instruction: hello doctor my year old daughter continues to have strong abdominal pains couple of months before it was really bad and was also coupled with mono and fifths disease at that time her levels were crazy high ast 1312 alt 1692 these levels freaked out the doctors so we went back the next week still high but much lower ast 394 alt 807 get 84 we also did a sonogram at that point which was inconclusive we went back two weeks later and not better ast 532 alt 682 get 71 doctors have no answers and no idea about what was going on the doctors seem to phone it in at that point my daughter started feeling better so we did not push it for a couple of months and went back in and the levels seem close to normal ast 57 alt 42 get 12 we were given no comfort as to what caused it my daughter does complain a couple of times a week about her stomach hurting but she is not in the extreme pain she was in until this week she is back to waking up in pain spending most of the school day in the nurse office so now we are heading back to the hospital for more blood as we did not get any answers from the first 37 vials of blood they have taken any clues what might be causing this
output: hi I can understand your concerns this appears to be a case of obstructive jaundice the main cause of obstructive jaundice is gallstones since get gamma glutamyl transferase levels are raised more than 70 in the first report it suggests an obstructive cause ast aspartate aminotransferase and alt alanine aminotransferase can increase in both hepatic and obstructive causes in obstructive jaundice the level of direct bilirubin increases more as compared to indirect bilirubin levels gallstones are easily visible on the ultrasound abdomen it also causes severe acute abdominal pain there are some syndrome like rotor syndrome which can also cause obstructive jaundice nevertheless the enzyme levels are falling and the child is improving now but I suggest you to repeat ultrasound to look for gallstones review with ultrasound report and liver function test report especially bilirubin levels I hope this helps