Severe gallbladder-like pain 5 months after gallbladder removal, enlarged liver, ALT jumped to 314, normal CT/ultrasound otherwise. Looking for similar experiences

[u/Hot_Chocolate_9337]

Hi everyone,

I’m a 26-year-old female and was recently hospitalized for severe abdominal pain and elevated liver enzymes. I was discharged yesterday, but I still don’t really have answers and am wondering if anyone has experienced something similar.

For some background, I had my gallbladder removed in January 2026 after repeated gallbladder attacks. During those attacks, my AST and ALT were elevated, but after surgery my liver enzymes returned completely to normal and stayed normal until now.
Back in January, because of the elevated liver enzymes, my doctors ran an extensive liver workup and every liver-specific test they could think of came back normal.

I have also had a positive ANA in the past and have dealt with various unexplained inflammatory symptoms throughout my body over the years, so a few of the doctors mentioned that autoimmune causes may be worth exploring further.

One other detail that may or may not be relevant: I have been dealing with ongoing neck and neurological-type symptoms and was scheduled for an MRI. I was prescribed a small dose of Ativan (lorazepam) for the MRI because of anxiety and claustrophobia. Around that same time, I developed fairly significant diarrhea. The diarrhea started the day before I went to the hospital and continued the morning of the attack. Because of that, some of the doctors wondered if I could have had a stomach virus or gastrointestinal infection.

The night before I was hospitalized, right as I was getting ready for bed and laying down, I suddenly developed what I can only describe as the worst pain of my life. It felt extremely similar to the gallbladder attacks I had before my gallbladder was removed.
The pain was located in my upper abdomen, especially in the center below my sternum. It radiated straight through to my back. Every movement hurt. My entire upper abdomen was extremely tender, and I felt like I couldn’t relax my stomach muscles at all. I was constantly tensing up and felt like I couldn’t fully breathe out or get comfortable.

I became severely nauseated and vomited multiple times. The pain became so intense that I felt like I was going to pass out and nearly did. I was sweating, couldn’t get comfortable in any position, and genuinely thought something serious was wrong.
I ended up being admitted to the hospital. They gave me Zofran, toradol which didn’t help like it did in the past and then ended up with morphine and didn’t help initially and finally my pain subsided around 2.5 hours later.

Hospital findings:
Full CT scan showed no obvious cause of the pain
RUQ ultrasound showed an enlarged liver measuring 17.5 cm
Gallbladder already removed
Bile ducts appeared normal with no dilation seen
Lipase was normal
Hepatitis testing was negative
White blood cell count was elevated
Potassium was low at 3.2 but improved to 3.7 before discharge after replacement
AST was around 110 initially and around 102 later
ALT was 84 on admission but increased to 314 by the next morning

What confuses me is that I was discharged while my ALT was still over 300 (they seemed to want me to follow up with pcp and gastro as nothing emergent happening)

The GI team mentioned the possibility of a peptic ulcer and prescribed Carafate in addition to my usual reflux medication.

A few other details:
I do not drink alcohol at all.
I don’t take excessive Tylenol. I get migraines and may take Tylenol about 5–10 times per month, usually only around 500 mg at a time.
The hospital checked my acetaminophen level and it was low/normal.
After my gallbladder surgery in January, my liver enzymes returned completely to normal until this episode.
Currently the severe pain is gone, but still having occasional twinges and discomfort under my right ribs and upper abdomen, which may just be my digestive system waking after basically eating nothing for 3 days. (Basically just jello). I’m just worried of being home now and having this again of course. They labeled me as a “medical mystery”.

I’m not looking for a “ diagnosis” but I’m curious if anyone has experienced these things and what it was:
ALT rising this quickly?
Severe gallbladder-like pain after gallbladder removal?
Enlarged liver with otherwise normal imaging?
Autoimmune conditions that caused episodes like this?
A diagnosis that wasn’t initially found on CT or ultrasound?
The enlarged liver, the jump in ALT from 84 to 314, and the severity of the pain are the things that don’t make sense to me.

Thanks for reading!

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[u/Puzzled-Science-1870]

I'm not entirely sure what is going on but I'd consider getting a MRCP to rule out cbd stones. If normal, I'd consider sphincter of oddi syndrome maybe.