ascites with heavy drinking

An ultrasound and CT scan have shown that I have ascites.  I drink quite heavily, about a pint a day, for around 4 years and about 4 or 5 drinks a day before that since I was about 25. I am know 43.  However all of my liver tests are normal, in addition my blood tryglycerides were very low despite the fact I am very overweight.  Also my Ferritin level was extremely low.  I was anemic, but after taking iron supplements for a month that is no longer a problem.  Also my platetlet count was normal.  The CT scan showed fatty liver infiltration, but nothing else specific.

The only signs of liver disease are the ascites(which is clear) and an enlarged liver and spleen.  The protein in the ascites fluid was 4.1 g/dl.  The albumin content was 2 g/dl. My blood albumin is 4.9 g/dl.  I know about the SAAG ratio and it would indicate I have portal hypertension.  However the ascites fluid was tested a full week before the blood.  I have read these tests should be performed within hours of each other.  Why must the tests be done so close together?  What other advice can you give me based on these facts. i.e what other tests etc.should my doctors be performing?

[Kevin Pho, MD]

You are correct in that ascites in your case is likely due to portal hypertension - commonly caused by liver failure.  I agree with the imaging of the liver.  At this time, a biopsy should be considered to confirm or exclude the diagnosis of cirrhosis.  If that is present, liver transplantation may be an option.  

Regarding the ascites can be treated symptomatically with diuretics and beta-blockers.  Occasional paracenteses can be done if the fluid becomes to excessive.  

I don't have an answer as to why the blood and fluid should be done so close together - however, it is possibly due to the fact that the SAAG is more accurate if the tests are drawn from similar times to exclude confounding factors.

These options 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_

[Jenn1234]

I was diagnosed a year ago with cirrohsis.  I had jaundice, ascitis, elevated enzymes, etc.  A biopsy was performed.  I am 39 and was a heavy drinker off and on for 10 years.  Aside from being an alcoholic I am in good physical shape.  I am very athletic and have always ate right.  My question is....since I was diagnosed I have been sober, followed a low sodium diet, etc.  I just went in for a follow up bloodwork analysis and everything is normal.  Does that just mean that the part of my liver that is not scarred is functioning properly?  Do I have to worry about the next bloodwork tests?  My doctor said he didn't need to see me until November.  He said it was extremly good news that my liver enzymes were 100% normal.  Only, I have cirrohsis.  I don't understand.

[orphanedhawk]

I have HCV cirrhosis. I was told by my heptologist that after I clear the hepatitis, my liver will begin to heal itself. It is a self rejuvenating organ. No doubt, your good health, otherwise has helped you to heal so quickly. It used to be believed that cirrhosis was irreversible, but that is not the current view.
    Congratulations.