Fatty liver and pain in upper right quadrant

Hi there,

i am from the UK a 38 year old male, 6'2", 215lbs non smoker, very occasional drinker no more than 2 units/week for many years, generally good health cholesterol count low (4.0)

as a result of a routine blood test almost 1 year ao, i discovered that my ALT was slightly higher than normal range (65), and follow up tests this year were april (97), and may (62) and june (70), the last 2 tests were the full liver panel and the GGT was aprox (70) both times, all other parameters in normal range.

the (97) test may have been influenced by anti-histamines which i stopped taking straight after i got the result so as not to skew future results

for about the last 6 weeks i have been experiencing mild pains in my right side in varying locations, mostly at bottom of ribs on right side, but sometimes lower down to the right of belly buuton and sometimes directly in the right side and very occasionally round the back.

these are not sharp but dull and asymptomatic, when the pain is directly on the side it is very similar to "stitch"

not much seems to make theme worse or better except when I wake up in morning they are very mild, and when I exercise (bike riding) they are hardly noticeable. sometimes no pain at all

I have had an ultrasound of my right side about 2 weeks ago, and the report said that all was normal except that there was fatty infiltration of the liver, and slight to moderate enlargement of the liver. no stones, nothing else reported.

I was advised to eat more healthily and exercise to lose weight, with a target of 180lbs, which I have been doing for the last 2 weeks and have lost 2-3 lbs already.

my doctor theorised that my pains may be partly psychological brought on by worrying about it (which I have been) and the varying locations may be indicative of this although he did say that he did think there was a physical cause, and it may be mild "irritable bowel syndrome" or possibly muscular, but he is basically not worried and didnt think i needed to see a specialist at this stage

at the moment all I have booked is another blood test in about 2 weeks and another ultrasound 3 months after the first one.

however the continuing pains do worry me as i understand that while the liver itself does not feel pain that the membrane around it does and it may be pushing on other things.

my question is do you think this is a reasonable cause of action, or should i be pushing for more tests/investigation in the meantime, I have read your other posts about fatty liver and have a basic "working knowledge" and would welcome your comments about what may be causing these pains.

my regards and looking forward to your opinion.

[Kevin Pho, MD]

Hello - thanks for asking your question.

As you know, the fatty liver itself can be causing symptoms.  Although most patients with NASH are asymptommatic, but others present with fatigue and abdominal discomfort.  

If you are drinking alcohol, I would repeat the tests off alcohol.  A liver biopsy should be considered to further evaluate the cause of your fatty liver.

Another consideration would be acalculous biliary pain - this is simply biliary pain without gall stones.  A HIDA scan with CCK stimulation can be considered to evaluate the gall bladder ejection fraction.  If low, then that may be an explanation for your discomfort.  

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]

I have fatty liver (NASH) and I do experience pains in all of the locations that you describe.  I know the doctors love to tell patients that the liver does not feel pain but I have been having liver pains for years and years.  One thing I have noticed is that I need to drink lots of water or my liver pain will get worse.  Especially if I wake up in the morning and have the liver/back pain, I will drink a large glass of water and it helps get rid of the pain.  
   From what you have decribed I think your doctor has done a good job and you are doing the right thing by exercising and eating right.  Don't try to lose the weight too fast.  You should lose one pound per week.  Losing weight too fast can damage the liver.

[vancerd]

I too have the pain you described.  Mine has been present for about 9 months.  I had my gallbladder removed roughly 18 months ago.  My ALT is typically slightly higher than normal.  I have had EGD, sonograms, liver biopsy, and lately an MRCP.  They all show up normal, except for a slightly fatty liver.  The only advice my doctor(s) (2 GI doctors, and my family doctor) have given me is to lose weight.  Since I have experienced this pain, I have become less active, which has caused me to gain more weight, most likely making the problem worse.  I am 215 now with a target weight of 180.  I fully plan on getting there. I will do anything to get rid of this pain.

[Aphrodite]

I know EXACTLY how you feel! for the past year and half I have that pain and I can only tolerate low fat food, 3 grams of fat every two hours, I've always been a big girl all my life, the doctor all the doctors I have seen (13) tell me that FATTY LIVER IN ITSELF DOES NOT CAUSE PAIN!! arghhhhhh it fustrates me, then what the hell does!  Sorry I just am tired of hearing it.  I am tryin to lose weight I recently had a baby so it's been hard for 9 months I couldn't do anything to try to lose weight.  But is there any other suggestions on this.  Have you been told if you lose the weight it will go away?  I hope this is true! I also was told that Lecithin is great for fatty liver.  ANyone else know of this?

[roxnsox]

Hello,  I haven't heard of Lecithin being good for fatty liver.  I do a lot of research on liver problems and gastro problems.  I am currently reading a Nursing textbook called " Nutrition Essentials and Diet Therapy".  One thing this books talks about is increasing fiber in your diet.  Increasing consumption of fiber by 14 grams daily can help you lose 1 pound of weight per month.  (I figure every little bit helps.)  The same paragraph in this book says that---" The Weight Watchers program now uses a point system.  Foods high in fiber and low in fat are counted as having fewer points than foods low in fiber and high in fat. "  (on page 216 of the mentioned book)
   So eating an apple a day should really be a good thing.

[TheHawk]

The pain that you from your liver, as far as i know, is caused by toxins.

[afzal]

LAST YEAR I have been told during ultrasound that I have fatty liver, my Dr advised to get my LFT done and also Tryglycerides. All test normal. I have pain under right rib which travel to side, lower and back. I am sure its due to fatty liver. I ignored this since 1 year but while I was on tour to europe in July, I have been walking a lot and felt negligible pain while I was on tour for 5 weeks. since august I have stoped walk and excercise, The pain is again there . since 1 week I have started walk and restricted diet too loose weight. I am 6feet weighing 212 pounds.
I also agee by taking some liquid ( water or juice or tea) it get eased. I dont feel in the day when I am busy.. when I reach home I feel pain.I hope I will get rid of this pain as soon as I will shed few pounds.

[afzal]

LAST YEAR I have been told during ultrasound that I have fatty liver, my Dr advised to get my LFT done and also Tryglycerides. All test normal. I have pain under right rib which travel to side, lower and back. I am sure its due to fatty liver. I ignored this since 1 year but while I was on tour to europe in July, I have been walking a lot and felt negligible pain while I was on tour for 5 weeks. since august I have stoped walk and excercise, The pain is again there . since 1 week I have started walk and restricted diet too loose weight. I am 6feet weighing 212 pounds.
I also agee by taking some liquid ( water or juice or tea) it get eased. I dont feel in the day when I am busy.. when I reach home I feel pain.I hope I will get rid of this pain as soon as I will shed few pounds.

[jcox]

   HI, I'm Justin and i am 21,  I have been drinking since i was 18, and when i was 20 for almost 300 days of the 365 i was drinking daily, about 2 drinks a day, i havn't been drinking for awhile, but i am having pains in my chest, lower left and right ribs, lower left and right hips and sometimes in my back, and my urine is a cloudy yellow no matter what i drink.  I doubt it has to do with drinking, and everything i have heard is it sounds like there is something whith my kidneys, i'm not sure which direction i should go with this, because it is not constant, and i have only had the pains for 5 days?

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