Freaking out over my recent skyrocket in my ALT/AST (Liver Labs)

I am 2 months post op and have NASH and also scarring of my liver (which was found and confirmed during my biopsy when I had my surgery). Pre Op we knew I had NAFLD and NASH, but we didnt know if any scarring had occured yet and we didnt find that out until my surgery. I have had a very fatty and enlarged liver for a while now which was also pressing on my spleen but in all images (CT Scans, MRI's, U/S) my gallbladder looked normal. Due to it showing up normal and looking normal during surgery they left it in. Biopsy showed nothing wrong with my gallbladder and I am on Urso to prevent gallstones.

I have been seeing my PCP every 2 weeks and then lately every 3 weeks to be monitered and also for blood work as my blood parameters were off. Now they are looking better but  now my ALT and AST have went way way way up. I complained the other night I had pretty bad pain where my liver and gallbladder is and he wanted to do blood work before sending me in for an U/S as the pain went away. 

My liver enzymes have been coming down and looking better and better but had blood work done Tuesday and they have rocketed up to higher than they have ever been (ALT and AST) that is. All my other blood work is good and improved and this was improved until this blood draw. Any ideas? I am freaking out and have had pain where my liver and gallbladder is off and on. 

 Here is what they were and have been (My 11/1/10 numbers are pre op):

ALT (Standard is supposed to be under 50) 11/1/10 136, 12/17/10 90, 12/27/10 98, 1/10/11 77, 2/1/11 183

AST (Standard is under 35) 11/1/10 80, 12/17/10 48, 12/27/10 48, 1/10/11 49. 2/1/11 92

I am just really worried with how high it jumped especially since it was improving so much. Would this indicate liver failure? Yes I know I am paranoid about it but cant help it. The only thing that changed during the two blood draws was that I started a lot more vitamins and have now almost worked up to the whole Vitalady schedule.

I am scheduled for an "urgent" U/S of my liver/gallbladder tomorrow at 12:30. They said I couldnt eat or drink for 6 hours prior which is going to be really hard. I dont remember this, do you? So I am going to be worrying and obsessing which I am the Queen of and just want to make sure my liver is not failing as through all this that little percentage of peoples livers who get worse and need a transplant has been my biggest worry. I am scared. Please swing critters and or pray for me. 

Consider prayers on the way.

Gail

Are you seeing a liver specialist? If not, I would suggest asking to be referred to one. You can also ask your doctor if it is okay for you to take milk thistle.

mine got pretty high right after surgery because my liver was working over time metabolizing fat. Do you think it could be that? 

I take milk thistle. It has really helped bring them down. 

Maybe someone else who knows stuff will comment.

Hope this helps.

 So I have been in a lot of pain since last night. I am thinking it might be gas as I have never really had bad gas pains but owwie can gas hurt this much? The pain is above my belly button and no I no longer have my appendix. I felt really awful so they took me a little earlier for my U/S and the tech had WLS and was really nice. She didnt say too much but nothing that made her hold me till she could call the radiologist. So now I am just waiting for him to read it and hear from my PCP. 

I do have a liver specialist who continues to just tell me to lose weight and walk and those will be the things that will take care of my liver. I used to take milk thistle and just bought some along with Vitamin E and Rester something or another I cant remember but its an antioxident that my surgeon told me to try for my liver. So I am going to try and start all those things. I am still trying hard to keep up with Vita Ladys full plan.

I took 2 Gas X (first time I have taken anything for gas since surgery) and while my tummy is rumbly it may feel a little better. Its too soon to say. Anyhow will update when I hear more which hopefully will be soon. Thanks to all *****sponded! 

I also had NASH, which was diagnosed 3 years preop. I had 30% scarring on biopsy examination.
Post DS, my enzymes went up slightly the first 6 months, then have dropped to low normal ever since. I haven't repeated the biopsy, but all my docs & I assume that my liver has fully healed.
Livers usually don't cause pain, imho. If I read correctly, you still have your gallbladder - right? Now that can be painful, and usually flares up postop if not taken out during the DS. This is why so many DS surgeons take it.
Even if it showed ok on ultrasound...they can be tricky boogers.

NASH is very rare - and as you know, the liver is an amazing healer. Try not to worry.
I've rarely seen any1 with NASH post here over the years, and have NEVER seen liver damage as a result of a DS.
I'll be swinging fowl for you!

 Lindy: Thank you so much. Does anyone remember if their numbers went higher than mine are now? I guess I am confused why they went up so much in such a short period of time. 

Here is what my PCP wrote me a little while ago:

Kim,

Your ultrasound didn't show anything worrisome. You still have significant fat infiltration in your liver but this is unchanged from your prior ultrasound and CT. No gallstones or kidney stone. All else looked OK. Very reassuring but doesn't give us an answer for your pain. Next steps would include repeating your CT scan vs. Looking at the GI tract itself since it's so different after your surgery. Obviously if things intensify over the weekend I want you to go to the ER to be safe, but I hope you won't need that.

JMM

I hope you are feeling better.
Seriously, I would suspect gallbladder first, when dealing with pain.
(And he was right to ck kidney stones too. Some of us develop oxylate stones in the first year postop. I did as well. All better now)
It would be interesting if you started a thread asking how many DSers still have theirs. You would be shocked - very very few keep theirs!
The few that don't get them out during the initial DS surgery end up needing them out later.
I don't have numbers to back this up, just 5ish years of reading the boards...

Lindy: According to my U/S nothing is going on. I had a CT scan today which was not fun just to back the U/S up and am waiting to hear the results.

I think the abdomen pain was from gas, but wow I never knew gas pain could be so intense. And I think the side pain that I have had off and on could be from my enlarged fatty liver.

I wanted my gallbladder out but my surgeon said not unless it looked bad during surgery since all my images/labs showed it was in good condition. I am on Urso 3x a day and told that it looks like I will be on that for a long time. Will let you know when I hear about my CT results.

On a happier note my PCP did repeat blood work yesterday and I came home from my CT scan to get an email showing the numbers have already improved. That at least makes me feel somewhat better!