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Liver Ultrasound Results
Hello:

I am 22 years old, and have never had a drop of alcohol or any other illegal drug.  I had Autoimmune hepatitis that was very late in diagnosis.  By the time they found it my liver was in stage 2 cirrhosis, as determined by liver biopsy.  I was put on heavy immunosuppressants, and everything appeared to be back to normal - or at least as normal as could be expected with cirrhosis.

Then I started with the following symptoms
-Belching and a type of belching/hiccup
-Intermittent pain in the right side (especially after eating)
-Slight Anemia
-Dizziness/Fatigue (also especially after eating and in the mornings)
-Cherry Hemangiomas all over my back, chest, and arms

The prompted bloodwork, which showed elevated AST/ALT levels (158 and 172 respectively).
-Bilirubin and albumin levels are normal
-All other levels are normal

This prompted a ultrasound of the liver, which returned the following results:

-There is a heterogeneous echo pattern of the liver.  The liver doe snot appear to be significantly elnarged.  The bile ducts are unremarkable.  The common hepatic duct measures 2mm.  The common bile duct measured 2.3mm

There is some thickening of the gallbladder wall, suggesting gallbladder is somewhat contracted despite the patient being NPO (meaning I hadn't eaten anything).  There is no pericholecystic fluid and no stones are identified

Survey of the pancreas and right kidney was normal

Impression:
-Heterogeneous liver pattern.  No definite masses.
-Normal bile ducts
-Contracted gallbladder.  Some associated wall thickening with the contraction




Question is - should I be concerned and push for additional tests?  
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4 Answers
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729009 tn?1237330483
Are you seeing a hepatologist? I would make sure they do routine CT scans to monitor any progression they can see. If there is no progression and they are satisfied with your bloodwork, well I guess it is true that cirrhosis does have some side effects that you can't really avoid. However, if I was you, I'd be going back. I'd want to know why the new symptoms because usually those are associated with your levels being off too. Have you been tested for other hepatitis'? How did they diagnose the autoimmune hep? Just curious...
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Thanks for the reply .  My AST/ALT levels were 2200 and 1400 respectively, which is fairly rare for viral hepatitis.  Since they checked my blood for any Hep viruses and they came back negative, the diagnosis was Autoimmune hepatitis.  I guess it was confirmed when the immunosuppressants brought those levels down.  

I am most concerned about the heterogeneous echo pattern of the liver and their choice of words
-"no definite masses" as opposed to "definitely no masses"

Are these basis for concern?
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729009 tn?1237330483
LOL, yeah, that would be the better combination of words, for sure! Geez, I wish I knew more about autoimmune hepatitis. Have you ever looked up Epstein-Barr Syndrome?  There is a really good website at Merck (a drug company, I know, but it's really 'medically' good) ... merck.com and also at the Mayo clinic's liver transplant section. I dont' know if the pattern you seem to have in your liver is indicative or fibrosis, but that is something I would ask your doctor. Once the tissue turns fibrous and whatever's causing it isn't stopped, it's next stop cirrhosis town. Wish I could be more helpful. Hopefully somebody will add something.... Good luck!
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729009 tn?1237330483
Woops, I just realized you said you already have cirrhosis... That's a big one to swallow at your age. Nonetheless, I would still want to make sure whatever caused it won't come back and what I could do to ensure that.
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