EXTREMELY high ALT (>400) and other liver enzymes high. ER worthy?

24 F 5’4 125 lbs half white-half japanese never drinker never smoker never drugs. lorazepam 1 mg 3x daily as needed (mostly take 2x daily) and propranolol 20mg 3x daily as needed (usually take 2x daily) for panic disorder. no physical health complications.

on may 4, i came down with severe pain in my abdomen, about an inch above my bellybutton that caused vomiting. this has happened to me 4 times in total. 2 of those times i went to the ER. ct scan with contrast and x ray of abdomen came back normal, along with all blood work except my sodium being slightly low and my WBC being slightly high. was told stomach flu both times and sent home. my last blood test prior to this was september 13.

most recently, on october 26, the same thing happened and i didn’t think much of it. i was doubled over in pain and vomiting but that was nothing new. later that night i spiked a fever of 103 but the pain had gone away so i figured it was a coincidence. i had a fever that high for 3 days that could be brought down with tylenol. i had no appetite. my urine was very dark but i figured dehydration and my stools were yellow-ish which isn’t out of the ordinary for me. when it passed i thought maybe viral infection but went to see a GI for the stomach pain. he wants to do endoscopy and abdominal ultrasound. endoscopy is scheduled for friday but the abdominal ultrasound isn’t scheduled until december 2nd.

i went to urgent care november 3 because my stools looked more grey. i got blood for viral hepatitis a, b, and c (i am vaccinated for hepatitis) which all came back negative. my CBC came back perfectly normal besides slightly elevated monocytes (8.7%) however my alkaline phosphate, ALT, and AST were very high. the numbers are as follows:

• Alkaline Phosphate - 161 IU/L

• AST - 201 IU/L

• ALT - 479 IU/L

i was called immediately after my results came in today and told to follow up with my GI asap. i got an appointment in for tomorrow at 9 am with a nurse practitioner but the receptionist didn’t seem to understand and acted like i was being a hypochondriac.

are these numbers er worthy? no more vomiting, intense pain, jaundice, or fever and my appetite is back and normal. what do i do? thanks for any help.

update: went to ER that night. it was gallstones.