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Question on Liver function

Discussion in 'General Discussion' started by auctionmom, Feb 11, 2006.

  1. auctionmom

    auctionmom Approved members

    Joined:
    Feb 11, 2006
    Messages:
    5
    Hello everyone,

    Wes just got his test results back and his liver function is 35. The Dr. was very concerned but yet I still have no clue on the meaning! can anyone help me understand it?

    A bit of an update, I joined the list when wes was dx at age 8 and he is now 17. We have been up and down and all over the map with A1c's. one year ago it was at 12.7 and this week it is 10.5.. Not good, but wes brought it down all by himself since he takes care of his D by himself.

    After all my years of begging him to get a pump, he refused so I shut up.. Now he wants one !!!

    After all these years, the one thing I have learned about Wes, if he starts complaining of headaches and needs advil.. Know he will be ill the next day....

    Lesson learned the hard way as I DID NOT take advil because of my work schedule, he 1. got in trouble at school, 2. was sick the next day. 3. He still get's in trouble for getting at trouble at school.. Kind of a round and round thing there.

    Anyway, wanted to say HI and ask the liver Q.

    Alesia
     
  2. Red (aus)

    Red (aus) Approved members

    Joined:
    Oct 23, 2005
    Messages:
    48
    Without knowing which test the doctor is referring to there isn't any advice anyone can give. There are several things tested when testing for liver function, so you really need to speak to his doctor about which tests, and what that particular result means to your son.
     
  3. bjgrayowl

    bjgrayowl Approved members

    Joined:
    Mar 4, 2006
    Messages:
    5
    Hello Alesia
    I can not help but to let you know that if there are liver problems. Please bug the doctors. My son Michael was 14 when he became Type 1. At 18 years old he died. I do not say this to scare you but my son was having liver problems. He had a real bad highs that sent him to the hospital for a week in December of 2004 and they could not find out why, Five months later he was gone. He was taking care of his on his own we found out after his death that he was testing only once every few days and guess at what dose of insluin to give him self. We would ask him every day to show us his numbers that he was writing down he was just making up numbers.

    Michael's Mom Barbara
    My sons death can not be in vain.
     
  4. Ellen

    Ellen Senior Member

    Joined:
    Oct 22, 2005
    Messages:
    8,240
    Have you had your son tested for celiac disease? When a person has one autoimmune disease such as T1 diabetes, they are at increased risk for others (celiac disease, thyroid,....). You mentioned he gets headaches - more than usual? It's another sign, although many people with celiac disease are completely asymptomatic.

    If you read the research on celiac, liver function tests come up. From one abstract: 'Abnormalities of liver functions are frequently seen in paediatric celiac disease patients. These abnormalities are not correlated with malnutrition and severity of intestinal mucosal lesions. Liver enzyme activities return to normal levels in a few months after gluten-free diet."

    From the link above:

    [​IMG]

    What are CD and DH?

    What is celiac disease?
    Celiac disease is an inflammatory condition of the small intestine, induced by gluten. It has diverse clinical manifestations that resemble a multi-systemic disorder rather than a primary intestinal disease. Originally considered a rare disease of childhood, celiac disease is, however, now recognized as a common condition that may be diagnosed at any age.
    Other terms for celiac disease include gluten sensitive enteropathy and non-tropical sprue.

    What is dermatitis herpetiformis?
    Dermatitis herpetiformis (DH) is the skin manifestation of celiac disease. All patients with DH have celiac disease. It is an intensely itchy rash that usually occurs in the same place for each patient. This may be on the hands or fingers, forearms, buttocks or scalp or anywhere on the body. The rash typically consists of very itchy, small red dots that may develop into blisters or pimples. They are intensely itchy.
    The diagnosis is clinical and can be confirmed by biopsy. The biopsy, for best results, needs to be taken from just adjacent to a lesion. The biopsy needs to have special immunofluorescence tests performed on it.
    Treatment is first and foremost a gluten-free diet. This results in resolution of the lesions and will prevent new lesions. The diet also will prevent the development of lymphoma, that occurs at an increased rate as in patients with celiac disease. Drugs (Dapsone) may help patients recover from a severe episode, but are not a substitute for the diet. Patients with DH are very sensitive to small amounts of gluten.

    What is gluten and why does it trigger the development of celiac disease?

    Gluten is the term for the storage proteins of wheat. The alcohol-soluble fraction, called gliadin, has been most studied, but most of all gluten proteins are likely to be toxic in celiac disease. Other proteins found in barley (hordeins) and rye (secalins) are also toxic to patients with celiac disease. These proteins are not strictly glutens, but are generally included in the term and should be avoided by patients with the disease. The proteins of oats are not toxic to individuals with celiac disease. There are multiple studies from both Europe and the USA demonstrating the safety of oats for patients with celiac disease and dermatitis herpetiformis.

    The only concern with oats is whether they are contaminated with wheat, barley or rye. Patients with celiac disease attending the CDCC are advised that they can consume oats.
    There must be other factors apart from gluten that can contribute to the development of celiac disease. Some of the factors are the timing of the first ingestion of gluten in childhood and the amount of gluten, whether breast feeding occurs and whether other members of the family have celiac disease. Smoking also influences the onset of celiac disease.

    Still, why celiac disease develops in some individuals in childhood and others as adults is unclear. One is not born with the disease. One is born with a genetic tendency to develop the disease. It is considered that gastrointestinal infections may be a factor that can trigger the development of the disease.

    How common is celiac disease?
    Celiac disease is very common, one of the most common inherited diseases that physicians can encounter. Originally considered to be a rare disease of childhood, it is now recognized predominantly as a disease of adults.

    It has been reported from each continent. Reports from all countries in Europe, as well as Asia, Australasia, North and South America, Cuba, North Africa as well as the Middle East attest to its widespread distribution. Overall, it is considered to occur in about 1 per 250 individuals. Most recent figures are 1 per 133 in USA, 1 per 122 in Northern Ireland, 1 per 99 Finnish school children and 1 per 100 in western England, which indicate it occurs in about 0.5 to 1% of those of European descent.
    Significance of celiac disease

    Symptomatic celiac disease is associated with a considerable amount of illness and morbidity due to chronic gastrointestinal symptoms and malabsorption of nutrients, weight loss, metabolic bone disease, anemia and general debility. Celiac disease results in an increased risk of the development of various malignancies including lymphoma at any site, not only the small intestine.
    There is also an increased mortality rate in celiac disease that is about two to four times that of the general population. The increased mortality is mainly due to malignancies. The increased mortality returns to that of the general population after about 5 years on a gluten-free diet. This is the main reason that patients are advised to remain on a strict gluten-free diet.

    Presentation
    Diarrhea, the hallmark of intestinal diseases, is the single most common presentation. Steatorrhea is the term for fat in the stools. The clinical feature of steatorrhea is oil or grease visible in the stool. Foul smelling or floating stools are normal findings and do not indicate the presence of a disease process.
    [​IMG]Patients do not have to have diarrhea to be diagnosed. In fact, it is the presentation now for less than 50% of adults with celiac disease. When present, diarrhea reflects a more extensive involvement of the length of the small intestine. Celiac disease should be high in the differential diagnosis of any patient who complains of diarrhea.

    Those patients with diarrhea are just the tip of the iceberg. By far, the majority of those with celiac disease are asymptomatic and not currently diagnosed. Other ways in which patients present include more vague intestinal symptoms that may get labeled as an irritable bowel syndrome (IBS). About 5% of those with typical IBS have celiac disease. Other symptoms include bloating and abdominal distention, indigestion or heartburn. Patients may present with weight loss or abdominal pain. Many patients get the diagnosis of celiac disease after upper intestinal endoscopy performed for ulcer-like symptoms or esophageal reflux symptoms. At the endoscopy, the features of celiac disease may be recognized by the endoscopist when the disease had not previously been suspected.

    Other patients present having been assessed for iron deficiency anemia or osteoporosis. Non-gastrointestinal manifestations of the disease include neurological symptoms such as peripheral neuropathy, ataxia (poor balance) or epilepsy. Apthous ulcers in the mouth is considered to be an autoimmune disorder associated with celiac disease. Dental enamel defects are frequent and may be noticed by dentists.

    Patients with celiac disease may have liver diseases. Abnormal liver tests are common at diagnosis and usually improve on the diet. Patients may be diagnosed because of being screened for the disease because of the known association with primary biliary cirrhosis.

    The diagnosis may be made because of screening groups at an increased risk to develop the disease. These include first-degree relatives of patients, those with Type 1 diabetes or Down’s syndrome.

    Diagnosis of celiac disease
    The diagnosis of celiac disease requires finding characteristic changes in a small intestinal biopsy, together with clinical and/or histologic improvement on a gluten-free diet.
    Biopsy is recommended to establish the diagnosis because the blood tests only suggest the presence of the disease. In addition, the disease is life long. Diagnosis requires the patient to adhere to the diet throughout their life. While it may not easy to control a small child’s diet, as they grow older they need to understand the disease, believe they do have the disease and treat it themselves. Documentation of the disease by biopsy reinforces the diagnosis. Studies have shown adherence to the diet is greatest in those who underwent biopsy.

    Positive blood tests are supportive of the diagnosis, but not essential, for the disease can be present in the absence of positive blood tests. This is especially true when there are lesser degrees of villous atrophy.
    Serologic testing for celiac disease

    A panel of serologic tests that included IgA and IgG antigliadin antibodies (AGA), anti-endomysial antibodies (EMA), anti-tissue transglutaminase antibodies (anti-tTG) and total IgA level provides the greatest likelihood of establishing the diagnosis of celiac disease.

    Many laboratories have substituted an anti-tTG for the endomysial antibody test, though these are not the same.
    Levels of the antibodies fall while on a gluten-free diet. EMA titers are usually undetectable after 6 to 12 months, but may take up to 30 months if the initial titers are high. Similar studies have not been performed for the anti-tTG levels. Antibodies become negative prior to improvement in the intestinal biopsy.
     

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