Elevated Liver Enzymes

I am 18 months post op and until recently had zero complications. I have went from 280 to 123 and maintained my protein and vitamin levels. Now all of a sudden my liver enzymes are 10 times normal and i feel awful. Constant nausea with occasional vomiting, no appetite, and right upper abd discomfort. Had an EGJ and they dilated the exiit from my pouch from 12mm to 15mm withno relief in symptoms (this is when they found the elevated liver enzymes). Now surgeon is talking about and ERCP and liver biopsy next week if my labs do not improve. Had gallbladder removed few years pre RNY. Does anyone know if this is a common complication? It is frustrating for me, but after reading posts here, it soundslike I have been one of the lucky ones.

I am sorry you are having this issues. I am almost three years out with no complications until September with a internal herina with scar tissue wrapped so tight around my intestines. The surgery was open because of this issue. I don't have an answer for what you are going through but work with your doctors. They probably have seen this before. My doctor didn't touch me and knew what the problems was; I am sure it was because he had seem it so many times. Trust God that He will allow your doctors to do the best for you. He did me! Please keep us updated. Chin UP Ms. Splenda

Are they going to do an ERCP or an MRCP? ERCP is harder after gastric bypass. MRCP is an MRI that checks for stones in the bile ducts. My liver enzymes have been elevated since about 9 months post-op. They fluctuate. They were very high (one over 300) when I was hospitalized with chest pains in June. The pains ended up being esophagael spasms from my vitamin tablets. Whoda thunk that? Anyway, they came down and all but 1 were normal for a stretch then they have moved back up a bit. But I was taking 1000 mg of milk thistle a day to help (it can cleanse the liver) and ran out of the one bottle and took 2 capsules of the new one and just found out they are a much weaker dose. I've upped the dose to the original amount and we'll see if it improves. My doc wanted me to get a liver biopsy but I was just diagnosed with breast cancer this week so that's first on the agenda, me thinks. Most of the folks that I know that have elevated liver enzymes have no symptoms like me. Just crazy labs. Some have found that milk thistle helps. Some have gone on to have liver biopsies which showed nothing wrong. I've had the CT scan and ultrasound months back and nada. And one gal said her doctor thought it to be the high intake of vitamins so he played around with what she was taking and her labs dramatically improved. Good luck to you! Kathy

Hey, I had this same surgery done end of October. This is not common, but my gastric doc here in CA, said he saw another case like mine, but her LFT's are not elevated. Losing the weight fast, your body makes the stones in some people and I had my gallbladder out 12 years ago or more, and so the stones went to the bile duct. They went in to do the lap exploratory and the ERCP doc is the best in the world, that other ERCP docs have sent their patients to him (Dr. Lee....UCI Med Center, Annaheim, Santa Ana CA) They told me when I woke up that I had no hernia, no obstruction, and Dr. Lee was barely able to make it to the bile duct, but he did. He almost had to call in another doctor to open me up, but they really wanted to keep me lap if possilbe. M y lab workup was really good, except liver enzymes, but they were really hit They got there and cut open the very large bile duct and it basically split open on its own. Dr. Nguyen of UCI and he is the gastric bypass doc....anyway, they opened it up adn lots of stones came pouring out with sludge and junk. I then was put back upstairs and that was that ;) NO More pain I am staying now at Hacienda Mariposa for plastic surgery recovery, and I am doing great. I had a lower body lift done on Wed, and tomorrow I have my 1st post op and I have a little skin irritation from tape. Hope this helps....go read my old posts from OCT NOV and I know I posted about the bile duct there Take care, Deb

Sorry about all the problems, but maybe I can shed some light on the liver biopsy. Usually when the liver enzymes are elevated, the doctor wonders about two things: NASH or Viral Hepatitis. NASH is more common with our group, because we lose weight so quickly that the liver gets "fatty." Usually if this is the problem, the says diet change, exercise, drink water, come back. If it's Viral Hepatitis, then he'll be concerned about either Hep B or Hep C, and will have you take tests for that. Either way, these are issues with the liver, and though many people swear by milk thistle, there are others who say it does little. It's an individual thing. Time will tell, but as a health counselor, I'm predicting that the number of liver-related issues will increase as this operation becomes more available, especially to men and women in their mid -to late forties and beyond. If he hasn't spoken with you about NASH or Hepatitis, I would ask him about taking the test -BEFORE the biopsy.

I am 10 months out and I just had internal hernia surgery done. I had no symptoms and no complaints. It felt like reflux and I was having pressure like heart burn. I spoke wiht my dr over the phone and was sent directly to the or for surgery. Everythings fine now, dr says it won't happen again and that it was 'fluke' which is ok since my recovery has been uneventful and fine. I do know that I will listen to my bodys clues before hand instead of trying to tough it out and ignore them. I'm very tired, had elevelated liver functions and was pooped. I'm on the mend now, I just had my surgery last we on the 26th. Happy New YEar, Jennifer

Hi there, sorry to jump in but I saw that you are a health counsler and I have just been diagnosed with NA**** is Grade 0 Stage 1 with fibrosis. I haven't had my appt with the Hepatologst yet but I was wondering if it's normal to have pain with this. I have severe pain in my upper abdomen  that sometimes goes straight through to my back. My surgeon seems to think this pain is not associated with the NASH and has me scheduled for reversal of my RNY on June 4th. I've been having this pain for over 6 months and been hospitalized numerous times. Have had all the tests they could do with no results so that's why i've chosen to go ahead with the reversal. To see if this takes care of the pain. I just want to learn as much as I can beforehand.  Jill

After such a surgery, a person's system cannot handle alcohol at all, so I would advise against ANY alcohol intake. This may not apply to you, but it's something I would highlight to anyone who's had bariatric surgery. Some surgeons tell you uniquivocally to give up alcohol; some surgeons don't even mention it. But I've seen three different episodes on TV recently (Dr G Medical Examiner, etc) where post-op patients died from alcohol poisoning and had characteristics of late-stage alcoholic liver changes that actually killed them, when in fact they had never been heavy drinkers prior to their surgery. Interestingly, the mention of the bypass surgery was only incidental -- no one seems to have made the connection that bariatric patients can drink themselves to death in a single evening. But it has happened several times. If your nutrition has been compromised in any way, the body gloms onto that alcohol -- which requires no dietary processing, it goes straight to the blood stream -- and you get this psycho sort of compulsion to drink and drink because the body needs those calories. There's a very fine line between compulsion and addition, but I found out the hard way. I never cared much for alcohol and did not have any for about two and a half years post op. But I let myself get run down and too skinny, and when I DID finally have some wine, my body and brain latched onto these calories and told me it was a matter of life or death to have them. I was not addicted to alcohol, yet was COMPELLED to binge drink. I went through 6 months of hell that nearly destroyed my life, and certainly my reputation. Every bariatric patient needs to hear this!!!!!

Hey, I had the same thing back in October.  They did the lap assisted ERCP, the doc here in UCI, California, did it, Jon Lee, he is supposed to be the top ERCP doc in the world.  I am now having symptoms again, but my LFT's are normal, and they did an MRCP which did not show stones or a stricture, but he said he could do the surgery again, but did not think it was a high probability vs. the risk to do it again. I would really tell you not to do the ERCP unless it is through your old stomach via a laproscope and not through your through your throat, too much a risk for perforation. I am just so sick, no raised LFT's again, but skip the liver biopsy as it is normal to have stones in the bile duct with no gallbladder just like me. Don't do the liver biopsy is what I am telling you, do the ERCP via lap assisted with your gastric bypass surgeon, and have the ERCP specialist come in through the surgery. I am in the same boat, been there done that in October and now I am back to don't know what the heck is going on. Take care, and I hope you have done okay. I am having an EGD done to see if I have an ulcer, but we are thinking its not that either. Love ya Deb