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Gastroenterology  (Expert Forum)
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Decreased Attenuation on Liver
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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MedHelp Member's Question

Decreased Attenuation on Liver

by newwoga, Mar 19, 2003 12:00AM
I am a female in my late 20's and have had digestive problems (IBS symptoms) for about 5 years. I am not over weight, I eat pretty healthy, and exercise. (I did use to bing drink quite often in high school and colledge, but now only have 1-4 alcoholic drinks a week. no drug abuse) I have had gas, bloating, upper and lower quandrant pain, brain fog, allergies, joint pain, menstrual irregularities, noise sensitivity, itchy skin, ect.  I feel like a hypocondriac.  I saw a GI Doctor 2 years ago and had many tests ran.  I was diagnosed with IBS.  Nothing else fit, all tests said I was otherwise healthy. I saw a family doctor recently and had many blood test ran.  One blood test came back with slightly elevated amylase. It was at 118. A CT scan was then done from my lower chest down.  Everything looked good.  The report did say this, " decreased attenuation next the the falciform ligament which is believed to represent area of focal fatty infiltration and is of no clinical significance".  I also had a 1cm cyst on kidney.  Anyhow, the family doctor said that the decreased attenuation area was very normal and of no concern since I don't have alcohol or cholestorol problems.  

I do drink herbal teas often like detox tea and stomach teas.  I  tried taking herbal remedies for my mentrual problems before, but that seem to make things worse.  



My question is in regard to the decreased attenuation.  Should I have concern with decreased attenuation (does it effect the functions of the liver)? Is it really normal? How do I know if fatty infiltration has occured or will occur.  And is it reversable if it is a problem?

Thank you
Doctor's Answer

by Kevin Pho, MD, Mar 19, 2003 12:00AM
Hello - thanks for asking your question.



Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.



Fatty liver is an excessive accumulation of fat (lipid) inside the liver cells.  There are many causes.  Here is a brief list:



Obesity

Diabetes

Chemicals and drugs (such as alcohol, corticosteroids, tetracyclines, valproic acid, methotrexate, carbon tetrachloride, and yellow phosphorus)

Malnutrition and a diet that is deficient in protein

Pregnancy

Vitamin A toxicity

Bypass surgery of the small intestine

Cystic fibrosis (most likely accompanied by malnutrition)

Hereditary defects in glycogen, galactose, tyrosine, or homocystine metabolism

Medium-chain aryldehydrogenase deficiency

Cholesterol esterase deficiency

Phytanic acid storage disease (Refsum's disease)

Abetalipoproteinemia

Reye's syndrome



Alcoholic fatty liver is rarely diagnosed clinically because most patients are asymptomatic and do not seek medical attention. The only complaint may be mild tender hepatomegaly. Liver tests are generally normal or modestly elevated, and jaundice is unusual.  Alcoholic fatty liver is reversible if alcohol use is stopped.  



Fatty liver may develop after a single large binge and does not predict progression to hepatitis.



If the fatty liver is due to other causes (see above), they will have to be properly appropriately treated to improve the fatty liver.    



I assume that you had liver function tests performed.  If they are normal, periodic tests can be done to monitor liver function.  If the liver function tests remain completely normal, it is unlikely that there is a serious liver disease present.  Fatty infiltration can be detected on imaging studies such as ultrasounds and CT scans.  



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

Member Comments (9)

by newwoga, Mar 19, 2003 12:00AM
Does the decreased attenuation neccesarily mean there has been fatty infiltration, and if not does the decreased attenuation affect the livers function???

by kevinmd, Mar 19, 2003 12:00AM
To: newwoga
Decreased attenuation can be caused by many things.  Without a biopsy we can only speculate.  From the radiology report, it is likely an area of fatty infiltration.  To determine whether it affects liver function, blood tests to evaluate liver function would have to be performed.



Thanks,

Kevin, M.D.

by newwoga, Mar 19, 2003 12:00AM
Thank you for responding so quickly.  I had tests that checked my liver function because of my symptoms. They only thing that was abnormal was my amylase. It was 118 and high limit was 100. Anyhow, I am going back in 6 weeks to get my amylase checked again.  My pancreas was normal in the CT scan.  My doctor said that where I don't have an alcohol problem or high cholestorol that the decreased attenuation was of no concern.  So you are saying that decreased attenuation usually means that there has been fatty infiltraton.  Could I have fatty liver and still have normal liver function blood test results?  I am also wondering if you can have decreased attenuation and not have fatty infiltration.



thanks for your help

by newwoga, Mar 19, 2003 12:00AM
I am sorry if I am asking too many question? I am just nervous about my doctors non-concern..

Does a CT scan show if the liver has fatty