After weight-loss surgery, some patients may experience a transient elevation in liver function tests that resolves over time. We have previously reported on this. IT is essential to distinguish between the Duodenal switch and the SIPS/SADI procedure, where some patients are led to believe they are identical. These procedures differ physiologically, and their weight loss and metabolic behaviours vary significantly.

Other than the stress of the weight loss, obesity, and comorbidities of obesity, there may be other anatomical post-surgical causes for elevated liver function test. This has also been discussed extensively.

A recent literature review supports the protective effects of vitamin D supplementation.

Effects of vitamin D supplementation on the glycaemic indices, lipid profile, and liver function tests in patients with cirrhosis: a double-­ blind randomised controlled trial

Low serum 25-hydroxyvitamin D levels are associated with liver injury markers in the US adult population

Exploring the Correlation Between Vitamin D Level and Serological Markers in Liver Diseases: Insights from a Cross-Sectional Study

Elevated liver enzymes may be caused by many factors, including nutritional deficiencies, excessive supplementation (turmeric), medications, alcohol, adhesions causing partial bowel obstruction, and increased enterohepatic bile reabsorption . I would be very cautious about associating vitamin D supplementation with elevated liver function test results, even if the vitamin D level is in the very high normal range, regardless of the  daily dose (much less frequent with injectable).

Vitamin D, as a fat-soluble vitamin, however, protects the liver and improves liver function test even in very high serum level . In rare cases, prolonged, elevated vitamin D levels may strain the liver. In Fact, the association of the vitamin D level and liver disease, including cirrhosis, leads to hepatocellular carcinoma (HCC) and dea h. Vitamin D protects the liver from HCC but cannot reduce the risk of cirrhosis.

Gallbladder disease can include both anatomical and functional condition. We are familiar with gallstones. Bile acids, Lecithin (a phospholipid), and cholesterol are present in the Bile. When the proportional percentage of each one of them is outside a very narrow range, gallstones are formed. Approximately 75% of the gallstones are formed because of the supersaturation of the content of the gallbladder with cholesterol which results in cholesterol stone formation.  The rest are pigmented stones.

Gallstones are usually identified by ultrasound and they are seen as shadows.

There are patients that have a normal gallbladder ultrasound result   that  continue to have signs and symptoms of gallbladder disease, such as abdominal pain in the right upper quadrant, nausea and vomiting with fatty meals, and bloating to name a few. These patients should be evaluated by a dynamic HIDA scan.

A dynamic HIDA scan study evaluates the function of the gallbladder, by creating a movie of the gallbladder, where as an ultrasound takes pictures of the gallbladder.

In a dynamic HIDA scan, and contractility of the gallbladder is reported in form of ejection fraction (%EF). This represent the amount of gallbladder contraction in response to the stimulation  by a fatty meal mediated thru cholecystokinin (CCK).  A normal EF is greater that 35%. Anything less than than with the sign and symptoms of gallstones, should be highly suspect for acalculous cholecystitis. Calculus because there is no stone.

(The bright white collection represents the filling of the gallbladder)

This short movie represents the uptake of the radio nuclear material in the gallbladder and its normal secretion in the small bowel.

These are the static images before the injection of CCK.

Following the injection, digital subsection of the images measure the amount of nuclear activity of the gallbladder before and after contraction and an Ejection Fraction is calculated.