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Ultrasound showed enlarged liver....what symptoms can result...
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Ultrasound showed enlarged liver....what symptoms can result...

I am a 27 year-old male, 6'0", 250 lbs. For the last 3-4 years, I have had periods where I felt fatigued, malaise, and generally under the weather. These would last 2-3 months, and then go away for up to a year. I have been to numerous doctors numerous times, with no diagnosis to speak of. The only lab test which have consistently been off is my ALT, which has only gotten as high as 68, and most recently was 45. A month ago, my upper right abdomen began aching, so after a few weeks, I went to my GP. He ordered an abdominal ultrasound which showed an enlarged liver, with all the other organs being fine. He told me that I have fatty liver, and I needed to change my diet and stop drinking. He also told me that he saw no reason for me to have aching in my right abdomen.

I have several questions:

1) Can fatty liver result in light abdominal aching?

2) Can fatty liver, over a long period of time, result in symptoms such as malaise and fatigue? If so, is this uncommon?

3) Given that I had an ultrasound and normal liver enzymes (other than the slightly elevated ALT), how likely is it that the enlargement of my liver is caused by something more sinister, such as cancer? Would the ultrasound have picked up on something like that?

4) I have noticed (and thought back to) that when I drink, my abdomen seems to hurt more that next day than normal. Is this consistent with the diagnosis of fatty liver?

5) Are there any additional steps that should be taken beyond my GP's recommendations, such as biopsy, CT scan, etc.?

Thanks in advance for the help,

Tim
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To answer your questions:
1) Fatty liver can result in abdominal pain.

2) It may be possible for fatty liver to result in malaise and fatigue.  However, you may want to inquire about other causes of these symptoms.

3) A normal ultrasound would make liver cancer less likely.  A CT scan can be considered if this is suspected.

4) Alcoholic hepatitis can lead to this symptom.  If there is an association between the pain and drinking, you may want to discuss with your personal physician whether abstaining from alcohol is an option.

5) A biopsy is normally not indicated for an ALT of that level.  A CT scan can be considered, as well as referral to a GI specialist.

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_
15 Comments
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Avatar_m_tn
Did your doctor test you for Hep C? Hep B? Be sure and ask him and be tested to make sure that isn't present.
You should get tested right away. I strongly advise you to stop consuming alcohol,start eating a good liver friendly diet and get some exercise.An enlarged liver is nothing to ignore.
Fatty liver can be controlled through diet and exercise and it can get worse if you ignore it. Google around and do a little reading on end stage liver disease, fatty liver and cirrhosis that should scare you into action. ifestye changes are in order. If you do have hep b or c, which is very possible, (milions of people have it and have no risk factors for it) and you continue to drink, the consequences can be dire. Get tested.
Up to a point your liver can heal itself so you can do something about it. Start today.
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Avatar_n_tn
I was tested for Hep B and C, both of which were negative.
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Avatar_m_tn
PS.
The only true measure of liver damage is a biopsy. I would encourage you to get one if your doctor feels it is warranted.
Discuss it with him. You might want to consult with a liver specialist ( Heptologist)

scans and CT's and enzyme readings and other blood indicators can offer some information, but to really KNOW your liver condition, you have to have a biopsy.
By the way, what were your bilirubin readings? How about your platelet count? Do yourself a favor if you haven't already and get copies of ALL your testing results so you can begin to educate yourself and learn what they mean.
Remeber, YOU are in charge of your own medical care, your doctors are there to assist you and advise you but ultimately you are in charge. Educate yourself about liver disease so you can speak intelligently with your doctor and know what questions to ask.

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Avatar_m_tn
That is great news you don't have hep b or c. Good to know that isn't a worry. Alcoholic hepatitis, which the doctor mentions, might be another area you want to read up on. Liver issues can be very sneaky and show NO SYMPTOMS for long periods of time leading the person to think they are fine and then suddenly cause you to feel super tired and have other symptoms like you are having. It isn't really "sudden" because the process has slowly been happening, it has just gotten to the turing point where you are feeling the symptoms.
Keep in mind you CAN do something about it and hopefully liver damage, if any, is still in the reversible stage.
Remember ANY alcohol at all on a stressed liver is not advisable. What you eat is very important too, you already have fatty liver, you need to reexamine your diet carefully and if you are not getting regular exercise, you might want to do that too.

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Avatar_n_tn
Well, I usually only drink about once a week, but I drink a lot on that day. During law school, I drank constantly, 4-5 nights per week. That has been over two years ago now.

I view this as my body finally telling me it is time to grow up and stop abusing it. It was going to happen at some point. As far as drinking, I am done. It has never been something I have to do. I only drink socially, and I enjoy the taste of a nice coke better than any alcohol.

The real problem is going to be diet. Man how I love food :)

Luckily, I don't think my liver is badly damaged at this point. The last liver functions were completely normal, and he said it was "slightly enlarged". I think I should be able to let it repair itself with good diet and abstinance from drinking.

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Avatar_m_tn
I agree with you, you are young and healing powers are strong at your age and the liver is a forgiving organ, thank goodness. You also want to be mindful of medications you might use and insure that they are liver friendly before you consume them.
One thing to keep in mind is that although consuming large amounts of alcohol is clearly not good for you, much smaller amounts can be problematic for some, particularly someone who has fatty liver at such a young age. We tend to think it takes a whole lot to cause us harm, but each person's body's ability to deal with alcohol and their liver's ability to deal with it differs. You can still enjoy the food you love, you just have to leave certain things out and add some things and you will be in tip top shape in no time.

As you know, many if not most drink too much in the college years but they have no clue (like symptoms)to let them know there is a problem brewing. Be glad your body gave you a signal that you were smart enough to follow up on and now are aware and can do something about it.
Congrats on making it through law school!
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Avatar_n_tn
kalio I have a question for you as i have asked you a few before. My ferritin level is high. I have grade one fibriosis
but doctor says that is nothing although i have all the symptoms of cirrhosis. Drank alot over 20 years have not  drank in 16 months. Is my high ferritin level high because of damage i have done to my liver. Also should i be getting symptoms of liver failure with grade one fibrosis.
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Avatar_m_tn
Sorry to hear you stil haven't gotten any answers, that must be frustrating. The fact that you have stopped all alcohol is great, congratulations on that. Here is a lik that misght prove helpful to you and give you some answers and possible eads on where to go from here and what tests to have done. a you get a referral to a Heptologist? That might be helpful. If you are not getting satisfactory answers from your doctor, seek aother opinion. You do not say HOW high the ferritin eve is, and that is relevant. I hope this helps.
http://www.mercola.com/2002/dec/18/iron_diagnosis.htm
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Avatar_n_tn
My results were 443 what ever that means. Have not seen doctor yet about results. Thanks for the info.
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Avatar_n_tn
Hi.  You mentioned using liver friendly medications if needed.  Do you know of any liver friendly meds recommended for headaches?  I can't find this info anywhere!  I know tylenol and advil are not to be used but whatcan be?
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Actually I was told advil is much easier on the liver than tylenol, as it is mainly metabolized in the kidneys?

Linda J
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Avatar_n_tn
Hi, I am not a doctor but I am wondering if a ferritin level of 443 might be a symptom of hemochromatosis?  
I believe that a normal level for a man is around 18-270 ng per mL. I would get this checked out with my doctor. Hemochromatosis is a buildup of iron in the blood and can many problems.  Sometimes this is genetic, especially among people of Celtic origin.
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Avatar_n_tn
I have been reading this column with great interest.  I am a 52 year old, very overweight female.  I was diagnosed at 30 with a fatty liver.  I was a heavy drinker at the time. (and fat!)  I stopped drinking for 10 years and my liver enzymes never went back to normal.  My liver has been enlarged since that time, so obviously for 22 years.  I started drinking beer again about 10 year ago.  I had a liver biopsy done and it showed that I had progressed to stage 2, alcoholic steatic hepatitis but showed no cell damage or cirrhosis.  I recently had a bout of diverticulitis and I had to have a CT scan with contrast that showed a "diffuse fatty liver" but no cirrhosis.  My MD knows that I drink (and its certainly more than a couple of beers, more like 10 but not every night) and she said if I had had cirrhosis, it would have shown up on the CT scan.  I'm not here to hear any lectures on drinking, I know I am an alcoholic or what I would call a "functioning alcoholic" but I am interested in the reasons for some people getting cirrhosis and others not.  My aunts had fatty livers, they were both non drinkers and they were both very thin, no exaggeration.  My grandmother, I read when I was researching our family tree, died of "yellow atrophy of the liver" which caused a stroke.  She did NOT drink, EVER and she was thin.  I definitely get pain and discomfort on my right side under my rib cage but my doctor said all she feels is the "tip" enlarged and not much else.  One question I have is does anyone get BACK pain that has liver disease.  I seem to get some muscle type, right sided back pain and the doctors say its not the liver, I've had spine tests etc and nothing shows anything.  So I was wondering if anyone out there had any back pain with their liver problems.
Thanks,
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Another comment to the person in this link about Tylenol.  Tylenol just killed my girlfriend's brother.  He got total liver and kidney damage and passed away.  He had surgery for something and was taking Tylenol for the pain.  So to all drinkers out there, even if you drink socially, Tylenol should not be your pain drug.  Even aspirin is better.  I was taking pain killers for trigeminal neuralgia and they had Tylenol in them.  My ALT and AST went off the roof.  And I was NOT drinking at the time and had not for years.
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A related discussion, enlarged liver and a ton of other symptoms was started.
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A related discussion, Ferritin levels was started.
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