Possibilities?

Three months ago my OBGYN suggested that I begin taking Metformin to treat Insulin Resistance. My fasting blood insulin levels are at 22. Before starting Metformin she wanted to do a total blood profile, because I was complaining about aching joints and fatigue, and Metformin has some harsh side effects.

My LFTs came back elevated. (tests were repeated 4 weeks following the original tests, with similar results)

ALT - 200's
AST - 80's

Total Cholesterol - 170

Hepatitis B & C have been ruled out.

I'm a 26 year old female with polycystic ovaries. I have gained about 20 pounds over the past six months and my joints continue to ache, especially in my ankles. I walk for 30 minutes each day, on a treadmill and haven't changed this routine since the onset of these symptoms.


I had an ultrasound done about a month ago that came back showing no evidence of stones, wall thickening, or pericholechystic fluid in my gallbladder. No biliary ductal dilation was seen either. My liver, however was said to be "echogenic diffusely". I'm not sure what that means. The report also states that no focal hepatic lesions are seen and that my spleen, pancreas and kidneys appear grossly normal.

I seem to be living in the bathroom these days, with very loose stools and pain on my right side, just below my ribs.

I'm currently waiting to be seen by a Gastroenterologist. I'm curious what might be the problem here... and what to expect when seeing the Gastroenterologist?

Thanks.

[Doug]

It is hard to tell what specifically is causing your problems, however given the location of your pain, your bowel symptoms, and your tests thus far, it is safe to say that your liver is a good place to start with your gastro. doctor.  Echogenic diffusely basically refers to the fact that the liver is supposed to look or "shadow" a certain way on ultrasound.  Echogenic means that something is showing up more "prominant" than is normaly seen.  Difuusely would mean that these "shadows" are seen scattered throughout the liver.  No focal lesion means that there is not a single lesion or mass that seems to dominate the liver.  Although there are several possibilities, my guess would be a fatty liver, or possibly diffusely cystic liver.  Of course I am not a doctor and your gastro. doctor will know more upon further testing which may include liver biopsy.  Best regards.