“Markedly Elevated LFTs and biliary colic in 23F”
I went to the ER on Christmas (boo for me) after 3 days of worsening abdominal pain, nausea, and anorexia with one episode vomiting. Hadn’t eaten for 3 days so my parents made me go. Originally, provider thought it was an ulcer related to my history of GERD for 15 years….. but my LFTs threw us for a loop.
Bilirubin total 1.3, alk phos 179, ALT 681, AST 399.
Ultrasound and CT showed no gallstones, but showed gallbladder wall thickening, splenomegaly, and hepatic steatosis.
(Sort of unrelated but I am adopted with a history of addiction at birth, so the provider was further worried by that). He discharged me as there was no apparent need for surgery, diagnosed me with biliary colic, said I need a HIDA scan and maybe EGD, and told me to get on board with my university hospitals hepatobiliary specialty.
I have no other history but I’m a nurse and I see these labs and I’m like what the fuck. What do we think? Simple biliary colic or something more at play?
1 Answer
OB-GYN(Obstetrician-Gynecologist)OBGYN
Im a gynecologist, but it is obvious to me that you have significant liver inflammation. The differential diagnosis is: 1. Infectious causes 2. Parasite pathology 3. Autoimmune causes 4. And with the spleen involved, malignancy needs to be ruled out 5. I suppose if there is significant fatty liver damage, then the venous portal flow could be shunted away from the liver and account for the enlarged spleen, but I can only be guessing about this to put all this information into one picture. 6. I didnt see any evidence of gallstones in the report and, anyway, gallstones dont affect the spleen. A gastroenterologist is your next step and I would be quick about it.
