High liver enzymes - what is causing

I don't want medical advice, but maybe someone has a clue what's causing my liver enzymes to spike. I'm seven months post-surgery, VSG. I lost 106 lbs since surgery and met my surgeon's goal and a little bit more. I have tremendous energy and feel better than I have since university, except for one thing: I have an ache in my upper right side when I walk more than about 10 minutes or carry things.
My liver enzymes are like 3x to 10x the 'normal' upper limit, and have risen substantially over the past 6 months. Ferritin is a bit above nomal and more than 3x what it was two years ago when last measured. I've read that a slight bump, maybe twice as high as normal is not uncommon post-surgery as the liver is stressed processing your fat as you lose weight. They've tested for hepatitis and I don't have it. Thyroid is fine, too. Most other things are pretty normal and the weight loss has been great for my cholesterol and sugars. Ultrasound found no problems with liver or gall bladder. My surgeon and physician are both stumped. Anyone else been through this and have a suggestion?

This is EXTREMELY common and not a cause to panic.

Many people get spked liver enzymes their first year out due to the amount of processing of protein your body has to do and the huge weight loss.  More people get it then don't.

Dawn

My liver enzymes spiked at 6 months post op, and I had several gallbladder attacks.  I ended up having to have my gallbladder out.  A month after it was out, my liver enzymes were fine.

It is common to get gallstones and have to have your gallbladder removed after WLS and rapid weight loss.

I also had that pain in the upper right part of my back, and it got worse, way worse.  I see your docs checked your gallbladder, but I would still suspect it.  Google "gall bladder attack symptoms"

I had elevated liver enzymes as do most of us post op but to be sure I went to a gastroentologist that specializes in liver disorders.  He did some labs just to be sure but said that everything was okay and as long as they were under 100, he wsn't concerned adn thhey never went over 100.

There are several things that elevate liver enzymes - PPI's - prevacid, protonix, nexium, prilosec.  Statins used for high cholesterol - lipitor, zocor, etc.  Tylenol or any products with tylenol in it (acetominophen).  Alcohol use.

As far as medical problems - it can be from hepaitis, gallbladder problems, pancreatitis, mononucleosis.  You might want to have other tests done - CT scan to check your liver for other problems that a sonogram can't see.  There is a type of fatty liver that is more serious than the regular type that most of us have and can cause really high liver enzymes.  You could also have a non-functioning gallbladder eventhough you have no stones on sonogram.  TO know if it is working, you need  a HIDA scan which is  a nuclear scan to check for gallbladder function - this is the gold standard of gallbladder tests - you can have stones in the ducts, sometimes you need an MRCP whihch is an MRI of the entire bilary tree, all the ducts, gallbladder, liver and pancreas.

If your liver isnt functioning properly, your ferritin and cholesterol will be elevated.

One thing I have to ask = you say you haven't had your levels checked in 2 years?  WHy so long?  YOu need to get labs done regularly, if not every  3months, atleast every 6 months to prevent problems like this, you can catch them early

goodluck

Thanks for your detailed answer.
I'd done a lot of research into causes but you've raised a couple I had not previously come across, including Nexium, which I have only been on since June's surgery of course.

My physician has recently cut out my crestor to see if that brings readings down. I don't take acetominophen lately, but I did for a while around the time enzymes were seriously spiking, to reduce tendonitis-related swelling. Also, I have been tested for A,B,C Hepatitis and syphilis and all were negative.

My spiking is definitely higher than that normally associated with bariatric surgery, according to the surgeon. My  physician just sent me for a second round of ultrasound so we'll see if they detected anything else this time. And he's referring me to a liver specialist. In Canada, where we have a great public health care system in many ways, but one where we avoid fishing expeditions that use high-cost tests, it's unlikely that I could get a CT or HIDA scan without substantially more information than I now have. But I will be showing your post to my physician.

You asked about the 2 years since levels were checked. I didn't give enough information. I have had levels checked one month before surgery, and then post-surgery at 3 mos, 6 mos and 7 mos (the latter to investigate the trend on liver enzymes picked up at 3 and 6 mos). I'll be having tests again now at 9 mos. As a diabetic, I usually got liver and kidney checks (among other things) once a year just prior to seeing my endocrinologist. Again, in Canada there has to be a clear reason — suspected problem or problematic trending in previous test results — to do it more often, and I think that's a good practice when you're trying to give the largest number of people a high level of health care while watching costs. As soon as the trend was spotted, the monitoring increased.

Again, thanks for your detailed response. It is very helpful and will be shared with my GP and my endo.

I know up in canada things are different but I believe that in some ways it is not a good thing. When you have a problem, you need to have tests and I am sorry but you shouldnt' have to go through hoops to get a CT scan especially a WLS patients. If you have severely high liver enzymes and abdominal pain then something is wrong - you shouldn't have to go through hoops to prove that you need more tests. If you already had your gallbladder out, then you dont need a HIDA scan because that determines if your gallbladder is functioning and that would be a useless test but what you do need is an MRCP - that is an MRI of the bilary system, the ducts leading to and from the pancreas, the liver - where the gallbladder used to be. You can still get gallstones even without a gallbladder and they can block the ducts causing severely elevated liver enzymes even pancreatitis. This is very serious and shouldnt' be overlooked because it could become an emergency.

I am glad you were negative for hepatits. What about a liver biopsy? If your enzymes are over 100, then you shouldnt' just let it go - under 100 it is nothing.

Are you on vitamin A? I have seen people get toxic on too much vitamin A

the other thing = it is standard practice here to get basic blood tests every 3 months by a PCP having nothing to do with WLS - a CBC, chemistry including kidney function, liver function, potasium and other electrolytes, proteins, cholestrerol levels. Then it is up to the doctor to do anything else. My doctors even before my WLS, did all my vitamins, minerals and hormone levels.