Enlarged liver, high albumin and normal LFTs

[mmizra]

I'm a 30 year old female with a 2 month history of heavy drinking (approximately a 6-pack or 1-2 bottles of wine every night for the past two months.)  Prior to this, I drank infrequently. I am height weight proportional 5'6, 125 pounds but with extra abdominal skin from a previous pregnancy.  I am scheduled to undergo elective surgery, a tummy tuck and mastopexy, on August 30th.  When the surgeon was feeling my abdomen he noted that my liver was enlarged.  I saw my pcp about this and she confirmed that my liver is enlarged.  Despite recent heavy drinking the ggtp was normal at 14.  ALT = 10, ALP = 69, AST = 20, Bilirubin = 0.5, Albumin 5.2, and total protein = 7.8.  I am hep c negative.  I had originally been concerned that I had alcoholic hepatitis although urine, stool and skin color are all normal.  What does a high albumin mean in the context of an elarged liver and otherwise normal LFTs?  My previous boyfriend was a gastroenterologist and he actually felt my liver about 5 months ago, just for fun, and he said it felt normal.  So an enlarged liver isn't the norm for me even though this was what the plastic surgeon suggested.   I have a really hard time believing that I'm dehydrated even with recent alcohol consumption.  I drink a lot of water.  Probably 10-12 glasses a day.  I have an ultrasound scheduled on Spet 7th, but I kind of need to know now if this enlarged liver/high albumin thing puts me at a greater risk of complications during surgery.  Any info you might have would be greatly appreciated.  Thanks.

[Kevin Pho, MD]

The albumin can be elevated in the following diseases:

# Chronic infection (including tuberculosis)
# Adrenal cortical hypofunction
# Liver dysfunction
# Collagen Vascular Disease (Rheumatoid Arthritis, Systemic Lupus, Scleroderma)
# Hypersensitivity States
# Sarcoidosis
# Dehydration (diabetic acidosis, chronic diarrhea, etc.)
# Respiratory distress
# Hemolysis
# Cryoglobulinemia
# Alcoholism
# Leukemia

That being said, the ultrasound is the most reasonable test for further evaluation.  It is encouraging that the other liver function tests are within normal limits.  

If there continues to be concern about the liver, a biopsy can be considered.

I am not aware of an isolated, slightly-elevated albumin being a risk factor for surgery - although this needs to be discussed with your personal physician or surgeon.

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.
http://www.straightfromthedoc.com

[Christie2004]

Does your plastic surgeon know of your recent heavy drinking?  Be absolutely sure you tell him, and be honest with your anesthesiologist prior to the surgery, too.

There can be repercussions both from an anesthesia standpoint and a recovery/healing standpoint from such heavy alcohol intake, if it continues as you describe.  Perhaps nothing will come of it, but you MUST be honest with your doctors or risk perhaps a bad outcome.  

Are you taking steps now to get off the alcohol?  I hope everything goes well for you.

[jbaum27]

A related discussion, Multiple deficiencies of the liver was started.