Fatty Liver, now normal ast/alt

[anc]

I am female, overweight (5'4", 178pounds) age 39, with no major health problems (mild asthma, heart murmur).  About 5 months ago my dr. found very mildly elevated ast/asl on a routine blood test.  An ultrasound of the liver showed this:  Liver is diffusely and markedly echogenic.  No focal liver lesions identified.  Portal and hepatic venous waveforums are within normal limits.  Gallbladder is normal. Common bile duct meausres within normal limits at 3.9mm.  Small portion of pancreatic head is visulalized; it appears unremarkable.  IMPRESSION:  Diffusely and markedly echogenic liver, consistent with underlying hepatocellular disorder, which includes but is not limited to fatty change.  A recent blood test showed my ast/alt and liver function test all as normal.  (ast 33, ast 2, LDL cholesterol 152, HDL 58, Triglicerides 86, cholesterol 227).  He said I had fatty liver and to try to lose 20 pounds and to exercise.  I have some very minor edema in my left ankle area (ie, socks leave a bit of an impression for quite a while, etc.).  I do NOT drink alcohol at all, but my diet could definetly be improved, and I do not exercise, which I know I should and intend to start doing.  Strong family history of diabetes, but my 2 hour glucose test was normal at 90/120/84.
My questions are:
1. Is the mild ankle edema related to the fatty liver? Doctor did not seemed concerned when I called and asked about it, he said not related to fatty liver.  
2. What do the ultrasound results indicate, a mild case of fatty liver, or more severe case of fatty liver?  What other heptocellular disorder could cause this, as mentioned on the impression of u/s?
3.  Does the fact that my liver enzymes are normal mean that the fatty liver is mild?
4.  Will the fatty liver return to normal if I lose weight?
5.  Can fatty liver cause cirhossis? How would one know? Would blood tests and u/s indicated this?

THANK YOU for you time!

[anc]

Thank you for your quick response.  However, you said you could not answer #2 without seeing the ultrasound report.  In my question I quoted the enire ultrasound report and the impression.  Was this an oversight, or what further information do you need? Thank you!

[Kevin Pho, MD]

To answer your questions:
1) Fatty liver may lead to edema.  Other problems that can lead to this would be heart failure or kidney disease.

2) I cannot answer this question without seeing the report nor ultrasound.  A liver biopsy would give a more definitive diagnosis.

3) Normal liver enzymes suggest a more mild course of disease.

4) If it is non-alcoholic steatohepatitis, losing weight is one of the mainstays of treatment.

5) Fatty liver can lead to cirrhosis if the underlying cause is not corrected.  Cirrhosis can be only diagnosed definitively with a liver biopsy.

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_