Abnormal Blood and Urine Test Results in Liver Health

Q: Abnormal Blood and Urine Test Results in Liver Health

Hello： 1. <br>For chronic hepatitis B carriers with abnormal liver function, regular follow-up is necessary. <br>2. <br>If there are symptoms of jaundice, such as intermittent high indirect bilirubin, it may sometimes be necessary to check for hemolytic anemia, G6PD deficiency, a

Regarding blood and urine test results?

In the year 2012, a health check-up was conducted, and the results suggested the following follow-up: weight loss (44 kg/160 cm), low white blood cell count, positive urine protein, weakly positive urine ketones, positive urine bilirubin, elevated liver function indices (GPT), elevated total bilirubin, and elevated direct bilirubin.
The patient has a history of being a hepatitis B carrier, and previous check-ups mostly showed no issues.
In February 2013, follow-up blood tests and ultrasound examinations showed the following: no significant replication of liver virus, liver indices decreased but still above the standard (GPT), and persistent jaundice.
The first ultrasound physician noted fatty liver, while the second physician stated it was not fatty liver but showed signs of previous inflammation.
The hepatobiliary department prescribed a liver support medication containing liver hydrolysate, cysteine, choline bitartrate, inositol, and B12.
The internal medicine department suggested treating for possible bladder inflammation (currently not treated as there are no symptoms of frequent urination).
The patient generally feels fatigued, has a fair appetite, and recently experienced mild itching, bloating, or discomfort in the upper abdomen near the chest, but not pain.
The lower limbs have started to cramp frequently.
Blood pressure remains normal, approximately 112 (systolic) / 74 (diastolic) / 91 (pulse rate).
Overall, it appears that there are no urgent issues, but for some reason, liver and gallbladder indices have consistently remained outside the normal range during two to three examinations.
The physician mentioned that during the next check-up, they may test for G6PD deficiency, as the physician seems uncertain about where to start.
I would like to inquire what possible disease symptoms this could indicate? What additional examinations might be necessary? And is there a need for the current medication (could it potentially burden the liver)?

Xiao Shan, 20~29 year old female. Ask Date: 2012/03/22

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello: 1.
For chronic hepatitis B carriers with abnormal liver function, regular follow-up is necessary.
2.
If there are symptoms of jaundice, such as intermittent high indirect bilirubin, it may sometimes be necessary to check for hemolytic anemia, G6PD deficiency, and other conditions.
3.
Proteinuria should be monitored, as a small number of cases of membranous nephropathy are associated with hepatitis B virus infection.
Best wishes, Dr.
Lin Ming-Hui, Taoyuan Hospital, Department of Health.

Reply Date: 2012/03/22

More Info

Understanding abnormal blood and urine test results, especially in the context of liver health, can be quite complex. Based on the information provided, it seems that you have a history of hepatitis B and have been experiencing various symptoms and abnormal test results that warrant further investigation.

Key Findings from Your Test Results
1. Liver Function Tests (LFTs): Your elevated liver enzymes (GPT) and bilirubin levels indicate that there is some degree of liver dysfunction. Elevated GPT (also known as ALT) suggests liver cell injury, which can occur due to various reasons, including viral hepatitis, fatty liver disease, or other liver conditions.

2. Urine Tests: The presence of urine protein, ketones, and bilirubin can indicate several issues. Protein in the urine (proteinuria) can suggest kidney involvement or damage, while ketones may indicate that your body is breaking down fat for energy, possibly due to inadequate carbohydrate intake or uncontrolled diabetes. Bilirubin in urine typically suggests liver dysfunction or bile duct obstruction.

3. Weight Loss and Fatigue: Unintentional weight loss and fatigue can be symptoms of chronic liver disease, among other conditions. These symptoms, combined with your abnormal test results, suggest that your liver may not be functioning optimally.

4. Ultrasound Findings: The conflicting reports from the ultrasound regarding fatty liver versus previous inflammation indicate that there may be some liver changes that need to be monitored. Fatty liver disease is common, especially in individuals with metabolic syndrome or those who consume alcohol.

Potential Conditions to Consider
Given your history of hepatitis B and the current findings, several conditions could be at play:
- Chronic Hepatitis B: Even if the viral load is low, chronic hepatitis can lead to liver inflammation and damage over time.

- Fatty Liver Disease: This can be non-alcoholic fatty liver disease (NAFLD) or alcoholic liver disease, both of which can lead to liver dysfunction.

- Chronic Liver Disease: The combination of your symptoms and test results could indicate a chronic liver condition that requires monitoring and possibly treatment.

Recommended Next Steps
1. Follow-Up Testing: It would be prudent to repeat liver function tests and possibly include additional tests such as hepatitis viral load, liver function tests (including albumin and INR), and imaging studies like an MRI or CT scan if ultrasound findings are inconclusive.

2. Consult a Hepatologist: Given the complexity of your liver health, a specialist in liver diseases can provide more tailored advice and management options.

3. Monitor Symptoms: Keep track of any new or worsening symptoms, such as abdominal pain, jaundice (yellowing of the skin or eyes), or changes in appetite.

4. Medication Review: Discuss with your healthcare provider the necessity of any medications you are currently taking, especially those that may affect liver function. Some medications can indeed put additional strain on the liver.

5. Lifestyle Modifications: If you have not already, consider dietary changes, regular exercise, and avoiding alcohol, as these can significantly impact liver health.

Conclusion
Your situation requires careful monitoring and possibly further investigation to determine the underlying cause of your symptoms and abnormal test results. While your current liver function tests and symptoms may not indicate an immediate crisis, they do suggest that ongoing evaluation and management are essential to prevent potential complications. Always consult with your healthcare provider for personalized medical advice and treatment options.

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