Post surgery ALT and AST off the charts

[mpbser]

After surgery (caudate biopsy, 5 or so other biopsies, wedge of segment 6, and ablation of two spots, gall bladder removal, and hai pump placement) yesterday, results were: ALT 460 and AST 605. His are normally very low and have never been elevated even after first liver resection. I read that post surgery it’s common for two fold increase but this is twenty or so fold. They did not test his liver enzymes today. Only a basic panel instead of comprehensive. So, I put a call in to Dr K’s office and she isn’t in until Wednesday next week. Assistant put email out to her team as well as D’Angelica’s. Sure hope it drops and fast. Worried.

[MissMolly]

I’ve personally had liver values (ALT and AST, in particular) in the range of 1,600 due to medication effects.

Your husband’s liver has been traumatized by the resection surgery. Be confident that his medical team will be monitoring him and acting as needed. Giving the liver rest for healing will serve your husband well. The liver has an amazing ability to regenerate and heal itself, unlike any other organ in the body.

Keep faith,
Karen

[LPL]

mpbser, was his other blood test ‘numbers’ OK?
Here is a review of a lot of tests the time after liver resection. A lot of words (my head was spinning a bit) but I know you like to read these things.
Systematic review of pathophysiological changes following hepatic resection (2014)
https://www.ncbi.nlm.nih.gov/pmc/articl ... o=0.588235

[mpbser]

Yes, for the most part, ok. ALK Phos normal. Only neutrophils elevated at 8.7% ( if I recall that number correctly). Thank you for the link, I will be sure to look at it this afternoon.

[radnyc]

That’s quite normal. Chill.

[mpbser]

Thanks, everyone. They worsened today. As much as I would like to relax, I’m not doing that until these numbers normalize.

[LPL]

Thanks, everyone. They worsened today. As much as I would like to relax, I’m not doing that until these numbers normalize.

I understand that you are worried. As a caregiver I often worry too .. Are you getting any comforting words from the doctors? I hope so. Thinking about you <3

[juliej]

Agree with other posters. That's a not-unheard-of post-surgery response.

The numbers are not terrific, but they are not dangerous in context right now. I'm sure Dr. D'A will be monitoring it to see if they drop in the next few weeks. If they go up more, there may be a problem (biloma, abscess, blocked bile duct. etc.). Dr. K may put steroids in the pump to help the liver recover. In the meantime, make sure he gets plenty of protein so the liver can repair itself from the surgery.

Juliej

[mpbser]

Thank goodness I was there this afternoon when the fellows came in to do their second rounds of the day. They explained to me that it's very common when there are ablations for those liver enzymes to jump up that high. What a relief that it is totally normal. He said that they may go up still in the next day or so but they will come down. I am so reassured and relieved that I will be able to have a good night sleep tonight. Between that and my husband looking and feeling so good this afternoon after they added toradol to his meds, I am confident he is on a swift road to full recovery.

[radnyc]

Thank goodness I was there this afternoon when the fellows came in to do their second rounds of the day. They explained to me that it's very common when there are ablations for those liver enzymes to jump up that high. What a relief that it is totally normal. He said that they may go up still in the next day or so but they will come down. I am so reassured and relieved that I will be able to have a good night sleep tonight. Between that and my husband looking and feeling so good this afternoon after they added toradol to his meds, I am confident he is on a swift road to full recovery.

That’s what lot of us been telling you, chill!

[kandj]

Very normal after ablation. The way one of the fellows explained it to me is that the ALT and AST response is pretty immediate. They jump high to an acute trauma (like say, someone going into the liver and burning tissue out). The Alk Phos is a little slower to rise, but do not be surprised to see it start moving up. It will come back down as the liver heals. All of those doctors are on top of it, try not to worry. Your husband literally has 4-5 docs on his case in the hospital alone, and several of them are what I like to call double doctors as they are MD and PhD. They know what they are watching out for. For your husband, the best thing to keep an eye on is his symptoms. He should be feeling better each day. If he gets better, then gets worse, that is when you need to get the docs attention. My DH had a life threatening liver abscess diagnosed about 2 weeks post op. We were already back home in TX and I wish I had made him go in when his shoulder started bothering him in NYC.

[mpbser]

What did his shoulder have to do with anything?

[MissMolly]

Liver, gallbladder, and bile duct distress will often present as referred pain to the scapula and shoulder.

The nervous system “wiring” is gut and abdomen is fairly primitive. The source of pain is not where the pain is experienced. It is one reason why diagnosing abdominal pain can be difficult and elusive.
Karen

[mpbser]

Yesterday morning around 10:30 he went for his first walk. When he got back into bed he complained about his left shoulder hurting.

[mpbser]

Ok, so the bloodwork from this morning came back. I have read (either here or on facebook) that having the ALT higher than AST a good thing (ideally a ratio of <0.8 ). The docs will often be more interested in trends and ratios of ALT and AST lab values, rather than just a single number i.e. an increase inside the normal range is not as concerning as the same proportional increase if you are above the normal range.

This is what we have so far:

Yesterday ALT: 577, AST: 649. Excellent ALK Phos. Albumin: 3.7, Bilirubin 1.8, BUN 22. Did not test phosphorous.

Today ALT: 653, AST: 379. Excellent ALK Phos. Albumin: 3.4, Bilirubin 1.7, BUN 35. Phosphorous low 1.9.

So, now there is a reversal/flip of the ALT/AST #s. But I see that ALT should be higher than AST. Hope this is also totally normal - hopefully good - on day 2 post surgery.