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Gastroenterology (Expert Forum)
Elevated AST/ALT after total colectomy for Ulcerative Colitis
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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Elevated AST/ALT after total colectomy for Ulcerative Colitis
by eman, Mar 25, 2004 12:00AM
Here's the background,
I am a 26 year old male. I've had Ulcerative Colitis (Pancolitis) for just under two years now. On Feb 4th, I underwent the first step of total colectomy + j-pouch procedure, leaving me with a loop ileostomy for 9 weeks. Prior to this I was on high doses of prednisone for 6 months, and was unable to attain remission. I lost 25 pounds (mostly lean muscle mass) after the first operation. As far as diet goes, I was consuming large amounts of sugar from gatorade, softdrinks, icecream, etc.. for the first few weeks after the operation. Throughout my entire course of UC, and 3 weeks post-op step 1 of my total colectomy, I've had absolutely no above normal marks (I was iron anemic for a couple weeks following the hospital stay) on any of my blood tests. At 6 weeks post-op, my blood test showed slightly elevated AST/ALT levels, and at 7 weeks, the same. Nothing other than those are out of normal range. Also, I've been less than adequately hydrated due to the loop ileosomy, and am consuming 2 liters of saline\potassium daily via IV home therapy. On another note, I've been itching quite a bit, I do live in Alaska, and it's very dry, and I've been less than adequately hydrated up until recently. My GI told me not to worry, and that he would re-test again in 3 months, but I am extremely worried. He stated that diet or nutritional changes can elevate those enzymes. I know that up to 5% of UC suffers develop Primary Sclerosing Cholangitis. My body has gone through much change and trauma recently. Based on what I've told you:
1. Is it likely that somone suffering from UC for under two years could develop PSC?
2. Could total colectomy have triggered the disease, if so?
3. Is it possible that nutrition, dehyration, or iron anemia could caused the elevated enzymes?
4. Could this be some time of viral infection or hepatitis?
5. What should I ask my GI, or what is my next step?
Thanks,
Erich
I am a 26 year old male. I've had Ulcerative Colitis (Pancolitis) for just under two years now. On Feb 4th, I underwent the first step of total colectomy + j-pouch procedure, leaving me with a loop ileostomy for 9 weeks. Prior to this I was on high doses of prednisone for 6 months, and was unable to attain remission. I lost 25 pounds (mostly lean muscle mass) after the first operation. As far as diet goes, I was consuming large amounts of sugar from gatorade, softdrinks, icecream, etc.. for the first few weeks after the operation. Throughout my entire course of UC, and 3 weeks post-op step 1 of my total colectomy, I've had absolutely no above normal marks (I was iron anemic for a couple weeks following the hospital stay) on any of my blood tests. At 6 weeks post-op, my blood test showed slightly elevated AST/ALT levels, and at 7 weeks, the same. Nothing other than those are out of normal range. Also, I've been less than adequately hydrated due to the loop ileosomy, and am consuming 2 liters of saline\potassium daily via IV home therapy. On another note, I've been itching quite a bit, I do live in Alaska, and it's very dry, and I've been less than adequately hydrated up until recently. My GI told me not to worry, and that he would re-test again in 3 months, but I am extremely worried. He stated that diet or nutritional changes can elevate those enzymes. I know that up to 5% of UC suffers develop Primary Sclerosing Cholangitis. My body has gone through much change and trauma recently. Based on what I've told you:
1. Is it likely that somone suffering from UC for under two years could develop PSC?
2. Could total colectomy have triggered the disease, if so?
3. Is it possible that nutrition, dehyration, or iron anemia could caused the elevated enzymes?
4. Could this be some time of viral infection or hepatitis?
5. What should I ask my GI, or what is my next step?
Thanks,
Erich
Doctor's Answer
by Kevin Pho, MD, Mar 25, 2004 12:00AM
, Mar 25, 2004 12:00AM
To answer your questions:
1) About 5% of those with UC have PSC.
2) The colectomy may have triggered the disease, but it can be difficult to tell.
3) Any of those causes can elevate liver enzymes. I would suggest basic causes of elevated liver enzymes first - including a hepatitis screen as well as a liver ultrasound to evaluate the liver and gallbladder.
4) Yes, it is possible that it can be hepatitis.
5) As mentioned above, an ultrasound as well as hepatitis screen would be reasonable steps to consider.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
1) About 5% of those with UC have PSC.
2) The colectomy may have triggered the disease, but it can be difficult to tell.
3) Any of those causes can elevate liver enzymes. I would suggest basic causes of elevated liver enzymes first - including a hepatitis screen as well as a liver ultrasound to evaluate the liver and gallbladder.
4) Yes, it is possible that it can be hepatitis.
5) As mentioned above, an ultrasound as well as hepatitis screen would be reasonable steps to consider.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
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I haven't regained any of the weight I lost during my 8 day hospital stay. I rarely drink alcohol. I haven't had a drink in a couple months, and I'm not currently not taking any drugs besides immodium. I did take liquid oxycodone during my hospital stay and probably up to 1 week following the hospital stay when I got home. Thanks again,
Erich