Ultrasound results ... diffuse echogenic liver

Hello,

About 3 weeks ago I was in the midst of almost daily attacks of what was very consistent with gallstones (pain in the mid upper abdomen that was brought on by greasy foods and lasted for a couple of hours).  I altered my diet and the pain has basically stopped (I had 1 attack 2 weeks ago and it was less intense and shorter than previous attacks).  I have had NO attacks in the last 2 weeks and only the one I mentioned in the last 3.

Last week, I went to my doctor to evaluate.  She also felt it was gallstones and I was sent for lab work and an abdominal ultrasound.  

Here is where my questions come:  #1, my gallbladder was unremarkable with no stones present. Is it possible that I did have a stone and passed it?

And now the more complex one:  My ultrasound results showed the normal gallbladder with no stones, a grossly normal biliary system (was not clearly visualized, but appeared grossly normal), and normal and unremarkable kidneys and spleen.  My Murphy's Sign was negative.  My pancreas was unable to be visualized and therefore no results were available for the pancreas. My liver, however, showed diffuse echogenicity with no infiltrate and no tumor or lesion with the impression of probably fatty liver with the recommendation for clinical correlation to r/o cirrhosis and hepatitis.  My LFT's were all normal in the blood work late last week.  The rest of my blood work was basically normal except for slightly high cholesterol, slight elevated EO% at 9.4 and very slightly low anion gap at 5.0.  I currently have no symptoms at all.  

So the second question: Does this just sound like plain old fatty liver?

Some demographic information: 29-year old obese male with a short bout with moderate alcohol abuse (when I was 21, I got drunk a couple of times a week).  I have no significant medical history.

Thanks!

     - Ben

[Kevin Pho, MD]

To answer your questions:
1) The scenario you described may be possible.  It is also possible a low gallbladder ejection fraction may be causing your symptoms.  A HIDA scan with CCK stimulation would be the best test to evaluate this.  

2) When the liver is echogenic, this refers to structures having strong reflectors of sound.  Gallstones and fat tend to have have strong echogenicity.  If there is no evidence of gallstones or masses, then fatty liver is a possibility.  Alcohol intake would increase the chances of having a fatty liver.  You may want to consider whether a liver biopsy would be a reasonable next step to confirm the diagnosis.  

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.

[njben]

Would a liver biopsy (considering the risks) be advisable at this point with no elevated liver enzymes?  From what I have been studying, a diffusely echogenic liver with no lesions or masses seen would really have to be a fatty liver, cirrhosis, or hepatitis.  Considering my enzymes or normal, that pretty much leaves a fatty liver.  And the best bet to treat a fatty liver would be losing weight (something I am in dire need to do anyway).  Of course, I am not a doctor, and I am sure that mine will have her opinion as well ... but I want to have some independent opinion on this matter as well.  Thank for your help!

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