NON-HEP Liver problems

[CSI007]

Hello,
I am sure this is not the exact forum to post this but I cannot find a forum specific to this question so here it goes.

My father (62) has been diagnosed with an enlarged spleen.  He has been through countless tests etc and we are still sitting here trying to find a diagnosis for his condition(s).  All of his blood work is good except for low platelets (Down to 59k from 75k a year ago).  AST is 60, ALT is 35.  

He has been tested for HEP and all tests have come back negative.  He does not drink or do drugs.  Though he does use quite a bit of over the counter medication and pain medicine and has for years and years.  He is overweight (obese) but he does not eat a great deal but is not very active because of a bad back and knees.  It seems that his AST/ALT has been high for over 30 years now.  We have tried to rule out possible cancers etc.

The docs say he has portal hypertension and a liver biopsy two years ago showed something going on but not cirrhosis.  Last year he went to a hematologist (actually my oncologist too) and he recently said that a CT scan done of his liver showed cirrhosis.  So we are not sure if he really is in cirrhosis of the liver or not.  He is going to see a hepatologist this coming Monday but we are not sure what to expect and I need to ask the hard questions so that we can know what direction to head in.  

Does anyone here have any ideas of where we should look?  What it appears to me is that he has some early stage of cirrhosis but we just can’t pin down the cause to take action so that he can start to battle it before it's too late to help.

And at the rate that his spleen is growing and killing platelets it's becoming a very serious concern as well.

Anyone help, please.

Thank you.

[FlGuy]

I'm sure not qualified to take a guess, but a couple of observations.  Clearly the best way to assess what's happening with the liver is a bopbsy, so make sure the hepatologist gets a copy of the prior report.  He may even request the slides.  The hepatologist is a very good next step.  The AST/ALT, AST is probably a ltitle high for range and ALT is with normal range.  Platelets are low and when I had (still do) have low plates the term used was 'they were sequestered' in the spleen and I don't know exactly know what that means.  Bring recent reports (labs) with you in some rational order it will help the doc divine a trend and a history.  Good luck.  Oh yeah, be ready to quantify and describe those otc and prescribed pain meds.  A lot of them are tough on the liver.

[CSI007]

Thank you,
I forgot to mention that my dad several years ago lost all of his hair on his legs too.  Onyl from his hips down.  He is a very hairy person including his legs, at least he used to be on his legs.

He saw a hepatologist two years ago who suggested the liver biopsy back then.  But the only thing he suggested to my father at the time was to get gastric bypass to lose the weight.  My father has never over eaten or eat bad foods but he just kept gaining more and more weight.  I think this might somehow be related to the rest of this mess.

Does anyone have any other suggests or comments with regards to this issue?

Thanks again.

[FlGuy]

Again, not an expert.  But, sometimes weight gain in people who have liver problems is retention of fluids in a condition call ascites.  You might google it for more information.

[CSI007]

I have some more information about my father.

RBC 3.8  4.20 to 5.80
WBC 3.9 3.8 to 10.8
PLT 59
MCV 102 80 to 100
MCH 36.2 27 to 33
BIL 2.0 .2 to 1.2
AST 60 10 to 35
ALT 35 9 to 60
Alkaline phosphatase 164 40 to 115

significant platelet clumping was observed upon microscopic review of a smear

From his Liver Biopsy of two years ago:

chronic portal inflammation and vague possible lymphoid aggregates.  There was increased portal fibrosis with incomplete bridging resulting in piecemeal necrosis.

From what I am reading it sounds like my father was exposed to HEP.  Is it possible to be exposed and not test postive?

Any additional info from anyone?

[CSI007]

Here is an update and I am afraid it is not very good.  My dad had another liver biopsy done last week and it appears that in two years it has progressed to Stage 4 liver disease.  Though the portal inflammation is less and the report says that the fibrosis is similar to the report two years ago but there is now bridging and mention of "suggestive of cirrhosis".

His doctor has started the process to get him on a transplant list.

Once again, all tests for autoimmune, HEP virus, metals etc. have come back negative.

FLGuy,
Looks like you were right, my dads abdomen is enlarging because of fluid.  The poor man has been dealing with this for years and we never knew.

He was put on another beta blocker to reduce portal hypertension.

His blood work (besides the platelets and RBC) are not all the bad, the billirubin is up slightly, the AST is at 60, the ALT is at 35.

Does ANYONE have any other ideas as to where we can look in the disease process to try to deal with what is causing this to occur that maybe someone is missing?

Thank you

[CSI007]

Anyway to increase ones platelets?  My dad is really starting to have a lot of nose bleeds. :(

[Susie2007]

I'm sorry to hear about your dad. Is it possible that because of the obesity he has something called NASH (non-alcoholic steatohepatitis?). That can cause fibrosis/cirrhosis and all the problems that go with it. They should have seen it on the biopsy I would think.

The portal hypertension is what is causing the spleen to enlarge and sequester (trap) his platelets. I hope the doctors can get to the bottom of the cause for his liver problems.

[CSI007]

Susie,
This is so frustrating for us.  I feel like if we only knew the cause we could fight back.