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Do I have liver disease?
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Do I have liver disease?

I went to the doctor with complaints of dizziness, some nausea
and unusual vaginal bleeding.  The bleeding has since subsided
and the only symptoms I have now are fatique, light colored
stools and dizziness.  My lft, ultrasound and CT scan were all
negative.  Do you suspect liver disease?
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There can be many diseases that can lead to your symptoms.  

However, if the LFTs, ultrasound and CT scan are all normal, it is unlikely that liver disease is present.  You can continue to further evaluate the gallbladder with a HIDA scan to complete the evaluation.

The dizziness can be evaluated via neurology evaluation and possible brain imaging.  Nausea can be initially evaluated with an upper GI series and/or upper endoscopy.

These options can be discussed with your personal physician.

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.

Kevin, M.D.
kevinmd_
39 Comments
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Avatar_n_tn
I forgot to mention I also have red spider angiomas and
nausea
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Avatar_n_tn
Dizziness and nausea? I don't think dizziness is a symptom of liver disease is it?  With all your negative tests i'm just curious why you are concerned about liver disease.The dizziness and nausea could be realted to an inner ear problem or to many other things.

Linda J
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Avatar_m_tn
You have every symptom of a liver issue going on, I'd get tested for hepatitis right away ( a, b and definately c) and have your liver enzymes monitored. See a Heptologist if you can, they are liver specialists there could be a lot of reasons, you need a good liver doc.
The spider nevi are a sign of liver issues too as are all the symptoms you mention including the nausea.
good luck, hope you find out soon what is going on.
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Avatar_m_tn
I wanted to add that having a "clear" CT scan or ultrasound really doesn't tell you much other than you don't have any tumors or masses, which is good of course, but the gold standard to determine liver damage is a biopsy and only a biopsy. You can have normal enzymes and have cirrhosis for example, so don't go by just within range enzymes.
How were your platelets?
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Avatar_n_tn
No doctor will order a biopsy of the liver, in my opinion, absent abnormal lfts, cat scans, and ultrasound. You are needlessly alarming.  Yhis can be the result of other issues than the liver.
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While a liver biopsy is the "gold standard", no doctor is going to order a liver biopsy based on normal LFT's and ultrasound. It would be highly unlikely to have liver disease with these 2 things being completely normal. A liver biopsy is highly invasive. This isn't something one undertakes lightly.

I'd say she needs to get the unusual vaginal bleeding evaluated by a good gyne. But, to jump to a liver biopsy based on what she posted is overkill.

Linda J
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Avatar_m_tn
She has symptoms of liver illness, light stools, nausea, fatigue and you CAN indeed have cirrhosis and not have elevated enzymes. She needs to be tested for all heps and be screened for other liver disorders and gallbladder problems, etc. Many go undiagnosed or misdiagnosed with liver problems. I know, it happened to me and I had the very same symptoms as she does. I said biopsy is the only way to determine her liver condition,I didn't say she should run out and get one just that she needs to understand that "silent killer" diseases do not always make themselves obvious. She needs a Heptologist or Gastro to look further and I agree it could be something else but she needs someone to look further. What are her platelets doing? If they are low that is another sign of liver problems, she needs to be evaluated more thoroughly. I agree she needs to also see a GYN to evaluate the vag. bleeding, but that too COULD be related to liver issues, particularly if she has hep.it can mess up your cycle causing spotting. That happened to me also.
It is not good to judge by enzymes alone to determine a liver issue especially when the person is symptomatic like she is and to suggest that if her enzymes arent elevated nothing is wrong with her liver is not correct, enzymes do not tell the whole story.
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Avatar_m_tn
PS. her spider angiomas are also a sign of cirrhosis and/or some other liver issue, she has all the earmarks of a liver problem even if she has a clear untrasound and CT scan, those tests can't determine if she has cirrhosis either. I sure hope she gets a liver speciailists opinion and doesn't have to wait until her symptoms are worse to find out what is going on.
My vag. bleeding was one of the things that threw the docs off the scent thinking it was a gyn issue, in the end after many months of sickness I finally saw a gastro who put it together right away.
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Avatar_n_tn
You can indeed have cirrhosis with normal enzymes and cat scan, but is it LIKELY she has that with normal tests?  Fine, test for hepatitis, but his could be gallbladder as well, as she has not had a hida scan as of yet.
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Avatar_m_tn
I agree, a hida scan would help too.
I know that the symptoms could be indicative of something else entirely, I just hope she gets to a specialist and gets some answers.
The spider nevi are a big tip off to it being liver related and you can also have a liver issue that can aggravate the gallbladder, they can go hand in hand so she should have both investigated. Many people with Hep develop gallbladder problems.


Didn't mean to be alarmist when I mentioned a biopsy, but many people think all is "ok" because they have a clear untrasound or CT scan and with liver problems, that just isn't the case, they can't see fibrosis or cirrhosis with those tests.
They don't tell the patient that little fact and the patient might have a false sense the liver is fine when it is not.
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Avatar_n_tn
Yes, you CAN have liver disease with normal scans and LFT's. But, my gastro said it would occur less than 5% of the time. Her spider veins can also be caused by sun damage. My hubby has them and has no liver disease. No offense, but you seem to want to "diagnose" everyone with cirrhosis. Lots of conditions have similar symptoms.

Linda J
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Avatar_n_tn
Just curious, how did your vaginal bleeding figure into a diagnosis of liver disease?

Linda J
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Avatar_m_tn
that's ridiculous, I didn't do any such thing. She asked if anyone thought her symptoms sounded like a liver issue and they do.
No offense, but you should read through more thoroughly before you go off accusing people of trying to diagnose someone which I certainly did not do. A gyn might help her with that one issue, what about all the other ssymptoms she mentions? You would just ignore those and suggest she just see a gyn for vaginal bleeding? I say she needs more extensive testing and to see a Gastro too.
Many people dont know they have a liver issue until it is advanced so she is smart to check it out.

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Wouldn't a cat scan or ultrasound SUGGEST fibrosis or cirrhosis though?  I know this can only be diagnosed with a biopsy, but every doc I have talked to thinks the cat would catch any changes to the liver, ie if the liver was enlarged or smaller, or if there was changes in the structure.  No test is perfect, but did you have liver problems with normal cat scan and lfts?
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Avatar_m_tn
I was told they can't detect it without a biopsy although I hear they are testing a new machine that is in trials now "Fibroscan" this is supposed to be able to detect it without having to biopsy.
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Not sure why you are so touchy. I know quite a bit about liver issues since I went thru extensive testing (about $3000 worth) myself recently. Dizziness is not a symptom of liver disease. That could be anemia or something neurological.

Again, with normal scans and normal LTF's it is UNLIKELY she has liver disease. You seem to not want to address that.

LInda J.
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Avatar_n_tn
I just went thru extensive testing by a well respected gastro specialist. He said exactly what muckman posted, while cirrhosis cannot definitively be diagnosed by CT or ultrasound, it is usually "strongly suggested" by these tests.

It is typically end stage cirrhosis that presents with normal liver enzymes. By that time the patient is exhibiting other symptoms like jaundice and ascites.

Were you diagnosed with cirrhosis after normal LFT's and ultrasound?

Linda J.
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I had my gallgladder removed in Marh due to stones. 2 weeks after sugery I had a severe attack, almost like the gallbladder attacks. I took pain meds and reported this to my surgeon during my follow-up post-op vist. He said to give it some time. It has been almost 2 months and I have been experiencing pain on the right upper abdomen. In additon to the daily pain, I get severe nausea, w/o vomiting with the exception of 2 occaisions. A couple of weeks I called and they sent me for a CT Scan of the abdomen. I receieved a call the other day and the Dr said everything is fine. I was very surpised because I am still having daily pain and nausea, I am worse off now than prior to my surgery, at least prior I had breaks in between attacks.
I also had the Xray office send me a copy of my report. In my report it states that there is a 4mm lesion on the left lobe of the liver, the etiology is unclear, possibly a hemangioma. Also states that there is mild ectasia of the bile duct which can be seen post cholecystectomy. At the conclusion it states Indeterminate lesion in the liver. Is this all normal, don't I require follow-up? Why would surgeon who performed cholecystectomy say that my results were normal. I am confused.
Meanwhile I have to live with the daily on and off sharp and sometimes crampy pani and several episodes of nausea EVERY DAY.

Any feedback?
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Avatar_f_tn
First I apologize to the original poster, for this was your thread! Valley GO to another gastro please, if for nothing else for peace of mind!! Many times a Dr. will say normal when there are a few "little" abnormalities on the test!!
I also had my GB out and have more problems, if you want to
e-mail me   ***@****

Again sorry that we posted our own thread. Also to the original
poster, Why not just seek a 2nd opinion with a hematologist, just to put your mind at ease!
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Avatar_m_tn
I think you are the one attempting to diagnose this woman. There are many liver conditions she should be evaluated for with her symptoms. Cirrhosis is not the ONLY liver problem there is. You are in no position to tell her what is or is not going on in her liver and she deserves toknow and rule out liver issues and hepatitis to try to solve her symptoms.
And regarding your doctors telling you you are fine and everything is rosy, unless she has a crystal ball she can't say with any certainty that you definately have no liver scarring.

Here, if you don't believe me, maybe you will believe experts on the subject:

"The onset of cirrhosis is usually silent, with few specific symptoms to identify this development in the liver. As scarring (fibrosis) and destruction continue, some of the following signs and symptoms may occur: loss of appetite, nausea and/or vomiting, weight loss, change in liver size, gallstones, itching, and jaundice. However, a large number of people live many, many years with cirrhosis without any decompensation or symptoms."
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Avatar_m_tn
If you paid 3,000 to a gastro for "liver evaluation" and all you got was your bloodwork done and your LFT's evaluated and an ultrasound? I am curious what you got for that large amount of money?
The big money goes into the CT scan costs I guess but a CT scan isn't the best tool for liver evaluation and in my view is a waste of money unless there was a specific reason, a suspected growth or something. Did you have symptoms to warrant the evaluation? If you needed an evaluation of your liver, why wouldn't you see a Heptologist and not a Gastro? Believe what you want but the truth is what I stated and even WITH a biopsy you can be cirrhotic in one area of your liver and fine in another, so even a biopsy is not telling the entire story.
The only way to examine the whole liver is an autopsy and I doubt you have had one of those.
You accused me of "diagnosing" someone here, that is why I was "touchy" you should watch what you say. You are the one who is telling her she is fine in SPITE of her symptoms and she has quite a few symptoms she is coping with,so clearly she isn't "fine"  she needs to be tested for Hepatitis, all types of it and she needs to get to the bottom of her symptoms.
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Avatar_n_tn
from what ive looked into yes both can be normal with cirrhosis
but if you had cirrhosis your symptoms would be alot worse.
But i have a question for you two. I have normal lft and had a normal cat scan last month. I also had a biopsy that showed
last year that reads minimal fibrosis, slight portal tract imflammion, and slight fatty liver, with moderate iron present.
After the biopsy i was on meds trazadone and clonapine for 3 months and took them both everyday. I was a heavy drinker for 20 years. Now i have all they symptoms of cirrhosis- stomach bloats,
red palms, weight loss, confused, loss of appitite, private parts shrunk, also severe dry mouth. Ive been back to 2 gastros and my primary doctor. They look at my biopsy and say yes it shows damage but not severe. I tell them that i think the meds i was no made my liver worse they all do not agree with me because my lft and cat scan came back normal last month. I have the history of drinking and then the meds i took. I had alot of symptoms before the biopsy mostly weight loss. First you mentioned the biopsy can be wrong as far a what piece of liver they took. I think my damage was worse to start with. It seems the gastro and primary doctors do not know everything about the liver. I ask some qustions and they do not know. I have and appointed with a hepatoligist in 2 months. They tell me this doctor just does the liver and also deals with transplants.
Do you think he is my best bet to see. What test should i ask for . Someone mentioned a test that tells how the whole liver is doing not just a little piece. Also when i got my first symptoms my lft were sky high. They are normal now that i dont drink.
Are their better blood test to get. Thanks
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Avatar_m_tn
If you are still concerned I think seeing a Heptologist is a good move. If you have stopped drinking that is the best thing you can do for your liver. Fatty liver can be controlled and reversed with  a good healthy liver friendly diet and proper excercise. Your liver can heal itself if it isn't being assaulted with booze and poor diet and lack of exercise.If it is not cirrhotic you can reverse damage to the liver, the liver is a very forgiving organ. Fatty liver should be addressed and dealt with with the above mentioned regimen, discuss it with the liver specialist.
You can live a long life even if your liver has sustained some permanent damage so try not to worry too much.  Anxiety can cause many symptoms even physical ones so you might want to address your anxiety if you worry far too much about it. You stop the behaviors that are causing the liver problem and you are on the right track.
I wouldn't assume the meds you took have damaged your liver unless you have some evidence that is true, you didn't take them very long and you don't take them now so I wouldn't worry.

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Avatar_m_tn
What you said is not necessarily true that if you have cirrhosis your "symptoms would be a lot worse" you can be cirrhotic and not have any symptoms at all.
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Thanks for the information. Have you ever heard of dry mouth being a symptom of liver problems. I have unbearable dry mouth all the time. I also get severe growls all the time in between both my breast. I ask my doctor if thats the area of my liver and he says its my stomach. But as i looked up the body iknow the liver is on the right side but it also looks like it extends to the left side of your body right where i have these growls.
When my syptoms (symptoms) started i drank more to get rid of them. But then it all hit me and one day and i had to quit as i thought my liver was shutting down. Its been 15 months no drinking but my symptoms are getting worse. Another question is , i had my biopsy only 6 months after i quit drinking, i thought i read that it can take 2 years to see exactly how much damage you have done to show up . You also said one piece of the liver may be damage more than  the other. How can the doctors tell this. Yes you are correct you can have cirrhosis with no symptoms. Thanks again. Do you have liver problems or just know the subject.
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Avatar_m_tn
Have you been tested for hepatitis? I would do that and rule out that possibility. I think evryone should be tested for it as you can have it and not know it and an amazing number of people in the US have it and have no idea. It is the number one reason for liver transplant in America so it is worth a blood test to ensure you are not dealing with hepatitis. It is a simple blood test. Yes, dry mouth can be a symptom of liver problems. I contracted Hep C in an out patient clinic as did several other patients on the same day, unfortunately. I developed acute hepatitis c several weeks after the surgery. That is what inspired my education about livers. Try not to obcess about it, you can have an area that has some damage and live healthy and top notch life, it really doesn't matter if you are taking good care of yourself and there is no reason to worry about it without raised enzymes or symptoms or any other indications of a problem. Think of it this way, if you cut your arm and it heals but you have a scar, your arm is forever altered, but it doesn't affect your health. With minimal damage to your liver, it is sort of like that and doesn't have any health consequence so it doesn't matter and doing all kinds of unneeded testing won't help you. If you continue to drink or eat poorly then you risk damage otherwise our livers can heal themselves and regenerate from past abuse to a large degree.
There are limitations to any medical test, most only have a degree of medical certainty, nothing is absolute but docs can tell a lot by various indicators in your blood, how you look, etc. Clean living will ensure your liver stays healthy.
If you dont drink now, forgive yourself your past behavior and enjoy your improved lifestyle.
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You don't know me OR my health issues and they are really none of your business. Who are you to judge how good my gastro doctor is? For your information I had over $2300 worth of blood tests run...not just general liver panel tests....but alpha fetaprotein, ANA, mitochondrial tests and many more. All came back normal, as did my $600 ultrasound. I have no symptoms of liver disease, so my doctor and I are comfortable in not doing a liver biopsy.

In science, short of an autopsy, there is no perfect info. Sometimes you just have to rely on the best info you have and weigh the risks and advantages.


Linda J
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I guess you don't agree with the forum doctor's response:

"There can be many diseases that can lead to your symptoms.

However, if the LFTs, ultrasound and CT scan are all normal, it is unlikely that liver disease is present"

You see he says it is UNLIKELY liver disease is present when the above tests are normal. No one said it wasn't possible. But, UNLIKELY is the key word that you keep missing.

Linda J
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Avatar_m_tn
I respect the doctor here but he, as you, seemed to ignore her symptoms too and I think she needs to be evaluated further and be checked for hepatits as I stated in the beginning, "unlikely" or not means nothing to Kathleen because she still has symptoms and many docs do NOT test for hepatitis,my enzymes were "fine" too but I still eventualLy found out it was hepatitis. Many medical conditions can be "unlikely" but they still happen! She needs a diagnosis and should be further evaluated. The initial question was not about YOU or your troubles in the last year at all, it was about Kathleen, so I am not sure why your health has anything to do with it, you didn't post a question. You don't know anything about my health troubles either because my health issues are not relevant here only Kathleen's are.
I think it takes a lot less that what you stated initially which was " I spent 3,000 to have my liver evaluated" and that seems very high to me, now it seems you aren't sure how much you spent, now you have said it costs 2,300 in one instance, and 2,00 in another instance so even you dont seem to know how much you paid. I had my liver "evaluated" and it cost one fraction of that . I don't want people to be scared away from having their livers checked out thinking it is very expensive, it normally isn't. I had the tests you mentioned too, ANA and AFP tests can be done with a blood draw so I don't get the enormous costs you paid. Who am I to judge? You put it out there and I responded, this is a forum that is what is done here.
I am far from a pessimist but it is important people understand there can be liver problems with NO symptoms and for some reason that fact bothers you. This whole thing wasn't about YOU so don't try to make it about you and your health, if you want to discuss something post a question but don't take up Katheen's thread with your health issues.Kathleen is the one who is suffering with undiagnosed symptoms.
I'd think you'd be happy your cyst was resolved and your liver was fine, I have had lumps taken out and they turned out to be nothing, I hope the same is true of you. Maybe you should be evaualuted for anxiety, that can cause symptoms too.
So far you have accused me of "diagnosing" someone online and called me names. I think you need to be more careful of the things you say to people. I won't respond to you again you seem to want to argue for no reason.
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Thanks i got tested last year for hep that was neg. I have done a lot of research myself. I just dont have baisic symptoms i have symptoms that are unbearable. Doctors just wont listen and they downplay most of the symptoms. The severe drymouth is one that they all cant explain. I know its a symptom but they say its not. Going  to the bathroom all the time. Again they say its nothing. Lost alot of weight but on the scale in dosent show that much weight loss. I explain to them that because my body is retaining water and im gaining weight that way. But my body is half the size. If i take meds my eyes get yellow. my hope is a hepatoligist will know exaxctly what im talking about. I bloat up all the time. My weight goes up and down 5 to 10 pds a day from the bloating.
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Avatar_n_tn
One year ago neg for hep. What other blodd test can they do to see that i have a liver problem. My symptoms only got worse after i took all the medication. I looked those mediactions up those are not good at all for the liver. Did they give me cirrhosis alone , no. I think they did because my liver was already damaged. Why do you get dry mouth with liver problems.
The way i look at it is when you drink alot you get dry mouth in the morning because you have done damage to your liver. Your liver than recovers. I think i have dry mouth all the time because my liver no longer can recover on its own. Does that make sense. I also sweat all the time. Is their a reason for that.
Thanks.
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You have issues. I know exactly what my tests cost and between the EXTENSIVE bloodwork and my scan it was $3000. Do you want an itemized bill? I was checked for everything including hemacromatosis, alphafetaprotein, ANA, mitochondrial issues and all the hepatitis possibilities. These tests ate not done in a regular liver panel. My doctor is one of the best and was trained at the Cleveland Clinic.

If you could read and comprehend you will see my responses did not start out about me. I responded several times directly to kathleen and her symptoms... until you began to argue the points I was making. I still maintain, her symptoms could be caused by lots of different things, other than liver. The doctor on the forum seems to agree with that. 'Nuff said.

Kathleen, best of luck and I hope you get to the bottom of your health problems.

Linda J.
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<<I had my liver "evaluated" and it cost one fraction of that . I don't want people to be scared away from having their livers checked out thinking it is very expensive, it normally isn't.

That is just not true. The bloodwork for specific liver tests can be very costly. It is the genral liver panel that runs about $200-$300. It also depends on the part of the country you live in.

<< I had the tests you mentioned too, ANA and AFP tests can be done with a blood draw so I don't get the enormous costs you paid.

yes, so? Lots of tests done with a blood draw are expensive. Many labs don't do these specialized liver tests and they have to be sent out. Mine were done in California and I live in Chicago.

<< Who am I to judge? You put it out there and I responded, this is a forum that is what is done here.
I am far from a pessimist but it is important people understand there can be liver problems with NO symptoms and for some reason that fact bothers you.


doesn't bother me in the least. There are lots of diseases that have no symptoms. All you can do is get tested, trust your doc and go from there. It sounds like Kathleen is already doing that.


<<I'd think you'd be happy your cyst was resolved

I had a partial hysterectomy to "resolve" it. Guess I should be dancing in the aisles over that, huh?

<<and your liver was fine, I have had lumps taken out and they turned out to be nothing,

so have I, but I am sure you can understand it is an unsettling experience.


<<I hope the same is true of you. Maybe you should be evaualuted for anxiety, that can cause symptoms too.

Thanks for the kind words @@. I won't be responding to you further either.

Again to Kathleen, it sounds like she is getting evaluated and I wish her all the best.

Linda J


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Avatar_n_tn
Kalio,

You passion is obvious but the reason you are frustrating is for comments like this.

"The big money goes into the CT scan costs I guess but a CT scan isn't the best tool for liver evaluation and in my view is a waste of money unless there was a specific reason, a suspected growth or something."

While it is true that the Ct is not the gold standard for the liver it is not a waste of money.  You are not a doctor and you are misleading the original poster in your argument with Linda.  Would not the Cat see an enlarged or shrunken liver?  Would not the cat detect an enlarged spleen, another problem with cirrhosis?  Would not the Cat scan detect free fluid in the ab(ascites)?

Using your logic, the original poster should not believe any tests that show a normal liver, including a biopsy, because they can biopsy the wrong part of the liver. I agree she should have a comprehesnive evaluation,that is fine, but at some point we have to trust the tests and the doctors, and live as healthy as possible day by day.  There is really no other choice.
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Bravo muckman! I agree with your post 100%. If even biopsies are not to be trusted because you "could" get the wrong tissue sample, then WHAT short of an autopsy, would be good enough? IMO, you must get tested and then trust the results, or you will live your life in fear. It seems that by Kalio's standards there would be NO test that would give you confidence that you DON'T have liver disease.

Linda J


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im still looking for answers. The last one on the biopsy could of got the wrong piece of the liver has me worried but might explain why i think i have cirrhosis and the doctors say n0.
I have all the symptoms but the biopsy showed minimal fibrosis.
Without another biopsy how can i tell if they did not get the piece of the liver that has cirrhosis. And because my liver function test are normal my doctors think im nuts. The liver function test is actually a misleading wording for a test. One would think that the liver is in great shape if those come back ok , but thats not the case. Im going to a hepatoligist instead of a gastro doctor. What test should i ask him for. He should know alot more that a gastro. Any  info will help.Im not worried i have a liver problem, im worried because no doctor can tell me i have a problem.
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quess you guys gave up note the thread. still needed some advise.
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I had an ultrasound for my kidney which was normal but they found a cyst on the left lobe of my liver. It is l.9cm x l.4 cm, with the liver and remainder of the upper abdominal structures normal. I am a 54-year-old female and thought I was healthy. I am so scared that this could be cancer. Please tell me if an ultrasound can definitely distinguish between a cyst and a cancerous tumor. My GP has received this report (he is not the one who ordered the test; it was order by another doctor I saw at a clinic after I injured my kidney in an accident a month ago.) My GP has not gotten back to me. I will do whatever is necessary to ease my mind..what kind of further tests should I have or is that not necessary? I do not have pain and pretty normal bowel most of the time.
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hello...i'm just curious if anyones has hep c. just found out myself......i had an ultrasound of my liver and found (what the gi said was blood blisters)  ok can anyone tell me what that meant...my dr talk in big words..just did not understand.
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A related discussion, stomach problems was started.
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