Enlarged Liver....Not sure on what to do ????

[RSBULLDOG]

Hello,
I am a 34 year old man, 6 feet tall, and my weight is 320 and I know I need to lose weight bad. I don't hardly ever drink, maybe 2 or 3 once a month and then not even that most of the time. I DO NOT smoke.have high blood pressure and I am on Monopril for it. I have a B-12 dEF,and have some acid reflex and on Nexium for that and I am also on Prozac and Klonopin 0.5 mgs 2 in the morning and one at night, for anxiety.  
I have been having pain on my right side around my liver in all and this has been going on now for almost 2 months. Well anyways, This pain May be intense, continuous stabbing at times, uneasiness and with some pain. The pain does feel as it goes towards my side and back somewhat. Well anyways, I have had a Ultrasound done, and it showed that my liver was 21.5 Cm and I think it is suppose to be only 13 cm is I am correct on that. They said that my spleen and everything else was normal but could not see my pancrease due to my weight. I then also had a Abdominal CT with Oral and Intravenous contrast. The CT said The Liver,spleen,pancrease and gallbladder are unremarkable. It did say that I had some enlarged nodes and are in my lower quadrant, near the cecum. I had a liver function test and my TBILI was normal,0.3 my Dbili is 0.1 normal and my ALKP was 107 normal and my AST Was the first time 47 and then they did it again in one hr for some reason and it was 19 and my ALT was 36 and my AMY was 43 and then my LIPA was done twice, the first time 26 and then again in one hr they did it and it was 21 and they had a footnote next to it. My white count was 10.9 but everything else on my CBC was normal. So I had a ultrasound that said my liver was enlarged at 21.5 cm and on the CT it said it was normal well (unremarkable). So on my liver function was all normal really except my Lipa. They did a Hep test and that all came back normal. I am not sure what to do and I am worried over my liver being enlarged as it is and was thinking on having them do a liver scan to make sure or to find out anything if possible, Do you think that is a good choice ? Also What else should I be looking into and asking about. So I had the GI doctor told me that I don't have cancer, cause I was worried and they did a endoscopy and that was all normal. He said he does not know what to do next, I am going to go see my PCP next week and talk to her, but I was kinda wondering if there is anything I should ask or be considering.? I hope I gave you enough information. I do think the Doctors think everything is in my head, but the ultrasound showed my liver enlarged. Please help me and point me in some kind of right direction. I just like to rule out liver disease or whatever 100% if possible and if not then get on top of it.

Thanks so very much and look forward to hearing from you real soon !
RSBULLDOG

[Kevin Pho, MD]

Surgeon has kindly answered your question in his comments below and I agree with his assessment.  With an unremarkable CT scan, an ultrasound not showing acute disease and unremarkable liver function tests, it is unlikely that a serious liver disease is present.  Biopsy would be the definitive test, but with the normal preceeding test it would be unlikely that your gastroenterologist would recommend it.  

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.

[roxnsox]

Do some research on Nonalcoholic Steatohepatitis (NASH).  Look on the American Liver Foundation website.  They have good information there.  
   The National Institutes of Health do clinical trials and they are studying nonalcoholic steatohepatitis right now.

[surgeon]

there's really not a "liver scan" that will give more info than the CT scan and ultrasound you already had. Your liver tests are pretty normal. It's most likely the liver size has to do with your obesity, which is associated with steatosis of the liver, or "fatty liver." If there were a reason to do it, the most definitive test at this point might be a liver biopsy, but you really don't have an indication to do it. If I were you, I'd consider my liver ok in terms of intrinsic diseases. I'd do whatever is necessary to lose about 150 pounds; I realize that's not easy. But clearly your health is much more jeopardized by your body size than by your liver size. If all else fails, you should investigate obesity surgery: placing a band around the top of the stomach is a much safer and less costly alternative to gastric bypass.

[RSBULLDOG]

Also, do most people of my size and height have a fatty liver ormost likely to have one.???

Thanks,

RSBULLDOG

[RSBULLDOG]

I just wounder why my ultrasound says enlarged liver, but not my CT Scan also. ?

I also wanted to mention that I have had a cough, not a intense one, but enough to make it upsetting i guess and this has been going on about the same time.