I am no doctor by all means,but I do have Early Stage Cirrhosis and Stage 5 Fibrosis and I have not had Ascites.With all you have been through I would have to say your Diagnosis is most likely correct.I am really surprised that no one has commented on your post already.I am really sorry to hear you are not feeling well.Please take it Serious and follow through with what your Doctor is telling you.
Best Wishes to you,
"But is it possible I could have actually had just an acute condition (e.g. alcoholic hepatitis), and not cirrhosis?"
No. You can't have ascites without cirrhosis and portal hypertension which are the cause of ascites, sorry.
"no one would guess I had anything close to cirrhosis."
Most people with cirrhosis of the liver have no symptoms and function normally. It is only when they develop ascites, vomit blood or other complication of advanced cirrhosis that anyone is aware that most of their liver has been destroyed. You are misinformed about the nature of cirrhosis and what it supposedly looks like. Most people with cirrhosis look the same as every one else until the final stages.
A GI specialist, unless they work for a liver clinic at a teaching hospital is NOT qualified to care for a person with cirrhosis. You need to see a hepatologist at a liver clinic or a liver transplant center.
It appears your liver disease is the results of alcoholic liver disease. Now that you are not drinking your liver is repairing itself which is why your ascites has resolved itself at least temporarily. Cirrhosis develops over decades of alcohol abuse. It doesn't magically disappear after decades of injury from alcohol. but ascites may resolve or become more responsive to medical therapy with abstinence and time. Also the reversible components of alcoholic liver disease can be revered over time by abstinence . So if you never drink again your liver may be able to bring itself back from the brink.
Unfortunately only people with advanced cirrhosis experience ascites. It is very common for ascites to come and go but that doesn't mean you don't have cirrhosis. Blood levels being with normal ranges also don't mean you don't have cirrhosis. That is wishful thinking I'm afraid.
Have you had a liver biopsy? It is the only way to know what stage your liver disease is. Although ascites is ONLY present in people with cirrhosis.
Once a person develops cirrhosis and ascites they have many other issues that they may not be aware of because they are internal. Having cirrhosis means you are more prone to liver cancer and will need to be monitor every 6 months as long as you have cirrhosis. Like liver damage, liver cancer has no symptoms until it is very advanced. If you don't get monitored for liver cancer by the time you feel something you will only have months to live. There are many other life-threatening complications of cirrhosis that can appear. You need to be under a hepatologist care at least until you no longer have cirrhosis. Unless cirrhosis is properly monitored prognosis over time is poor.
Continue to see a doctor until you no longer have cirrhosis. Remember cirrhosis can be fatal without proper treatment.
I didn't have a biopsy. The cirrhosis was diagnosed by the admitted alcohol consumption, ascites, elevated enzymes, lowered albumin, and the ultrasound which showed "numerous hard nodules most likely due to cirrhosis. No reason to doubt the diagnosis at that time.
I still see a GI specialist every 3 months or so; I go again in a couple of weeks. But accordng to what I have been told cirrhosis is completely irreversible (unlike fibrosis). I would not expected to have gotten better if I actually had cirrhosis, which is why I wonder. Maybe people go through different phases and are better for a while -- I don't know. As of now every blood test aspect that might be seen as bad due to severe chronic liver disease -- enzymes, albumin, bilirbin, platelets, etc., -- are all completely normal.
I'm reluctant to disagree with Hector because he is extremely knowledgeable but there can be ascites without cirrhosis.
Admittedly the overwhelming majority of ascites is due to cirrhosis related portal hypertension. There are however other possibilities, though very uncommon.
Congestive heart failure can cause ascites as can advanced renal disease/kidney failure. These are portal hypertension related but without cirrhosis.
Internal and external obstructions of the portal vein can also cause ascites(tumors, blood clots). These too are portal hypertension related but without cirrhosis.
So too can some advanced cancers - malignant ascites.
And there is Pancreatic Ascites which is not portal hypertension related.
"...Pancreatic ascites is defined as massive accumulation of pancreatic fluid in the peritoneal cavity.1 The amylase is generally above 1,000 and often in the 5,000 to 10,000 range. It can be due to traumatic rupture of pancreatic duct from recent abdominal trauma such as a car steering wheel injury, or more likely from chronic alcoholic pancreatitis.2 It has been described in approximately 4% of patients with chronic pancreatitis and in 6% to 14% of those with pancreatic pseudocysts.3 Many patients with alco-holic pancreatitis may not even have abdominal pain and therefore it might be confused with ascites from cirrhosis. The confusion is less likely when there is a history of recent trauma. As with any cause of ascites, paracentesis is mandatory. Treatment of ascites is dependent on the etiology and the best way to deter-mine this is with paracentesis. In the case of pancre-atic ascites, in addition to an elevated amylase, it is usually an exudate with the serum albumin ascites-gradient less than 1.1 grams/dl. .."
Pancreatic Ascites is quite rare but it is associated with alcohol use and I guess it is one possibility, although unlikely.
So far, tests have shown no cancer. There is no hepatologist within 100 miles of where I live, but Realize I would have to be under a hepatologists's care to receive a transplant. As of now, I don't even come close to meeting the criteria for a transplant.