After a hysteroscopy D & C operation, a female was found to be infected by UTI proteus mirabilis. In the middle of clindamycin treatment (not the tested "Sensitive" antibiotic), specifically 2 days later, she was infected with enterococcus faecalis. Following this, hereunder was found -
1. The liver enzyme ALT was raised three times, ALP by two times, GGT by two times
2. A HPB ultrasound found that the patient (obese) has no "remarkable symptom" as the bowel gases clouded the pancreas, liver and gall bladder a.k.a. the radiographer cannot "see" anything but bowel gases
3. The patient was tested negative for all hepatitis (isn't increased liver enzyme is all about hepatitis illnesses?)
4. A week later, a re-run of the test indicated the same result, could it be that fatty liver is the most likely diagnosis? If so, what is / are the next treatment?
5. How dangerous is the fatty liver considering the likely infiltration could be in the premise of 40% of the obese patient?
Thanks and regards - Mariam
Dear Mariam Ahmad
Generally, first sign of liver disease is changed liver enzymes in blood. But in some diseases such as hepatitis B/C may you cannot find any change in enzyme level. Rising in enzyme level is not "only answer" to this diseases; serological tests are needed to check.
In this case multiple issues arise. In presence of obesity, fatty liver can occur but this might or might not cause liver enzyme elevation and surely not ALP & GGT. Since the patient underwent an operation, chances of contracting HBV/HCV is there and they can cause liver enzyme elevation. In addition the sepsis can itself cause all these liver enzyme elevation. A preoperative liver enzyme level is not available in this case. Since all viral markers are negative, CRP, serum lactate, procalcitonin levels may be estimated to exclude severe sepsis as cause. The other point is that some anaesthetic agent may affect liver post operatively. If all these are negative, then the most likely cause is presence of fatty liver on which the stress of operation and sepsis has caused the worsening. Best is to fully control the sepsis and wait for some time for the liver to recover by itself though the outcome is unpredictable.There is no definite treatment of fatty liver though ursodeoxycholic acid and vitamin E have been found to decrease enzyme levels
The elevation of the liver enzymes is not specific for viral hepatitis only .Many factors can cause elevation of sgot &sgpt just as introperative hypotension can cause ischemic hepatitis , effect of anesthesia, sepsis induced cholestasis, autoimmune markers must be done.PCR HCV&HBV must be done to exclude acute hepatitis.
In this case you need to check one more time the serological marchers for viral hepatitis, but I think in this case we are talking about the effects due to antibiotico-therapy...
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