Question Title: Liver Biopsy

I am a 29 yr old female (non-smoker, non-drinker and not overweight), with a few questions about elevated liver enzymes and the need for a liver biopsy. Here is some background on the tests I've had to date:

Liver Enzymes
ALP 188
ALT 112
AST 67
GGT 290
Cholesterol, sugar and bilirubin - normal
Hepatitis B,C - negative
Ultrasound of liver, pancreas and kidneys - normal
Currently awaiting results of bloodwork for more uncommon causes of liver disease, i.e., Wilsons, PBC, etc. and 24 hour urine-copper collection done.

Medication: Heavy use of Tylenol #3 for 2 weeks (2 pills every 4 hours for pain from a surgery), antiviral drug Valtrex for one week and birth control pills.
Note: Liver enzymes were checked 10-14 days after Tylenol and Valtrex were stopped.

Questions: (1) If all of my bloodwork and ultrasound have come back normal (except for the elevated enzymes), is a liver biopsy really necessary?
(2) If a biopsy is necessary, what would one be checking for at this point?
(3) Can a fatty liver be missed on an ultrasound?
(4) Can excessive weight loss cause elevated enzymes? (I've just lost 60lbs over the past 6 months of pregnancy weight)

Any insight would be most appreciated!

Dear Lisa,
The only way to know, with relative certainty, the extent of liver disease is with a liver biopsy. It is standard of care to perform a liver biopsy when there has been prolonged elevations of the liver tests (> than 6 months).

You do not list all the tests being done for 'unusual' causes of liver disease. I would assume that your doctor is also considering autoimmune liver disease and has ordered the appropriate blood tests. The liver biopsy is necessary to exclude treatable causes of liver disease that might be missed by the noninvasive tests (remember that no test is 100% accurate) AS WELLAS TO ASSESS THE EXTENT OF DAMAGE.

A fatty liver may be missed by ultrasound.

Excessive weight loss can produce a fatty liver. The meatbolic changes associated with pregnancy can also produce a fatty liver.

This information is presented for educational purposes. ASk specific questions to your personal physician.

HFHSM.D.-rf
*keywords: fatty liver
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