what is my problem?

[me_just34]

I had elevated liver enzymes and pain in right quadrant 1.5 years ago.
From ultrasound they told i have signs of fatty liver.
After exercising and weight loss, my enzymes came to normal level in 4 months and
CT scan at that time for right quadrant was totally normal.
Then, I thought my health problem was solved and I neglected my weight and exercising.
2 months ago, my enzymes elevated again: ast 50, alt 101. I exercised and lost weight again and
did a blood test a few days ago: ast 33 and alt 37. they were in the normal range.
the pain in my right hand side is changing: sometimes dull and sometimes sharp, sometimes very weak and it continues.
in fact, most of the time it is below the liver region. i have irritable bowel syndrome and one of my GIs
thought that the pain may be coming from it. my CRP (C-reactive protein) was always normal in all blood tests.
CRP measures inflammation. if my pain in right quadrant was from liver inflammation, should crp not be normal?
my last blood test was totally normal.
I never drink alcohol. Due to my IBS problem, I have gas and bloating almost every day.
i am not sure if my problems are liver related or not.
what do you think?  what is the source of my pain?

[me_just34]

dear dr,  my last question: 1.5 year  when i had pain in right quadrant, elevated liver enzymes and did ultrasound the result was:

Ultrasonography of the right hypochondrium:

Signs of hepatic steatosis, no focal liver lesions.
Transsonante gallbladder with normal gallbladder wall, no dilated bile ducts.
Normal right kidney.

does this mean i have nash?

[me_just34]

the strange thing is that when my ct scan was normal still i  had the pain.
and my GI specialist said this:
"Your CT scan was completely normal, maybe your pain is coming from an irritable bowel syndrome."

[Dr. Kokil Mathur]

Difficult to say whether the cause is liver or not as fatty liver can cause a mild ache in the region. You need a more current CT or ultrasound to assess the liver morphology. The pain could be a combination of liver, IBS and acidity.

[me_just34]

my crp two months ago was 1.3 mg/L.
I did  upper endoscopy  8 months ago and doctor told i have h pylori infection.
then after treatment and re-test he told me that i  removed it from my body.
most of the time, i hear gas movements and grumbling in the right hand side of my body.  i did a gluten test and it was negative.  all over the 1.5 year i was almost fine (without any right hand side pain) just for a period of 1 month last summer.  my ct scan one year ago was as follows:

my ct scan one year ago for right quadrant was as follows:

Normal volume of the liver with homogeneous contrast capture of the parenchyma; subtotal visualization of liver segment 8 in this study which some reserve for the assessment.
No dilated bile ducts.
Normal opacification of the portal and sushepatische barrels.
Normal movement of the adrenal glands.
Normal volume of both kidneys with a symmetrical contrast excretion.
No perirenal collections.
No renal trim marks.
Normal volume of the spleen.
Normal volume of the pancreas with a homogeneous contrast captation of the parenchyma.
No dilatation of the duct of Wirsung.
Normal volume of the gallbladder without intraluminele densities, normal wandaflijning.
Normal caliber of the abdominal aorta.
No pathological enlarged retroperitoneal nodules.
Normal movement of the abdominal wall.

Do you think my right hand side pain is related to liver or not?
Thank you very much for your comments,.

[Dr. Kokil Mathur]

Hi!

As you probably know, right upper abdominal pain can be due to cholecystitis (inflammation of gall bladder), stones in gall bladder, abscess under the diaphragm (unlikely in your case due to long standing history), liver problems (this you have), inflammatory bowel disease (IBD) such as Crohn’s or celiac or IBS (you have IBD but the type needs to be diagnosed) or due to duodenal ulcer.

I don’t know what you mean by normal CRP. Normally C reactive protein is undetectable in blood. A level less than 1 indicates a low risk, a level between 1-3 shows moderate risk and a level above 3 shows increased risk for heart problems, infection, inflammation, dental problem, arthritis, cancers etc. So, I am assuming it was less than 1, which is normal.

A person can have low grade IBS and normal CRP. Also if you have duodenal ulcer then the CRP is likely to be normal. Again a chronic liver inflammation will cause a rise in CRP.  Fatty liver disease which is causing a rise in AST/ALT with rise in weight is also not an inflammatory process. So, your CRP is likely to be normal.

In your case the cause of IBS like symptoms need to be ruled out. Hence you may need endoscopy or video encapsule endoscopy to diagnose Crohn’s or duodenal ulcer. You may also need blood tests to rule out celiac disease. Also you can log in what you eat and the symptoms as they appear (pain, gas, bloating) and see if there is any correlation between any food type and symptoms.

Bloating and gas can also be due to sedentary life style, acidity, duodenal ulcer, thyroid issues and diabetes and can cause pain in upper right abdominal area. S, these causes need to be looked into.

Please consult your doctor regarding this. I sincerely hope you will find this information useful in your consultation with your doctor. Hope you get well soon! Good Luck and take care!