MRI indicating Cirrhosis

Have suspected liver disease for 5-6 years due to pain in upper right quandrant.  Diagnosed with fatty liver 5-6 years ago but no liver disease.  Not an alcoholic, in fact I rarely drink, but after drinking for 2 nights in a row, had hematuria.  Since this was the third episode in one year, I went to my internist.  I neglected to tell him at the time that I have noticed a few times in this past month, my face and ankles appearing to be greenish in color.  My weight fluctuates by ten to fifteen lbs per day due to edema.  

He ordered a CT which showed an area 3 cm x 6.4 cm of diminished density.  

Followed by an MRI results:

Same areas on the correlative CT scan do not appear to show as areas of elevated signal intensity on T2 weighted pulse sequences or T2 weighted pulse sequences obtained with fat saturation.  On T1 weighted pulse sequences these same areas of diminished signal density.  This in conjunction with the non-enhancing on CT scan raises suspicion that it represents areas of focal fibrosis, scarring or cirrhosis.  Biopsy recommended.

My internist believes this finding to be nothing more than fatty liver.  He said I am not juandiced because my eyes are not yellow.  He did order full blood work stating we need to rule out lupus and hepatitis and is referring me to a gastroenterologist.  

I have also been extremely sleepy during this past month, sleeping 16 hours at a time almost every other day.  I have been on a diet and working out.  I track everything I eat through a software program and noticed the days of extreme sleepiness that I have eaten meat. I am concerned that this could be the ammonia reaction to the meat protien.  

I quit eating meat over the weekend, placed myself on a fruit and vegetable diet.

Are there differing stages of juandice upon the onset of symptoms?  How often is cirrhosis not diagnosed until into the progessed stages?  Is the meat protein reaction common in any stage of the disease?  Does fatty liver present as cirrhosis on MRI's?  Does the fact I vomited during the MRI when the contrast was administered mean that my liver had difficulty processing it?  If the sleepiness is caused by the ammonia reaction, should I go to the ER?

[Kevin Pho, MD]

Cirrhosis can only be definitively diagnosed by biopsy.  Imaging studies can only suggest its presence.  I would suggest going forward with the biopsy to exclude this possibility.

I am not aware of a meat protein reaction being common with cirrhosis.  Although uncommon, it may be possible for some cases of fatty liver to look like cirrhosis on imaging studies.  

Vomiting the contrast can be due to many reasons that can be considered before concluding that you had difficult metabolizing it.  

If there is concern about the ammonia concentration, blood tests can be considered to evaluate the levels.

These questions can be discussed 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.

Kevin, M.D.
kevinmd_

[lilYellow]

My MD said he doesn't want to do the biopsy.  He said we could just watch it.  When he realized I am not happy with a wait and see approach, he decided to schedule an appointment with a gastroenterologist and to do the blood and urine studies.  

I had a reaction to the CT scan dye and had the blood test on the 4th day of the steroid treatment.  I wonder if this will interfere with the results?

I haven't had the urinalysis yet.