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Blood Work/Symptoms Show Probabiltiy of Cirrhosis?
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Blood Work/Symptoms Show Probabiltiy of Cirrhosis?

Blood work is as follows: M born 2/4/76 - 5'9" - 185lbs diagnosed with IBS and Panic disorder for 7 years..Took Paxil for 6 years.Tear 2001 results weight- 190lbs: Sed Rate-1, AST-25(0-40), ALK PHOS-68(24-140), Total Bili-0.7(0.1-1.2),ALBUMIN-4.6(3.5-5.5),Globulin(CALC)-3.0(2.2-4.1),Total Protein-7.6(6.0-8.5)WBC-6.6(3.7-10.5),RBC-5.57(4.1-5.6),MCV-83(80-98),Platelets-301(155-385), glucose-93(65-115)
Dec 2002 quit chewing tobacco/ Gained 30LBs weighs 210lbs.--Stopped taking Paxil Jan1 2003 lost roughly 35lbs in 4 months due to below symptoms and anxiety over disease (cancer etc)
Presents with dyspepsia/Indigestion/Burping/problem swallowing due to excess mucos/ Possible reflux but no pain or burning/ 2003 results weight- 190lbs: ALT-92H(1-55), AST-42(1-45), ALK PHOS-61(27-142), Total Bili-1.2(0.1-1.5),ALBUMIN-5.0(3.8-5.0),Globulin-2.5(2.0-3.8),Total Protein-7.5(6.2-8.3)WBC-5.5(4.1-11.3),RBC-5.74H(4.2-5.5),MCV-85(82-103),MPV-8.0(7.1-12.1),RDW-12(10.8-14.8),Platelets-260(150-400),glucose-91(65-110)Ultrasound Following blood work found everything normal size and ok with the exception of a Fatty Liver. Spleen, pancreas and gallbladder perfect, liver normal size.Much stress in personal life anxiety made it hard to eat..lost mor eweight down to 169lbs moving to FLorida from CA..Experienced a period of time where I was EXTREMELY drowsy, sometimes experienced difficulty in choosing the correct words when speaking..(not sure if related to coming off of Paxil, anxiety, extreme stress ro multi-tasking, Also had a bout with itching on tops of feet and slightly on palms.Thought it was fleas on feet and legs. Extreme exhaustion around time we were to move. Regular spasms of muscles in arms, chest stomach etc..Stools went from extemely dark with constipation to lght brown/tan/yellow.Have occassional had blood on toilet paper in past every since i had IBS but now it was more blood and attributed it to constipation. 9-24-2003 :Get to Florida have Colonoscopy, Endoscopy and all come back fine with nothing except a hemmorhoid. Hep screens all negative, Cholesterol-181 with HDL-73 and LDL-94,Trigly-68- sed rate-4 - ALT-87, AST-36. Stree level drops as we settle in and I get retested 12-12-03:ALT-70(12-72),AST-33(10-40),ALK PHOS-79(30-120), Total Bili-0.6(0.1-1.5),Bili Dir-0.1(0-0.3)ALBUMIN-4.6(3.2-5.5),Globulin-3.4(1.9-3.9),Total Protein-8(6.5-8)GGT-25(8-61),Amylase-55(25-115),Lipase-268(114-286),Ammonia-19(10-47),Ferritin-142(22-322),ANA index-0.70,ANTI NUCL AB-Neg,Cerulopl-21,MYOCAR SCR-<1:20, PROTIME-10.3(8.8-11.2),INR-1.03(0.8-1.2)Sed Rate-11. Dyspepsia comes back following much stress, fatigued alot again, yellow bruises on right leg not known. Have ultrasound done and technician only looks at Panc,Liverand GB, all normal except "VERY Small faty infiltration". 3/18/04:WBC-5.3,MCV-82.3L,MPV-8.9L,RDW-13.2,Plate-223,ALBUM-4.6,Glob-3.1,TBILI-0.8,BILDIR-0.2,ALKPHOS-84,ALT-107H,AST-47H,GGT-28.Gastro/HEP observed-Rec Biopsy for"Comfort"-Internal Dr-Rec no biop
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You note mildly elevated iver enzymes as well as a colonoscopy, upper endoscopy and ultrasound.  The ultrasound comes back with small fatty infiltraion.  You also not discomfort in the left and right upper quadrant.  

Typically a liver biopsy is considered if the liver enzymes are 3 times above the normal limit (i.e. around 100).  You note some values close to this in the past (ALT of 92).  Hepatitis screen was negative.  

You can also test for iron levels to evaluate for hemochromatosis as well as an ANA level to evaluate for autoimmune causes (although this is more common in females).  

If there continues to be question as to what is causing the liver enzyme elevation, you can discuss a biopsy - at least to rule out serious causes.  This can be discussed with your gastroenterologist.  Other tests to consider would be an abdominal CT scan, 24-hr pH study (to evaluate for GERD) and gastric emptying scan (to evaluate for gastroparesis).    

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.
14 Comments
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Just to clarify..I am the patient who has thought he had everything from Esphogeal(SP) Cancer to Colon Cancer and now Cirrhosis again.. Visited 3 docs to look for "signs" and none have said they see any jaundice, spide veins on upper right neck area, ascites, or anythign to make them suspcious..All felt liver and said it felt fine and not swalloen..Once he siad he could not even feel it. Hep Doc says to do liver biop "for comfort"..Which I am guessing from what other two docs have said is because he is worried about my anxiety and thinks that doing Biop would jsut let me relax knowing it was either NAFLD or NASH and not Cirrhosis. It is weird because I have felt pains nowon left side..not sure if IBS or spleen..But in past when I wass convinced I had EC or Colon Cancer or Kidney problems I was able to create extereme discomfort in those areas as well. Now I hope I am creating them in my left side and a little on the right..I do get pains that seem to be gas on right side that make me want to burp but are in or around liver area..Also most of discomfort tens to come from around the side of ribcage like in line with armpit towards back.

I have looked at much research and stats and being that I am not a women, am 28, not obese, not diabetic(though I do have it in my family and often feel bouts of "low blood sugar"),that I hope I am not in the 15% of NASH that turn to Cirrhosis. Also if I were to be having "Real" symptoms from Cirrhosis decompensated liver such as fatigue, bruising easilly, enlarged spleen etc..would it not have been somewhat visible through US and bloodwork..I mean I know it is silent until symptoms present but if these are symptoms presenting such as bleeding hemorhoids and such would it not be reflectd in thigns such as Liver function, not just enzymes etc...?? I just had a little baby and stress is building so I need to get an understandign of the situation as it were...I got panicked about the fact that my Platelets and WBC ahve been trending downwards in 3 test since 2001 but Internal Doc said not to worry and Hep just said to watch..Is this not a trend of Cirrhosis or would it be more dramatic?

What is time to Cirrhosis on average for those without Diabetes, being Obese etc with NASh..Stats all seem to poitn to 8-26% Progression but fail to say of which percent of them are patients with these extreme conditions.

Is my mind going mad with OCD again? Am I really ok...? Docs say it is a mostly benign condition and hep said that maybe in 20 years I will see Cirrhosis but that by then there will be meds etc....

Just need input.. Technician said Fatty Liver would proably not even be categorized as one since it was so little and she checked with radiologist who said the same but on report it did say fatty infiltrates..Although on previous one at different hospital under impression it said clearly" Fatty Liver" Does this mean it is improving?

Anyway thank you for your time,
Stephen and GOd Bless
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Wow a suitable candidate !!! read this and my other posts ,question; you say youve reasearched your symptoms ,havent you come accross yeast before???

Dr. Truss, author of The Missing Diagnosis, is an internist in Birmingham, Alabama. He has had more than 20 years of clinical experience with over 3,000 candida patients. He is convinced that yeast is implicated in a wide variety of human ills, from depression and hormonal disturbances to allergic reactions and auto-immune diseases. Chronic yeast infections, he believes, may be a causative factor in diseases such as multiple sclerosis, Crohn's disease, schizophrenia, myasthenia gravis and lupus.
Article by Dr Truss
Lack of energy and digestive disturbances, arthritic joint pains, skin disease, menstrual problems, emotional instability and depression. All symptoms of what I call the 'antibiotic syndrome' which have greatly increased in frequency in recent years.
On further examination, more symptoms may be discovered. Most of the gastro-intestinal tract is tender when pressed, especially the small intestine, liver and gall bladder. There may even have been a gall bladder operation that failed to improve the condition, sometimes even worsening the symptoms.
There could be a history of thrush or oral, anal or vaginal itching. When these are present the diagnosis of Candida is obvious but it may also be present in the absence of these manifestations and that can be somewhat confusing. The yeast or fungus Candida albicans, of course, thrives during antibiotic treatment. I regard it as reckless negligence to prescribe antibiotics without simultaneous fungicides and replacement therapy with lactobacilli afterwards. I believe that this practice has greatly added to our vast pool of a chronically sick population.
However, the 'antibiotic syndrome' is not just due to Candida. I regard it more generally as a 'dysbiosis' where the wrong kind of microbes inhabit the intestinal tract, not just Candida and other fungi, but many types of pathogenic bacteria including coli bacteria which are normal in the colon but become disease-forming when they ascend into the small intestine.
If the problem has existed for years, there is usually a lack of gastric acid which then allows the stomach to be colonised by microbes, causing inflammation with pain and later, ulcers. The toxins released by the microbial overpopulation cause in addition chronic inflammation of the liver, gall bladder, pancreas and intestines. I regard it as rather likely that a chronic inflammation of the pancreas is a major contributing factor in the development of insulin-dependent diabetes.
Bacterial attack
Specific types of pathogenic bacteria appear to cause or contribute to specific auto-immune diseases. One variety of coli bacteria, for instance, produces a molecule that is very similar to insulin. When the immune system becomes activated against this molecule it may then also attack related features at the beta cells of the pancreas
Another type of bacteria, Yersinia enterocolitica, induces an immune response that attacks the thyroid gland and leads to Grave's disease with a serious overproduction of thyroid hormones.
Ulcerative colitis is linked to overgrowth with pathogenic microbes, the same as Crohn's disease, osteoporosis and ankylosing spondylitis. In ankylosing spondylitis the vertebra of the spine fuse together causing stiffness and pain. Other joints may in time become affected.
Klebsiella, another type of pathogenic bacteria, produces a molecule that is similar to a tissue type found in people with this disease. When klebsiella numbers in the gut decrease, related antibodies in the blood decrease and the condition improves.
Rheumatoid arthritis is linked to other bacteria, called proteus. Proteus is also a common cause of urinary tract infections. Women suffer urinary tract infections as well as rheumatoid arthritis twice as often as men, while men usually have higher levels of klebsiella and three times more ankylosing spondylitis than women.
In addition microbial overgrowth dam ages the intestinal wall so that only partly digested food particles can pass into the bloodstream, causing allergies. In this way all auto-immune diseases can be linked to food allergies.
While rheumatoid arthritis is a frequent feature of the antibiotic syndrome, and I regard it as relatively easy to cure, not many sufferers of this disease seem to be interested in this natural approach. The other day a young man with severe rheumatoid arthritis knocked at my door to collect money for a medically sponsored walkathon. When I told him that I do not give money for drug treatment as it can be overcome with natural therapies, he shouted: 'You are mad!' and left visibly upset.
Other auto-immune diseases that have so far been linked to dysbiosis are psoriasis, lupus erythematosus and pancreatitis. When remedies are given that bind bacterial endotoxins, these conditions usually improve. A further consequence of dysbiosis is susceptibility to food poisoning as with salmonella bacteria, while a healthy intestinal flora prevents these from multiplying and causing trouble.
Staphylococcus aureus or golden staph cause serious infections in hospital patients. It has been found that not only golden staph but also other infections are greatly potentised when they occur with a Candida overgrowth. As Candida overgrowth is a natural outcome of the standard hospital treatment, it is easy to see why golden staph is so deadly in hospitals.
A similar picture emerges with AIDS. People do not die from the AIDS virus but from Candida-potentised bacterial infections. I also see the antibiotic-induced dysbiosis in babies and infants as the main cause of their frequent infections, glue ear and greatly contributing to cot death.
While it used to be uncommon for children to have more than one or two infections a year, now more than six is the norm.
In the 1940's Candida was found in only three per cent of autopsies, now the figure is nearer thirty per cent. There are, of course, other factors that can cause dysbiosis - the contraceptive pill, steroids and other drugs, radiation treatment and chemotherapy - but the main culprit is, without doubt, antibiotics.
Closely related to Candida are the mycoplasms or pleomorphic organisms. These have been shown to be a main factor in the causation of cancer. Therefore, antifungal therapy has also major benefits in cancer treatment.
Dr Orian Truss
In 1953 Dr Orian Truss discovered the devastating effects of antibiotics in  Alabama (USA)

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Oh doctor I should also mention physical symptoms:

Previously experienced:

Drowsiness
Fatigue
Feeling like leg and hand muscles were weak
Rapid Onset of Eye Floaters follwoing 30lbs weight gain after quitting tobacco and Paxil
Mental Fuzziness, like not feeling as "sharp" as I used to.
return to panic attack symptoms though more confusion and disorientatin at times...liek a sensation of haze ..
Dark stools and constipation switching to Light stools
Bleeding hemmorhoid
Episodal occurrence of itching on tops of feet and palms...moderate on top of feet and in the exact same location not generalized over the entire foot
Dyspepsia (worse when nervous or over consumption of soda)
Nausea (worse when anxious etc)
Chronic burping (especially when upset or talking frequently)
Spasms in regions GI Doc said was my Common Bile Duct area
New Sensations of cramping in or around same region that ultrasound technician said were my bows
Cramping sensation on right side of ribcage in line with armpit
Yellow bruises in a line on leg that no idea where they came from.


Thank you again
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Oh I forgot:

excessive thick mucos in throat when eating
Sometimes sudden shrtness of breath (though peak flow meter says I am fine)

These two have contributed the most to my lsing the 35-40lbs. I am back at 183lbs now though..Trying to get back down to 170LBS at 5'9"
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Again an answer that is lacking, but this time you did not even bother to examine the question..An example is that you recommend checking for ANA test..When I did list in my post : "ANA index-0.70" ..Also you mention Iron levels well a low MCV would be contradictory to an over abundance of Iron in the blood. What's more you state 3 times the normal range...If you are speaking of Normal range then you would see that of the 2 labs testing ALT one had a normal range high point of 55 which would equal 3x55 or an ALT of 165. This a far jump from a high of 107. Also the other lab, which is rated #5 in the Nation - florida Hospital Celebration, has a normal high point of 72 which would be 3x72 =216..again this is a far jump from 107. SO your indication that a liver biopsy is practical at 3's normal range high and you say near 100 would mean that the high end of the normal range you are referring to is between 30-40. Which is a range I have yet to see on any of the 4 labs that have done blood work on me. Also usually such indication to perform a biopsy for the reasoning you state would be that it is absent of any imaging test findings. I.E. My Fatty Liver finding would justify the ALT levels.

I was hoping for someone with knowledge of lab results regarding Cirrhosis trends etc..as well as an understandign of NASH stats to give me an opinon that showed they cared enough to actually think on the matter at hand instead of posting what is apparently a canned response.

I am sure that you are an outstanding person Kevin and that you mean well, but I must say that I wish that you would have at least been thorough in reading through my blood work.

I guess one could not expect more for $16 and I appreciate your time. I will continue to read the other posts from patients on here and hope that you can be prove instrumental in their cause.

God Bless,
Stephen-k
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Hello Stephen,  I would be glad to discuss NASH with you.  I have been diagnosed with NASH by the doctors at the National Institutes of Health and was treated there during a clinical trial.  I have access to Medical books since I work in a library.  Medical text books have to be updated and new editions issued every year to keep up with changes in the field of medicine.  NASH is considered a mild disease.  Doctors are not overly concerned with treating it yet.  I live with NASH every day and I know how hard it is.   Did you know that symptoms like stuffy nose and itchy skin is from liver disease?
Anyway, if you are still loggin on and reading posts, here I am.  

   Roxnsox (Alice)
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RoxnSox....God bless you for replying..I would love any info you have to offer..If you are interested in my case all of the info is above...May I ask how old you are and what is your disposition towards NASh..In other words do you have trouble with obesity, are you diabetic, are you female middle-aged etc... Currently I fit into none of these categories though I have been experincing what appears to be a feeling of low blood sugar lately almost 3 times a week. Do you have any symptoms with yours and have you had the biopsy..What are some of your blood levels? Have you heard any stats regarding NASH progressing to Cirrhosis in those without obesitity, Diabetes Melititus, male in younger then 40. Also I have not drank a beer in over 7 years and in the past 7 years the only meds taken were Paxil and Xanax...Never took anything else..not even asprin...Have not taken any meds in over 1 year either. Most concerning is blood work...I have been told by 3 Dr.'s that I am letting my OCD take control because the WBC and platelet decline is still in normal range and nothing to worry about....

Anyway any inout would be great...Also where did you hear stuffy nose is related to Liver Disease? I have been stuffed up for over 6 years now..But I think that is mor eallergy related..Only link I have ever seen between stuffy nose and Liver disease is with Cystic Fibrosis..

Any input,
Stephen-k
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You asked (in another thread) for my input. I'm no expert in hepatology, but I'd have the following comments: first, the liver test abnormalities are so minimal, and are associated with normal liver function in every other way, that it seems highly unlikely to have significance. There's really no indication for liver biopsy, other than peace of mind -- but in my experience, it's in those situations, where something is done that has slight risk, and really no indication, that problems such as bleeding seem to occur. I'd recommend against it. If it were me, I'd plan to have liver function tests every 6 months or so for a few years, and do nothing more unless they are changing in a significant way. I realize it's hard not to obsess when there are lingering questions. But I'd say that seems to be what you are doing. Finally, as I've said in other posts (always resulting in scathing from "paj"), the yeast thing is totally bogus in my opinion, and the doctor cited is regarded my scientests as a quack. In such matters, of course, there's never universal agreement. Bottom line: it sounds as if at the present time you don't have a significant liver problem, and followup monitoring is an appropriate reaction.
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Is PAJ a Physician?
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Hello again,  I'll give you some more background information---Yes, I had 2 liver biopsies---one at the beginning and one at the end of the clinical trial.  I had many other medical tests, including Oral Glucose Tolerance test, IV Glucose Tolerance test, DEXA scan, MRI, Ultrasounds, X-rays and numerous blood tests.  I have mildly elevated liver enzymes, and mildly elevated cholesterol.  (I do not take Lipitor or other cholesterol meds because I have a "liver problem".) I am a bit overweight.  I weigh 200 pounds and I am 55 years old.  My doctor has advised me to follow the diet recommended by Dr. Walter Willett in his book, "Eat Drink and Be Healthy".  (There is a similarly titled book--be careful you get the right one.)  I avoid all trans fats in my diet.  I found that once I eliminated them from my diet I felt much better.  It is a difficult thing to do but it can be done.  I rarely eat fast food.  And I don't buy anything from a vending machine.  The testing I had done during the clinical trial showed that I am insulin resistant.  My mom is diabetic and I see her suffering with the effects of the disease.  
  In all the reading I have done about NASH the researchers have found that anyone can have NASH.  In the beginning they thought it was just a disease of plump women over 40 years of age, but that is not true. There are studies in the medical literature about children with NASH.  
   I'll write more later.  roxnsox (alice)
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Me again,  There was an article in the New England Journal of Medicine, April 2002 (Volume 346 number 16 pages 1221-1231) entitled "Nonalcoholic Fatty Liver Disease".  This article explains most of what is known about steatohepatitis (the nonalcoholic type) up until the time the article was published.  It is a good place to start.  There is a website for New England Journal of Medicine---www.nejm.org.  If they won't let you read the artricle online for free there are ways to obtain it.  You can get it and other items by interlibrary loan through your public library.  Or maybe a library near you has the Journal.  
  More later....
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Actually I have done exhausting research through just about every piece of info found online. In terms of "insulin resistance" what specific tests did they do to determine that diagnosis and did they give you meds to treat? Once they treat the insulin resistance doesn't that then stop the NASH as this would be the cause?
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Surgeon thank you ever so much for your reply as it has given me some relief from thinking that this Fatty Liver was going to kill me soon..

God Bless,
Stephen-K
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The Oral Glucose Tolerance Test (OGTT)and the IV Glucose Tolerance Test (IVGTT) determined that I am insulin resistant.  The drug that they were testing in the clinical trial is Actos (pioglitazone).  Actos has a website---actos.com.  They put some information on their website about insulin resistance.  
  There are more Clinical trials in progress at NIH and elsewhere.  If you go to NIH.gov and click on the Clinical Trials link and then search on Fatty liver, steatohepatitis or pioglitazone you will find the Clinical Trials.  There is a lot of information there about what qualifies a person to be studied.  If you participate in the clinical trial all of the medical tests are FREE.  Nothing is submitted to insurance companies.  I am so glad that I participated.  

  roxnsox (alice)
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