Cirrhosis of the Liver Community
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Avatar universal

Liver Issue?

Not sure where to post this since I am awaiting diagnosis. I have antiphospholipid antibody syndrome and lupus. I have had a major health decline the past 6 months. Everything in me was telling me to have my liver checked. All of the specialist I see brushed me off.  I ended up in the ER in early April 2013 due to chest pain. No mention of lab results at all. I saw a new cardiologist this week and she asked me if anyone had talked to me about my liver - I said no why? She said well I think that should be your primary focus before the other stomach test the GI doctor had ordered. She gave me a copy of the results: My ALT was 124 (maximum range is 38); My AST was 265 (maximum range is 40) and my Alkaline Phosphates were 139 (maxiumum range is 126). My GI sent me for an ultrasound of the liver today as well as an extensive blood work panel.  

The ultrasound technologist said my liver looked good to her. I had one cyst but the ducts looked clear. My question is can I have a liver issue going on and have a normal ultrasound?

I am nearly 45 and do not drink alcohol.  I did consume alcohol on weekends in my younger "party" years but have never been a heavy drinker.  Thanks for any experience/advise you can lend me. My new GI doctor has the personality of a stick of wood and it's almost impossible to talk to him...
8 Responses
446474 tn?1446351282
Liver disease?
Whether or not you have liver disease depends on how long your liver has been injured. An ALT of 124 (maximum range is 38); AST of 265 (maximum range is 40) and my Alkaline Phosphates were 139 (maximum range is 126) indicates liver injury when you had the test taken.

" My question is can I have a liver issue going on and have a normal ultrasound? "
Yes. An ultrasound can only see when liver disease is advanced and you develop cirrhosis or liver lesions. A liver biopsy is used to measure the amount of liver disease someone has.

Having a GI that you can't communicate with will always leave you wondering what is happening with your liver. If it turns out the you have liver disease I would suggest finding a GI you can talk to because depending on your condition you could have to manage your liver disease for many years.
Atlanta has many good GI and hepatologists (liver specialist) so there is no reason you can't find a very good doctor especially because of your other health conditions your health is more complicated than many. Lupus can also injure the liver. *See below*
Emory University Hospital
Atlanta, GA

Emory Liver Center

Emory's liver program provides compassionate and individualized care to patients with a wide variety of liver diseases and conditions. As a leader in the treatment of liver diseases, we have assembled a multidisciplinary team of liver disease specialists, including hepatologists, surgeons, radiologists, pathologists, and oncologists, whose expertise is unrivaled in the Southeast.

Our liver program covers the continuum of liver care, including: diagnosis of liver disease and conditions using the most sophisticated diagnostic tools available (including MRI and advanced endoscopy), management of all diseases and conditions of the liver, and cutting-edge treatment options including laparoscopic liver resection, endoscopic procedures, interventional radiology, and liver transplant.

Call 404-778-5301 Monday through Friday from 8 a.m. to 5 p.m. EST.
Lupus and Liver Complications

Your liver is the largest organ inside your body. It is also one of the most important. The liver has many jobs, including changing food into energy and cleaning alcohol and poisons from the blood. Your liver also makes bile, a yellowish-green liquid that helps with digestion. When lupus causes inflammation in the liver, a condition called hepatic vasculitis can occur. This affects the blood vessels that supply the liver and can cause blood clots in those vessels. The liver may become enlarged due to ascites or congestive heart failure. People with lupus also may develop jaundice, a liver condition that gives a yellowish color to the skin. Jaundice in lupus also can be a sign of anemia or pancreatitis. If your liver enzyme levels are increased, this may be due to NSAIDs or acetaminophen, or may be a sign of lupus activity.

Autoimmune hepatitis is a disease in which the immune system attacks the liver, causing the liver to become inflamed. Autoimmune hepatitis is classified as either type 1 or 2. Type 1 is the most common form in North America. It occurs at any age and is more common among women than men. About half of those with type 1 have other autoimmune disorders, such as type 1 diabetes, proliferative glomerulonephritis, systemic lupus, thyroiditis, Graves' disease, Sjögren's syndrome, autoimmune anemia, or ulcerative colitis. Type 2 autoimmune hepatitis is less common, typically affecting girls ages 2 to 14, although adults can also be affected.

Fatigue is probably the most common symptom of autoimmune hepatitis. Other symptoms include an enlarged liver, jaundice, itching and skin rashes, joint pain, abdominal discomfort, abnormal blood vessels on the skin (spider angiomas), nausea and vomiting, loss of appetite, dark urine, and pale or gray colored stools.

Because severe viral hepatitis or hepatitis caused by a drug -- for example, certain antibiotics -- have the same symptoms as autoimmune hepatitis, tests may be needed for an exact diagnosis. Your doctor also should review and rule out drugs you are taking before diagnosing autoimmune hepatitis. Both types of autoimmune hepatitis are treated with daily doses of a corticosteroid (such as prednisone), but azathioprine (Imuran®) is also used.
Good luck!
Avatar universal
Thank you so much! I do believe I need to change GI doctor. I saw him for the 1st time last week and he walked in and said "you have 10 minutes - go" I thought he was kidding but he wasn't he said he had 20 more patients to see that day and he didn't have time to go thru my prepared list of symptoms. He then ordered a special CT scan that requires 7 bottles of contrast PLUS contrast thru IV. I know contrast is not what a troubled liver needs. He is still insistent on this test (it will look at my small intestines) and I told him I refuse until we know for sure what's going on with my liver. I am not his wife, mother, or grandmother - I am a number he allows 10 minutes of time with. Well, I am all those to my family and they as well as myself deserve for me to have the best of care! Thanks for lighting that fire for me!
446474 tn?1446351282
You are the consumer of his medical services. If you don't like the service you are free to look elsewhere depending on the type of health insurance you have. The days of the doctor as god are long gone. Patients want to be more involved in their own care more than ever, so of course they want to be listened to and participate in their own healthcare. We are people NOT our diseases.

As I said Emory has an excellent liver center where you can receive some of the most up to date care available anywhere. Why put up with 3rd rate care, possibly be misdiagnosed, treated as a number, when you can have some of the best care available? This is your health. We should all value our health because without it life can be a challenge just getting through everyday. As someone who may be terminally ill, I can tell you that you don't want to be chronically ill and suffering every day wondering how much time you have remaining.

Value yourself and your health and seek the health care you deserve.

Good luck to you!
Avatar universal
I took your advise and called the Emory Liver Center. They do accept my insurance and don't require a referral. I just need the test results from "Mr. Personality" faxed to them. The current GI's assistant said they have my ultrasound report and part of my blood test results but not all of them. I asked her how I can get that information and she said the doctor has to call me. GREAT! No telling when/if I will get that call... My appointment at Emory is June 20th so only 2 weeks away. Thanks for the encouragement!
Avatar universal
You made a very wise move.

Good luck,
89592 tn?1391278022
MichelleK....I have rheum arthritis and early cirrhosis.  Just dx'd in March positively.  I also have lots of other autoimmune issues..sjogrens, raynauds,.....etc etc  I am seeing a hep at Cleveland Clinic.  I felt like my gastros...tried 2 weren't really addressing it and didnt have the knowledge of dealing with cirrhosis along with autoimmune disease.

Just wanted to wish you good luck and you're not alone.

Avatar universal
Thank you! I have found that it's much easier for all my doctor's to just blame everything on my autoimmune stuff than to actually do the testing and foot work to verify what they are saying is true. So glad to have found this support community!
89592 tn?1391278022
Any questions..ask away.  someone will be able to answer for you.  Hector is a Godsend to this community.  You wont find anyone like him...maybe the hep..but it will be a close call.  LOL  

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