Post surgery ALT and AST off the charts

[hopie]

I’m glad he was able to walk so early on and that all is in order! I’m so happy that you were able to talk to his surgeon and got some answers as well. What I was able to gather from all the studies I’ve read is that there are no specific guidelines about what bloodwork shows. That is, they expect things to go crazy, and what they care about is whether and when they turn to “new” normal. So while older information about both normal/healthy liver as well as post-op liver values may say something, I think it’s too early to make sense of them—thus to freak out about them! I know it’s easier said than done, but please try to relax a little bit and enjoy his cancer-free, walking body

[mpbser]

Not sure if it's normal for some of these labs to get worse before they get better. Plus, not sure if the continuous drop in plasma inorganic phosphorous should be a concern.

Today's ALT: 450, AST: 146. ALK Phos still great but up by 10 to 74. Albumin 3.4 (stable, same as yesterday), Bilirubin 1.4 (still high but improving). BUN now normal. Phosphorous low 1.4. CBC results now somewhat out of whack: Abs mono 03/10/2019 1.5 K/mcL [0.0-1.3 K/mcL] High, 03/09/2019 1.5 K/mcL High, 03/08/2019 1.0 K/mcL Normal, 03/07/2019 1.4 K/mcL High. Immature granulocytes: 03/10/2019 0.7 % [0.0-0.6 %] High, 03/09/2019 0.6 %, 03/08/2019 0.4 %, 03/07/2019 0.3 %. Hematocrit: 03/10/2019 35.7 % [37.5-49.3 %] Low, 03/09/2019 36.4 % Low, 03/08/2019 39.0 %, 03/07/2019 38.8 %. Hemoglobin: 03/10/2019 12.0 g/dL [12.5-16.2 g/dL] Low, 03/09/2019 12.1 g/dL, 03/08/2019 13.2 g/dL, 03/07/2019 13.1 g/dL.

Going to look at his labs following his past three surgeries for comparison.

Thankfully, the liver enzymes are headed in the right direction although I am not sure if the rise in Alk phos could be an issue.

Oh great. Just read that correction of acute hypophosphataemia tends to leave no long-term complications but failure to recognise and treat an acute, severe situation can lead to fatality.

[kandj]

What did his shoulder have to do with anything?

It is called referred pain and it can be caused by a whole host of things in the body. It is not uncommon to ha e shoulder pain (in my husband’s case, right sided shoulder) when there is something wrong with the liver, gallbladder, kidneys, internal bleeding. It is actually a common symptom in women who have ectopic pregnancies! Blood or swelling irritate a nerve that runs from your shoulder down through the central part of your body. We originally chalked it up to his arm position during the 3+ hour surgery. But it got progressively worse, to the point it kept him up at night and the narcotics they gave him did not touch the pain. I should have forced him to go to the ER right then! For him it turned out to be a pyogenic liver abscess. The symptoms for this did not show up in his original hospital stay. It started about 10 days post op.

Your husbands labs look good. Like I said in my previous post, the Alk Phos can climb later. This is fairly normal.

[mpbser]

Thank you for the further details. That’s something just to keep in mind in case my husband experiences that and I don’t know what is going on.

[mpbser]

Just saw one of the fellows. Apparently phosphate is used in ATP production and the cycle of cellular reformation post liver surgery would drain the phosphate levels. They would actually be worried if it hadn’t dropped but at this point they are supplementing him with phosphorus.

[mpbser]

kandj,

I read what you wrote on another thread "He also had right sided pain and referred shoulder pain following his liver resection. He brushed it off as pain from nerves that were cut and from his arm being held up during surgery. Turned out he had a liver abscess. They are 100% fatal if they burst. He went in to the ER about 12 days post surgery because he spiked a fever and that us how they found that."

Just curious, was the pain constant or did it come and go?

[mpbser]

As per usual, I want to understand EVERYTHING, so I discovered this afternoon that intraabdominal abscess formation after major liver resection is more common when the patient underwent a significantly longer operation. https://www.ncbi.nlm.nih.gov/pubmed/2264428 My husband's was at least eight hours.

I also learned that prolonged operation time is a predictor of development of biliary complications. https://jamanetwork.com/journals/jamasu ... cle/211502

[kandj]

kandj,

I read what you wrote on another thread "He also had right sided pain and referred shoulder pain following his liver resection. He brushed it off as pain from nerves that were cut and from his arm being held up during surgery. Turned out he had a liver abscess. They are 100% fatal if they burst. He went in to the ER about 12 days post surgery because he spiked a fever and that us how they found that."

Just curious, was the pain constant or did it come and go?

My husband is very funny when it comes to pain. He has an incredibly high pain tolerance (except when it comes to the “man cold”). So it is hard to say. I think there was low grade constant irritation with bouts of pain in the evenings. I think the real key is that every day should be a little bette then the day before. So if you see a backslide in progress, keep an eye out and take him in if you need to. There is an urgent care at the 67st hospital for a reason!

[kandj]

And I would caution you on reading too much. I too am a researcher by nature (and profession) so I know how hard it can be not to. But you are just setting yourself up for more stress. My best advice is to trust the amazing doctors available to us and keep your eyes on your husband for any changes. That is the best help you can be to the doctors. You know your husband best so when something doesn’t seem right, mention it.