Guest guest Posted March 17, 2009 Report Share Posted March 17, 2009 Hello All, I am pretty new here and was hoping someone can give me a little insight to my symptoms and my MRCP test. I went to the doctor in the beginning of January because I had fever like symptoms, then became jaundice 3 days later and I also had severe pain right under my ribs. After a few weeks of blood test I was sent for an ultrasound (came back OK) and then a week later I went for a MRCP. The results of the MRCP, which I just recieved a copy of last week, stated that my CBD has a somewhat irregular contour. My blood test at the time came back as the following: bilirubin total 13.4 Alkaline phosphatase 173 AST 73 ALT 136 antinuclear antibodies direct 201 After another 2 weeks of no changes to my blood work, no sleep, fatigue and of itching he put me on prednisone and said I had autoimmune hepatiis (he never told me that on the MRCP that it said that PSC could be a possibility). When I decided to get a second opinion at Columbia Pres in NYC my doctor there said I probably have a disease of the bile ducts. He said he would get back to me but I still haven't heard from him in over a week even though I left a few messages for him. Since I have been on the prednisone my blood work is the following: bilirubin total 2.4 Alkaline phosphatase 135 AST 81 ALT 256 One important thing I left out is that in 1993 I had UC. If anyone knows of any good doctors in Northern NJ or can give me any advice I would greatly appreciate. THanks and Happy St. s Day, Danny Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2009 Report Share Posted March 18, 2009 I do not know any Doctor's in NJ, sorry. I was wondering if they have done a Anti Mitocodrial (this is really mispelled) test? This would help differentiate between PSC and PBC from what I understand, but I don't really understand very much. Sorry Dawn > My blood test at the time came back as the following: > > If anyone knows of any good doctors in Northern NJ or can give me any advice I would greatly appreciate. > THanks and Happy St. s Day, > Danny > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2009 Report Share Posted March 18, 2009 I do not know any Doctor's in NJ, sorry. I was wondering if they have done a Anti Mitocodrial (this is really mispelled) test? This would help differentiate between PSC and PBC from what I understand, but I don't really understand very much. Sorry Dawn > My blood test at the time came back as the following: > > If anyone knows of any good doctors in Northern NJ or can give me any advice I would greatly appreciate. > THanks and Happy St. s Day, > Danny > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2009 Report Share Posted March 18, 2009 Dawn, Thank you, I looked it up, Anti-mitochondrial antibodies (AMA), I will check with my doctor if he tested for it when I see him tomorrow. Thanks for your help, Danny > > I do not know any Doctor's in NJ, sorry. I was wondering if they have done a Anti Mitocodrial (this is really mispelled) test? This would help differentiate between PSC and PBC from what I understand, but I don't really understand very much. Sorry > > Dawn > > > > > My blood test at the time came back as the following: > > > > > If anyone knows of any good doctors in Northern NJ or can give me any advice I would greatly appreciate. > > THanks and Happy St. s Day, > > Danny > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2009 Report Share Posted March 18, 2009 Hi Danny; Welcome to the group. Your antinuclear antibodies blood test results do suggest the possibility that autoimmune hepatitis may be present, since antinuclear antibodies are common in autoimmune hepatitis: " Seventy to eighty percent of patients with AIH have antinuclear antibody (ANA) or smooth muscle antibody (SMA) or both (>= 1:40). " : Mod Pathol. 2007 Feb;20 Suppl 1:S15-30. Autoimmune liver disease: overlap and outliers. Washington MK. http://www.nature.com/modpathol/journal/v20/n1s/pdf/3800684a.pdf However, this test alone cannot be used for firm diagnosis, since about 20% of patients with PBC (primary biliary cirrhosis) are ANA positive, and 6% of PSC patients are ANA positive. AIH tends to show greater elevation of ALT and AST than alkaline phosphatase. Therefore since your blood test results also show elevated alkaline phosphatase, this hints towards bile-duct disease/blockage. Demonstration of elevated gamma-glutamyltranspeptidase (GGT) would be needed to confirm a bile-duct involvement, and rule out other causes. For example, bone disease can cause elevated alkaline phosphatase! But it's not possible to rule out an overlap-syndrome such as AIH-PSC, as discussed in the above paper. Best regards, Dave (father of (23); PSC 07/03; UC 08/03) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2009 Report Share Posted March 18, 2009 Hi Danny; Welcome to the group. Your antinuclear antibodies blood test results do suggest the possibility that autoimmune hepatitis may be present, since antinuclear antibodies are common in autoimmune hepatitis: " Seventy to eighty percent of patients with AIH have antinuclear antibody (ANA) or smooth muscle antibody (SMA) or both (>= 1:40). " : Mod Pathol. 2007 Feb;20 Suppl 1:S15-30. Autoimmune liver disease: overlap and outliers. Washington MK. http://www.nature.com/modpathol/journal/v20/n1s/pdf/3800684a.pdf However, this test alone cannot be used for firm diagnosis, since about 20% of patients with PBC (primary biliary cirrhosis) are ANA positive, and 6% of PSC patients are ANA positive. AIH tends to show greater elevation of ALT and AST than alkaline phosphatase. Therefore since your blood test results also show elevated alkaline phosphatase, this hints towards bile-duct disease/blockage. Demonstration of elevated gamma-glutamyltranspeptidase (GGT) would be needed to confirm a bile-duct involvement, and rule out other causes. For example, bone disease can cause elevated alkaline phosphatase! But it's not possible to rule out an overlap-syndrome such as AIH-PSC, as discussed in the above paper. Best regards, Dave (father of (23); PSC 07/03; UC 08/03) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2009 Report Share Posted March 18, 2009 Hi Danny; Welcome to the group. Your antinuclear antibodies blood test results do suggest the possibility that autoimmune hepatitis may be present, since antinuclear antibodies are common in autoimmune hepatitis: " Seventy to eighty percent of patients with AIH have antinuclear antibody (ANA) or smooth muscle antibody (SMA) or both (>= 1:40). " : Mod Pathol. 2007 Feb;20 Suppl 1:S15-30. Autoimmune liver disease: overlap and outliers. Washington MK. http://www.nature.com/modpathol/journal/v20/n1s/pdf/3800684a.pdf However, this test alone cannot be used for firm diagnosis, since about 20% of patients with PBC (primary biliary cirrhosis) are ANA positive, and 6% of PSC patients are ANA positive. AIH tends to show greater elevation of ALT and AST than alkaline phosphatase. Therefore since your blood test results also show elevated alkaline phosphatase, this hints towards bile-duct disease/blockage. Demonstration of elevated gamma-glutamyltranspeptidase (GGT) would be needed to confirm a bile-duct involvement, and rule out other causes. For example, bone disease can cause elevated alkaline phosphatase! But it's not possible to rule out an overlap-syndrome such as AIH-PSC, as discussed in the above paper. Best regards, Dave (father of (23); PSC 07/03; UC 08/03) Quote Link to comment Share on other sites More sharing options...
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