Healthy Liver ultrasound

I am writing to follow up on a question I had about my liver.  I am a 40 year old male with a 15-17 year history of heavy drinking. The last 5 years I have had liver function tests done(ast,alt,ggt,bilibrium,albumin,etc) 4 times.  The results of which were all normal. You suggested that I have an ultrasound as I could have normal enzymes and still have liver desease. the results are as follows:
   The liver is at the upper limits of normal 16.3cm.  No discrete focal masses or abnormal echotexture is seen.  The gallbladder,spleen,pancreas, and aorta are normal. Common bile duct measures 3mm. no free fluid is seen. Impression: Borderline hepatomegaly.
  My questions are; 1. Should I be concerned about The results? 2.Is it unusual for my liver to be this size and could it be due to fatty liver and if so why didnt the fatty liver show up on the ultrasound? 3.Is it unreasonable to ask for a biopsy to rule out serious liver desaese (ie. cirrhosis). I asked my doctors assistant and she said that would be foolish. I have an appt to discuss my concerns with my doctor in 2 weeks. I would like to go ahead with the biopsy but it dosent seem to be an option. I would appreciate any thoughts or suggestions. Thanks for your help. Oh, and I have stopped drinking.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

First of all, congratulations on quitting drinking.  

If you have completely normal liver enzymes, a liver ultrasound that only shows borderline hepatomegaly, and you are completely asymptomatic (i.e. no signs of liver failure), there is no obvious indication for a liver biopsy.  Even though a biopsy would give a definitive answer, a biopsy is not without risk as it is an invasive procedure.

Alcohol itself can cause hepatomegaly - this result would not be surprising given your prior alcohol history.  Note that you are still within the "upper" range of normal.  It is reassuring that there is no abnormal echotexture seen - it makes fatty liver unlikely.

Given your normal tests and asymptomatic presentation, it would seem an extreme step to proceed to a liver biopsy.  However, I would discuss this with your personal physician.  

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.

[Char_young]

Thats great that uve given up the drink! If you havent had one already, heres a pat on the back! Keep up the good work!