Normal ultrasound, still a liver scare

Hi everyone!

I have a question about the ultrasound of the liver (or abdominal ultrasound as a whole) and liver function tests. I went to see my gp two months ago complaining general itching (pruritus) and vague right upper quarter abdominal pain. Physical examination revealed nothing, but liver function tests revealed a slightly elevated AST (56), a GGT of 177 and total bilirubin of 22. The doctor said that there is unlikely to be anything seriously wrong with me (the upper normal referance value for bilirubin is 20 at least with the lab they use, and GGT, upper normal 70, is "a bit of joke, indicates nothing but boozing" according to the gp).

I was, however, worried enough to have an ultrasound in a private hospital. It revealed nothing at all, and the radiologist said not to worry.

Some weeks ago I spotted a spider naevus in my nose, and went back to my gp. He shrugged it off and said that it's nothing and there should be at least five and more likely in the torso area to indicate a liver disease. He also said that pruritus and spider naevi are end stage symptoms, and it would be quite weird for a guy who jogs 7 miles twice a week and lifts waits to be in an end stage cirrhosis. I have a history of heavy drinking for 12 years or so, which I told the doctor as well. He adviced to cut it down, of course.

So, what puzzles me is that do I have a liver disease (cirrhosis)? The pruritus is only mild to moderate, but it does not seem to go away. I have no other symptoms, and my high albumin (53) certainly does not point to an end stage liver disease. I feel fantastic, no nausea, tiredness, weight loss or the like - yesterday I ate two steaks and a mountain of potatoes after an hour at the gym!

Sorry for the long question, but the doctors certainly don't care to listen as they think I'm OK. But I do have some abnormal LFT ratings and a symptom and a sign of chronic liver disease. Has anyone heard (or experienced) of anyone being in perfect health + showing a clean ultrasound and yet having a developed cirrhosis? I know it's possible in theory, but is the chance like 1/1000?

[Dougs582]

You don't have end stage liver disease.  If you did your albumin would be low, your bilirubin would be high and you would have a bleeding problem.  You would symptoms/signs of a sequelae known as portal hypertension which would give you a bloated, fluid filled abdomen, and prominent veins on your abdomen.

Ignore the funny enzymes.  Liver function tests is a misnomer.  They should be called liver insult tests.  They are a sign of short term damage, not function.  If you have 30 beers a day for 20 years then take a week or two off and check your enzymes they would be normal despite the damage you would have done to your liver.  The elevated enzymes are either related to a recent drinking session or a brief, viral illness (many, many cause a transient increase in the enzymes but no long term problems... we never concern ourselves because we never know).

In chronic liver disease, liver function is important in gauging the problem.  Usually an underfunctioning liver would manifest itself as blood clotting problems (the liver makes clotting factors), a low albumin (which the liver also makes) and signs of portal hypertension.

The only definitive test for degree of liver fibrosis (which is what cirrhosis is) is a liver biopsy.  But in someone who feels well, has a normal albumin, normal ultrasound and normal bilirubin (22 doesn't count) it is completely unjustified.  The risks, including infection, bleeding, pain, reaction to anaesthetic agent far outweight the benefit, which is a test telling us what we already know, your liver is fine.

1 spider naevus is normal.  Multiple are a problem.

Not to get too personal, but is there are reason (beyond a reasonable concern for your health) for the anxiety you are experiencing?  Is that worth thinking about?

Your liver disease does not explain your itch.  Ever had allergy testing?  Tried an antihistamine, and if so did it help?  Changed your clothes/food/surroundings recently?

Hope I have helped.