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Gastroenterology  (Expert Forum)
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Fatty Liver
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
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MedHelp Member's Question

Fatty Liver

by Jigger, Apr 07, 2003 12:00AM
About 7 months ago, I went to my internist suffering from epigastric pain. My internist, who is also my best friend, ran a complete physical on me. The whole nine yards. Two days later he called back and said that everything was just fine except my liver enzymes were slightly high. ALT 70 and AST 58. Their lab scale is 0-59. He was not real concerned about this, but he did want to find out why I was having epigastric pain, so the next day we did an ultrasound of my belly. I had significant fatty liver. I immediately got nervous. I unfortunately have been a very heavy beer drinker since my feshman year in college. I'm 32. So, for 15 years. I'm an avid jogger and kind of thought it would all balance out. This is not the case unfortunately. I would not say that I drank every day, but I drank very heavy when I drank. Needless to say, I have not drank since the day, I got that news. And after studying the liver on the web for the past 7 months, I never will. My enzymes were back in the low normal range within 3 days. And my fatty liver disappeared within 3 weeks. My uncle is a radiologist and he ran an MRI and an ultrasound on me. He said, I was fine just lay off the beer. The internet is full of so much information, I started worrying about my liver. Fibrosis was my main concern and still is. The imaging test that I have had do not show microscopic scarring. My internist as well as my uncle have told me that a biopsy is out of the question. I do not have any other concurrent damage occuring like HEP C. They said that my liver is perfectly fine. My other liver panels have been OK also. Bilirubin( direct and indirect, PT, albumin, ect. My stomach pain turned out to be gastritis. I've had every test in the world run on me to find this out. Hida-scan,barium swallow, and finally and upper endoscopy that revealed gastritis. It has passed and I feel great except for my anxiety and guilt from drinking all those years. I woory because I'm marrying a beautiful girl in May and want to live a long healthy life with her. Do you concure with my internist. He say's I'm very healthy for my age. I run 10 miles a day and have since I was 17. Even with all the drinking. He said a biopsy might show come minimal fibrosis, but it was not compromising my liver and was of absolutely no significance. My uncle, the radiologist agrees. He says--"GET OVER IT"    Can someone have mild fibrosis and live a normal lifespan? I probably do not even have fibrosis, but what if I do. Your in put would be Appreciated----  AL
Doctor's Answer

by Kevin Pho, MD, Apr 07, 2003 12:00AM
Hello - thanks for asking your question.



I would agree with your internist and your radiologist uncle.  You have had an ultrasond and MRI which your uncle said was fine (i.e. no more fatty liver).



If your liver function tests (AST, ALT, TBili, GGT, PT etc.) are completely normal, then I would not be worried.  To give yourself further peace of mind, you may want to run heptatis screens to ensure you do not have concurrent liver disease.



The definitive test would be a liver biopsy, however in the light of a normal ultrasound, MRI and liver function tests, I do not think it is necessary.



It is possible to have mild fibrosis and live a normal lifespan - if you continue to be concerned, then periodic liver function tests can monitor any decrease in liver function.  



Congratulations on quitting alcohol - that is probably the best thing you could have done in light of your previously elevated enzymes and fatty liver.



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 (35)

by roxnsox, Apr 07, 2003 12:00AM
Hello,  I have NASH (Nonalcoholic steatohepatitis).  I was diagnosed after extensive testing, including oral glucose tolerance tests, blood tests, and liver biopsy at the National Institutes of Health in Bethesda, MD.  After being diagnosed with NASH, I then participated in a Clinical Trial at the National Institute of Health to test a drug for this disease.  I have completed the clinical trial and am now participating in 6 months of follow up visit with the docotrs at NIH.  This is a newly recognized disease and a lot of doctors are not up to speed with the current research.  I would imagine that most doctors are quite busy and don't have time to read the in depth articles on current research.  NASH is a fairly mild disease and it is not on the top of the doctor's list of things to worry about.  So it is best to educate yourself and learn to take care of yourself.  I am glad that you have given up the alcoholic beverages.  Just remember that everything that you eat goes through your liver.  I was very careful about what I ate during the year that I was participating in the clinical trial and the biopsy I had at the end of the trial showed that I had less fibrosis.  So if you take care of yourself you can improve your "liver health".  My liver enzymes have dropped back into a normal range as well.  The best place to read about the liver on the internet is www.liverfoundation.org.

  I'd be glad to discuss "fatty liver" with you again, if you like.

by Jigger, Apr 08, 2003 12:00AM
I just get confused with the fine line between fibrosis and cirrhosis. What foods are bad for the liver?  JIGGER

by roxnsox, Apr 08, 2003 12:00AM
alcohol

by hgreene, Apr 08, 2003 12:00AM
Is it possible for a relatively healthy 26-year old woman to drink herself to death if she's only been a moderate/heavy drinker since the age of 18? (I ask because, in short, my mother had an alcohol problem (in part due to spousal abuse)... died at the age of 26.) I would like to know if it's possible or even remotely likely...

I did get the autopsy records, but as I do not have a medical background, it reads a little difficult. I had another relative bring them to work and it would seem that she may have had some sort of hepatitis. Is there a hepatitis that is not passed along to children/spouses and that she would have been likely to contract.... She lived in New England for most of her life, was a housewife... did no needle drugs... I would be most thankful for your assistance. :)

by roxnsox, Apr 08, 2003 12:00AM
Alcohol is one thing that the doctors are sure is bad for your liver.  Tylenol is also bad for the liver if you take more than the recommended dosage or combine it with alcohol.  There are some other drugs that are known to be bad for the liver and they are drugs that are used for epileptic patients to control seizures.  

   A person can have this nonalcoholic steatohepatitis for years and not have symptoms except for