Increasingly elevated liver enzymes

I had my gastric bypass in December of 2016, with normal LFTs at surgery and again 6 months post-op. Then, in December of 2017, my ALT and AST started to rise. Now, in March 2018, my ALT is 298, my AST is 179. It doubled in less than a month. I don't take herbal supplements or anything with acetominophen in it, and I don't drink at all. I have gone from 243 lbs. at surgery to 112 lbs. now, and my BMI is just under 18. I tested negative for viral and autoimmune hepatitis, and my fibroscan was negative for fibrosis. I'm getting an ultrasound tomorrow, but my doctor doesn't think it's NASH or NAFLD since I had none before surgery and my LFTs were all normal. No idea what is causing this now! Anyone else have a similar story? What did you find out?

Not exactly your situation, but before surgery I was diagnosed with NASH with levels like yours. The scan will help them know what is going on now and provide a baseline for future updates. i have to get a scan every 6 months to watch for liver disease, etc. Is your doctor a Hepatologist? If not, you may want to get scheduled now - that's a small specialty and getting an appointment can be tricky. Good luck.

Thank you! Yes, I'm seeing a hepatologist who works closely with my bariatric surgeon and team at a major medical center. He's already checked for all the common causes of hepatic damage and rising liver enzymes and they are all negative. Unfortunately, I'm an RN and starting to worry about zebras, like pancreatic or liver cancer, instead of horses for the hoofbeats I'm hearing!

I know a lot of bariatric surgery patients have elevated liver enzymes before surgery due to obesity, and shortly after surgery due to high levels of fat mobilization, but mine were normal until more than a year after my RNY. That's what's wierd about it.

I also had a rare complication of RNY in January of this year: Intussusception of the small bowel at the jejunojejunostomy (where they sew the alimentary limb of the bowel back together). It caused a complete small bowel obstruction and resulted in an emergency airlift from my small rural hospital to a major medical center and GI surgery. However, my LFTs stayed high but did not get worse during this ordeal, so go figure!

Same thing has happened to me and I've had all tests run come back normal. No idea what it is. Let me know what you find out. My md is sending me to a gastroenterologist next.

Thank you, will do! Did you liver enzymes rise right after surgery, or were they normal for a time and then rose?

I had normal liver enzymes before and after until about a year out then they started to rise.

Mine have been elevated and just started to come down this year. Bariatric Doctor didn't seem that concerned, I cannot tell you numbers. I know people have posted in this before, so not an unheard of side effect.

Mine were normal before RNYGB, and normal afterward. At my six-month labs, they were normal, right smack in the middle of the normal range. Suddenly, more than a year after surgery, they shot up and have been rising, doubling nearly monthly. All of the comments I've seen in the forum were about liver enzyme elevations right after surgery or persisting after surgery. Mine are suddenly elevated, that's what seems to be weird about it! It doesn't seem to be a direct result of the RNY or a lingering aftereffect of fat mobilization in weight loss. During my most rapid and extreme weight loss my enzymes were normal.

Mine went up too.