Uncertain with diagnostic response, elevated enzymes, splenomegaly
I am a 28 year old caucasian male. Two weeks ago (9/24) I became very ill with flu like/viral symptoms. I went to a local clinic (9/29) after five days of not getting better (fever, chills, body aches, etc) for good measure as we have a 3 month old infant.
About that time I started feeling better. Flu, Mono, chest xrays, etc came back fine. Blood test showed moderately elevated liver enzymes, and low platelets. White blood cells were almost below low end of normal. (AST 83, ALT 91, ALP 108, WBC 4.0, PLAT 109). Clinic referred me to my primary care doctor.
Went to my primary care doctor late the next day (9/30) and did another blood test. By this time the viral symptoms were going away and apparently my immune system had got me over the worst of the illness. LFT results came back dramatically worse. (AST 134, ALT 152, ALP 156, WBC 3.5, PLAT 107)
Went back in to review results. Doc downplayed results and attributed them to the virus. Referred me for an abdominal ultrasound and metabolic panel including LFT. AU (performed on 10/6) showed mild splenomegaly (high end of normal is 12cm, I measured 14.9 in widest spot). Liver, gall, pancreas, etc showed perfectly normal. No evidence of hepatomegaly or abnormal markings on liver. This time (10/6) white blood cells and platelets were not measured, however (AST 61, ALT 120, ALP 163).
I am 6'2" 246lbs with a BMI of 31.6. Blood pressure, cholesterol, etc is totally normal. Most recent BP was 128/88.
I have been a moderate drinker for about 10 years. From 18-24 I binge drank frequently, with frequent long periods with no alcohol intake. From 25-28 (present) I drank almost every day (3-6 drinks per evening) with an occasional heavy binge on New Years, parties, etc.
I have smoked off and on since 18 (10 years) with a couple year long durations of quitting.
My diet is not horrible, but fairly poor. Fairly high frequency of fast food, dining out, high fat, high calorie meals.
Since the day I became ill I have not had an alcoholic drink, so it's been two weeks. After seeing the LFT results I became a bit nervous and also stopped smoking. It has been a week. I also changed my diet (I know how to eat right, just chose not to) back to perfectly healthy. Salad bars for lunch, fresh fruits and vegetables for snacks, baked/grilled chicken and fish for dinner. I began taking milk thistle supplement once per day.
My doctor seems to be downplaying everything, attributing enzymes and wbc and platelets to the "virus" still. Doctor didnt even order the ultrasound of the spleen, I asked the radioligist to check it out after understanding the signs the white blood cells and platelets were pointing to portal hypertension. When I had my blood drawn on 9/30 I bruised severely on my arm. A week and a half later the severe bruise remains. I do not usually bruise easily.
For the last 2.5 years I have had an on and off pain in my right side, especially after heavy drinking. I shared this with the doctor.
What do you think, community? Do the clean liver results on the ultrasound, coupled with the recent illness make you think I should just ignore it and cut down on my alcohol intake?
Or do you think the elevated liver enzymes coupled with symptoms of portal hypertension (including splenomegaly), right side pain, bruising from blood draw, etc could possibly mean I have a variation of fatty liver, or even a stage of cirrhosis?
I have displayed no jaundice, no symptoms of ascites, no swelling, etc. However it's my understanding you don't see those things until advanced cirrhosis, so I probably wouldnt see them.
I should also note that now that I am over the illness completely, have eliminated alcohol, stopped smoking, and corrected my diet, I do feel great. Not 100% at the height of my energy each day, but I think I am still paying back a bit of a sleep debt from having a 3 month old baby keeping me up at night.
I am primarily worried and do not wish to downplay these symptoms because I am very young. I just recently got married, bought my first home, had two beautiful children, and have a great career. I am only 28 years old. My daughter will be graduating high school when I am 46. I want to be around for that, and much longer. If my liver is already really suffering from my actions so far in my life, I need to know the dramatic life changes I've recently made MUST stick so I can STICK around.
I need to know - can I have a cocktail on my birthday, and perhaps New years? Or must I abstain 100% for the rest of my life? Can I have the occasional slice of pizza? Or Cheeseburger from Red Robin? Or must it be the salad bar forever?
An enlarged spleen and low platelets are not good signs. These can be signs of early cirrhosis.
Have you ever been tested for hepatitis?
I would get a copy of your ultrasound report. It should indicate if there are nodules on your liver, indicating cirrhosis. How does your doc explain the reason you have splenomegaly ? The most common causes of splenomegaly in developed countries are infectious mononucleosis, splenic infiltration with cancer cells from a hematological malignancy and portal hypertension (most commonly secondary to liver disease).
I would recommend you see a gastroenterologist or hepatologist who specialize in digestive system and liver diseases to be on the safe side. You primary doctor is not trained to do this and can miss a correct diagnosis until your disease is irreversible. You could very well have the signs of early cirrhosis as usually there are no obvious symptoms.
AST and ALT are associated with inflammation and/or injury to liver cells, a condition known as hepatocellular liver injury. Damage to the liver typically results in a leak of AST and ALT into the bloodstream. AST can indicate liver disease. Most liver diseases are characterized by greater ALT elevations than AST elevations. Two exceptions to this rule exist. Both cirrhosis and/or alcohol abuse are associated with higher AST levels than ALT levels, often in a ratio of approximately 2:1.
Since your ALT is higher then AST there may be something else injuring your liver. So you may want to follow up.
A biopsy is the only way to accurately assess the status of your liver. Depending on the results, you may be able to drink in moderation (although with your drinking history you appear to have a problem with alcohol and it would be best for your overall health and your child's life if you stayed away from alcohol). Pizza and cheeseburgers are fine as long as you don't have advanced liver disease.
I think you are right to make sure you don't have liver disease now instead of waiting too long. It will put your mind at rest.
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