and was instructed to monitor for any discomfort, jaundice, or edema, and to seek medical attention immediately if any symptoms arise.
Since I have downloaded the National Health Insurance app to view my personal test data, on the 14th, I checked the results and found that the retested data from January 13 showed ALT skyrocketing to 1010, AST 378, which is also higher than a week ago, total bilirubin 0.5, PT 12.2, and PT (INR) 1.13.
Today, the viral load results came back at 5.97e4 IU/ml, compared to the previous viral load of 1.7e3 IU/ml.
Over the past few days, I have been monitoring my physical condition and have not experienced any symptoms, but I still have a week until my outpatient appointment.
Given that my indices are so high, should I seek emergency care early, or is it acceptable to wait until my outpatient appointment next week?

jason, 50~59 year old female. Ask Date: 2021/01/19

Dr. Chen Shidian reply Gastroenterology and Hepatology

You may schedule an earlier follow-up appointment to discuss.

Reply Date: 2021/01/19

More Info

When dealing with abnormal liver function tests, particularly in the context of chronic conditions like hepatitis B and fatty liver, it is crucial to understand the implications of elevated liver enzymes and when to seek urgent medical care. Based on your recent lab results, which show significantly elevated AST (378) and ALT (1010), along with an increase in viral load (5.97e4 IU/ml), it is understandable to feel concerned about your liver health.

Understanding Your Results
1. Liver Enzymes (AST and ALT): The AST and ALT enzymes are indicators of liver cell injury. Normal ranges for ALT are typically between 7-56 U/L, and for AST, they are between 10-40 U/L. Your results indicate a severe elevation, particularly in ALT, which suggests significant liver inflammation or damage.
2. Viral Load: The increase in your hepatitis B viral load from 1.7e3 IU/ml to 5.97e4 IU/ml indicates that the virus is replicating more actively, which can contribute to liver inflammation and damage.

3. Bilirubin Levels: Your total bilirubin level of 0.5 mg/dL is within the normal range, which is reassuring as elevated bilirubin can indicate more severe liver dysfunction or bile duct obstruction.

When to Seek Urgent Care
Given the context of your chronic hepatitis B infection, fatty liver, and gallstones, the following symptoms should prompt immediate medical attention:
- Jaundice: Yellowing of the skin or eyes.

- Severe Abdominal Pain: Especially in the upper right quadrant.

- Swelling: Particularly in the abdomen or legs (edema).

- Confusion or Altered Mental Status: This can indicate hepatic encephalopathy.

- Nausea/Vomiting: Especially if it is persistent and severe.

Recommendations
1. Monitor Symptoms: Since you mentioned that you are not currently experiencing any symptoms, continue to monitor your health closely. However, do not ignore any new or worsening symptoms.

2. Consider Early Evaluation: Given the significant rise in your liver enzymes and viral load, it may be prudent to seek earlier evaluation rather than waiting for your scheduled appointment. If you have access to urgent care or can see your healthcare provider sooner, it would be wise to do so.
3. Follow-Up Testing: Your doctor may recommend additional tests such as a liver ultrasound or a liver biopsy to assess the extent of liver damage and to determine the best course of action regarding antiviral therapy or other interventions.

4. Lifestyle Modifications: While awaiting further evaluation, consider lifestyle changes that can support liver health, such as maintaining a balanced diet, avoiding alcohol, and managing weight.

5. Stay Informed: Keep track of your lab results and any changes in your health status. Having this information readily available can facilitate discussions with your healthcare provider.

Conclusion
In summary, your recent lab results indicate a concerning trend in liver function that warrants close monitoring and potentially earlier intervention. While you may not currently have symptoms, the significant elevation in liver enzymes and viral load suggests that you should consider seeking medical attention sooner rather than later. Your health is paramount, and proactive management is key in preventing further complications related to liver disease.

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