Hello and welcome to the Cirrhosis of the Liver Community.
My expertise is in liver disease and its complications, not alcoholism and its issues, so I will focus on liver disease and particularly cirrhosis and its diagnosis.
How likely is it that cirrhosis would develop after "only" several months of very heavy drinking?
- Cirrhosis, which is the last stage of liver disease only develops over many decades of continuous liver injury. Whether that injury is from alcohol addiction, a virus such as hepatitis B or C, or autoimmune disease it typically takes decades before the liver becomes so damaged and scared that the normal architecture of the liver is changed and normal blood flow through the liver itself is disrupted.
Note; this is not to say that other health and liver issues besides cirrhosis can’t exist in the abstinence of cirrhosis. Various stages of fibrosis (leaser stages of liver disease), fatty liver disease, alcoholic hepatitis (liver inflammation caused by drinking alcohol), alcoholic poisoning and other conditions and diseases can exist without a person having cirrhosis.
As far as your worries about having cirrhosis…
You mentioned having a recent ultrasound. If you had cirrhosis of the liver it would have been detected on the ultrasound. When a person has cirrhosis there are many physical changes to the liver and the surrounding blood supply that can be seen on any imaging study, including an ultrasound. Since your scan was “normal”, except for the finding of fatty liver disease, you can be assured you don’t have cirrhosis currently.
The fatty liver disease found on the ultrasound is a result of your drinking. Alcoholic fatty liver is an early and reversible consequence of excessive alcohol consumption. Patients with fatty liver typically are asymptomatic. Fatty liver disease is usually found in a patient who is undergoing evaluation for abnormal liver function tests. While no laboratory blood test is diagnostic of fatty liver an ultrasound will see the characteristic echo reflections of a fatty liver.
The AST blood test indicates that the liver has been recently injured. The GGT blood test is often used to screen for chronic alcohol abuse and to monitor for alcohol use and/or abuse in people who are receiving treatment for alcoholism or alcoholic hepatitis. So it would be expected that these levels would be elevated after excessive drinking.
Malnutrition is common with alcoholic liver disease. Perhaps your doctor can help you with nutritional assessment and if needed diet changes and supplementation for any vitamin, mineral or protein deficiencies you may have.
Alcohol often has harmful interactions with prescription medications, over-the-counter drugs, and even some herbal remedies. Because alcohol can adversely interact with hundreds of commonly used medications, it's important to observe warning labels and ask your doctor or pharmacist if it's safe to use alcohol with any medications and herbal remedies that you take.
Obviously as you already know you have problems with alcohol. Abstinence is the cornerstone of treatment of all alcoholic liver disease. Without abstinence any level of current disease you have will only continue to progress. As long as you abstain from drinking there is no danger of developing worsening fatty liver disease, cirrhosis or other alcohol related medical conditions. Of course recidivism is a major risk in all patients at any time following abstinence. Therefore I would suggest you get help for your drinking problem. Talk to your doctor or find a local AA group that can help you stay sober.
Thank you, Hector, for such an informative and detailed reply.
I saw my family doctor on Friday and he gave me a copy of relevant blood tests (bloods taken last Tuesday). Unfortunately, the ALT enzyme was not tested for (and has never been). Results are as follows:
Albumin: 48 (normal: 35-50);
Total Bilirubin: 7 (0-20);
AST: 23 (0-40);
GGT: 70 (8-61);
ALP: 84 (35-130);
Platelets: 390,000 (150,000-450,000);
Prothrombin Time: 9.3 secs (9.5-12.5).
I also had a full blood count test done, and everything in it was in normal ranges.
My doctor said that all of these measures were good, especially the AST falling from 96 a few weeks ago to the middle of normal range, and GGT almost falling back to normal, too.
I told him I was concerned that, if my liver was badly damaged, it would not now have enough healthy cells to actually be being damaged now (and leaking enzymes), but he said that, if that was the case, other measures would be abnormal and I would also be having very serious physical symptoms. Do you agree?
I asked him about the medications I'm taking. He said that my liver function tests were normal before I started drinking heavily, so the excessive alcohol has to take the blame.
We talked about the abuse of alcohol, and I was completely honest with him about my intake and motivations for drinking, as I have been since it started. I would love to be able to go back to the way I was but, if that is not possible, then avoiding alcohol is the only way. Avoiding cirrhosis is a very strong motivator indeed.
It appear that you have a good perspective on what is going on with your liver's health and your relationship with alcohol.
I agree with your doctor as regards to you not having developed cirrhosis or extensive accumulated damage to your liver. And yes as he says you would be experiencing other serious physical symptoms (depending on how advanced your cirrhosis was) which can be disabling and life-threatening. You would not have the normal blood levels that you do. As one example, no one with cirrhosis has a platelet count of 390,000.That is unheard of in someone with cirrhosis. Even early cirrhosis. Platelet count is one obvious marker for cirrhosis because of the effect of the large amounts of scarring that occurs with cirrhosis and its impact on the spleen and surrounding blood supply which is reflected in an abnormally low platelet count. The abnormal blood levels that you have had relate to the current immediate impact of alcohol injury to the liver (AST and GGT levels) not to accumulative damage of cirrhosis over many decades. Which are reflected by changes in bilirubin, INR, creatinine, platelet count and other blood levels.
As you can see your abnormal blood levels return to normal or close to normal when you abstain from alcohol.
Luckily your liver is still in good shape at this point and you have received your wake up call regarding alcohol. You still have time to make life-style changes concerning alcohol that can prevent you from ever developing permanent damage to your liver.
Good luck to you.
Thanks, Hector. That's all reassuring.
A couple of other points, if I may. (I did mention these to my doctor but, being a general practitioner, he can't know everything.)
Can/does having a fatty liver alone cause quite unpleasant physical symptoms, such as tiredness, weakness, bloating, loss of appetite, general pains and aches, etc?
To those unpleasant, visible symptoms that appeared suddenly (and have now largely gone) ... could alcohol poisoning have caused them?
Finally: I am convinced that my hair (head, facial and body) appears thinner and less dense than it did, even a month ago. Could this be liver-related, or do you think I need to look elsewhere for an explanation?
Thanks again, Hector.
Your GP has been correct about everything she/he has said about liver disease. Cirrhosis vs temporary reversible liver damage. So that says something about their knowledge at least in this area.
Twenty percent to 30% of the general population in the western world suffer from (NAFLD) Non Alcoholic Fatty Liver Disease. A form of fatty liver disease not caused by alcohol but with the same result of fatty build up in the liver. The prevalence is increased in type 2 diabetes mellitus (70%) and morbid obesity (90%). So fatty liver disease is a very common form of liver disease. Obviously it commonly has no symptoms (can you imagine all those people feeling ill all of the time?) which is why the vast majority of these people don't even know they have fatty liver disease along with their other health issues. The good news is that both forms of fatty liver disease can be reversed when the cause of the fat build up is stopped. Stopping the drinking of alcohol or and weight loss for those with NAFLD.
Hair loss is unrelated to fatty liver disease for the same reason. I would look elsewhere. Have you had your thyroid checked?
"To those unpleasant, visible symptoms that appeared suddenly (and have now largely gone) ... could alcohol poisoning have caused them? "
- I don't personally know enough about alcohol poisoning to say.
From the Mayo Clinic website.
Alcohol poisoning signs and symptoms include:
Slow breathing (less than eight breaths a minute)
Irregular breathing (a gap of more than 10 seconds between breaths)
Blue-tinged skin or pale skin
Low body temperature (hypothermia)
Passing out (unconsciousness) and can't be awakened
It's not necessary to have all these signs and symptoms before you seek help. A person who is unconscious or can't be awakened is at risk of dying.
Thanks for that.
No, I haven't had my thyroid checked. The doctor mentioned thyroid function last Friday, but we then started talking about something else and forgot about it.
I have been feeling particularly unwell today. I don't think I mentioned it, but I have been seeing spots of blood when I start to urinate and my whole pelvic region feels sore and uncomfortable. However, I had a sample of urine checked and it was free of infection.
What I am about to say is a bit graphic, so sorry about that. Over the past few days, after passing stools, I have noticed lots of tiny brown specks on the toilet tissue. I am concerned that this may be blood, which has me again concerned about a liver problem.
As I said, I just don't feel well: tired, a bit weak, light-headed and lacking appetite. There is definitely something wrong and I just can't be convinced that it could be "only" a fatty liver causing all of this.
I am sorry to hear that you continue to not feel well.
When you mention "spots of blood when I start to urinate" I thought of kidney stones which is something I am very familiar with as I have had more than a dozen over the years and 4 surgeries to have large ones removed. Usually though you will have some pain which typical comes in waves and can be very painful if you have kidney stones. Particularly in the back or back sides or groin.
Blood in the urine is definitely not normal and I hope your doctor continues to follow through to find the root cause.
When a person has blood in their stool from advanced cirrhosis, which you definitely do not have, the stool will appear black. This is the color the blood turns when it goes through the digestive system. Many people think they will see red blood but no the blood turns black when a person has an internal bleed from varices (enlarged veins along the GI tract caused by portal hypertension). Again something that you don't have to worry about.
It differently sounds like something is going on and I hope your primary doctor can get to the bottom of it soon so you can begin to start feeling better soon.
I would write down any symptoms you have and notice the time or any correlation to time of day, eating etc. That might help your doctor to narrow the scope of what could be going on. And again none of these symptoms are symptoms of liver disease.
Good luck Gavin.
Hi Hector, and thanks.
I felt so unwell yesterday (Monday) that I called the "out-of-hours" doctor, described how I was feeling and the background. He said I should go to hospital and tell them he sent me.
I told them I was feeling faint, energyless, had no appetite and had considerable pain and discomfort in the pelvic region. I described it as like having a bad flu, but without the cough and runny nose.
He did blood tests (complete blood count, liver function and lactate) and also tested my urine. He also gave me a physical examination.
All of the tests were normal and I do not have diabetes or any sign of inflammation or infection. He also said he had examined my liver and couldn't feel it (he said that's how it should be - he shouldn't be able to feel it).
He told me there was no reason to admit me to hospital but he could see that I was feeling ill and should go back to my GP to discuss further testing and see if I needed referral to see a specialist.
I am getting more and more depressed by not getting to the bottom of things.
The doctor did the right thing by having you go to the hospital, just in case something was seriously wrong. However hospital ER departments job is only to make sure you aren't having a major condition or disease such as something life-threatening, They really don't have the resources for tracking down other (non life-threatening) more regular conditions.
So I agree that going back to your GP is the best thing you can do. It is the job of a GP to figure out what could be the cause of all of your symptoms (among the many things that can cause such symptoms) and then, if it is required, get you to a specialist who can treat you. It is really their responsibility to get to the bottom of this. I hope they can figure this our soon for your sake.
Since you are having pain in the pelvic region I would think they could do a ultrasound, to make sure there is nothing physically abnormal internally in that region that might explain the blood in your urine.
Of course all of us would feel frustrated, upset and worried if we were feeling sick and no one could figure our what the problem is and offer us some kind of a solution. For many of us "the unknown" is worse than a "known" where we might at least have something we can do about it.
Keep pushing your GP to do further testing.
I am hoping you get a proper diagnosis soon so you can start to feel better.
Hi again, Hector, and anybody else.
I saw a different family doctor this morning, and had written down a few things so that I would not forget anything.
I admitted I was very anxious, but have continued to have the following symptoms: considerable weight loss, hair thinning, fatigue, whole body aches, marks on skin, loose dark stools, and apparent build-up of 'breast' tissue.
She examined my 'breasts' and said they seemed to be just fat. Nonetheless, she said she would have my blood taken to check prolactin levels. Could that be liver-related?
She also said they would take blood to check my thyroid function.
We then discussed my fears about my liver again. She looked at my various blood tests. She said they were all now good. The most recent platelet level was actually 387,000. She again said that I do not have serious liver disease.
The trouble is that no one or nothing has (so far) explained why I have been feeling ill and the symptoms I have been experiencing for the past 6-8 weeks.
It's becoming extremely frustrating as I feel like my life is on hold and, don't laugh, but I still feel really worried that every time I sneeze, blow my nose, clear my throat or go to the loo, a lot of fresh or stale blood is going to appear.
No doubt I will now have a weekend of worry and anxiety until I know the blood test results, and then I'll still probably not be any wiser as to what's going on!
It might help for you to learn as much as you can about Hep C and liver disease. Knowledge is power
Here's a good place to start:
I have read the ways that Hepatitis C is caught, and I don't see how I could have caught it. I am also immunized against A and B.
I think that excessive alcohol consumption over the past year and possibly the added factor of prescription drugs are what have caused the trouble.
Gavin. Anxiety and stress can cause a lot of the symptoms that you are describing including hair loss. When a friend of mines father was ill and dying he became almost bald within that year. Some of the additional side effects you stated could also be stress related.
You must of course rule out disease first. As Hector said a low Thyroid could also be responsible. Hope you can get to the bottom of this.
Keep us posted and hope you find answers.
Hello folks, it's me again!
I went back to see my regular doctor yesterday afternoon.
He had the results of my thyroid function and prolactin blood tests and these were both normal. (The prolactin test was done because I thought I was growing breast tissue and, apparently, high prolactin levels are sometimes associated with serious liver disease - correct?)
He also had my most recent liver function and complete blood count tests to hand, and these were all normal, including:
ALP: 77 (normal: 30-130);
AST: 24 (0-140);
GGT: 54 (8-61);
Albumin: 50 (35-50);
Total Bilirubin: 6 (0-21).
The doctor again said that all of these tests now being normal (GGT is still high normal, but had been 121 in August) show that my liver is recovering well and has NOT been permanently damaged and I do not have serious liver disease.
I asked him how and when I would know that the fat was reducing from my fatty liver. He said that the blood tests showed that that was happening, and would continue to be monitored by blood tests.
I asked him how the radiologist who saw my fatty liver on the ultrasound could see underneath the fat. He said that's not how the fat accumulates - it doesn't cover the top of the liver, it infiltrates it.
Finally, I again suggested to him that my liver enzymes were never that high (the highest was AST 96 and GGT 121 at the start of August) and so I was concerned that the reason these enzymes only showed a modest increase because only a small part of my liver was still healthy, so only a small number of enzymes were capable of being leaked into the bloodstream. I asked him if my theory was "nonsense" and he said, yes, Gavin, it is nonsense.
So, I guess I should be pleased with all that?
I should say that I am still concerned by less hair density on my head, face and body, and sweat which seems oily, but my appetite is better than it has been in 2-3 months and I have actually put-on 5 pounds of weight in the past 7-10 days. I don't have any other strange or suspicious signs, though I am on continuous high alert for them, which I wish I wasn't.
I finally got a FULL 'liver panel' done recently, and now have the results, which finally includes an ALT figure, and the results are as follows:
BILIRUBIN: 4 umol/L (normal range: 0 - 20)
ALK PHOS: 88 IU/L (40 - 129)
AST: 21 IU/L (0 - 37)
ALT: 43 IU/L (10 - 50)
CK: 66 IU/L (38 - 204)
GAMMA GT: 44 IU/L (10 - 71)
SODIUM: 143 mmol/L (135 - 145)
POTASSIUM: 5.4 mmol/L (3.5 - 5.5)
CHLORIDE: 98 mmol/L (98 - 107)
BICARBONATE: 16 mmol/l (22 - 29) *LOW*
UREA: 4.3 mmol/L (1.7 - 8.3)
CREATININE: 82 umol/L (66 - 112)
TOTAL PROTEIN: 73 g/L (63 - 83)
ALBUMIN: 49 g/L (34 - 50)
GLOBULIN: 24 g/L (19 - 35)
CALCIUM: 2.49 mmol/L (2.20 - 2.60)
Corrected Calcium: 2.43 mmol/L (2.20 - 2.60)
PHOSPHATE: 0.84 mmol/L (0.87 - 1.45) *LOW*
URIC ACID (Gout): 237 umol/L (266 - 474) *LOW*
RANDOM BLOOD GLUCOSE: 5.7 mmol/L (3.5 - 7.9)
FASTING BLOOD GLUCOSE: 5.7 mmol/L (3.5 – 5.8)
IRON: 19.8 umol/L (10.6 - 28.3)
T.I.B.C: 69 umol/L (41 - 77)
TRANSFERRIN SAT: 29 % (20 - 55)
TRIGLYCERIDES: 2.1 mmol/L (< 2.3)
CHOLESTEROL: 4.8 mmol/L (Optimum <5.0)
COMMENTS (from the lab) – Biochemistry Profile:
"A good Biochemistry Profile.
All of your results were within the normal range apart from the bicarbonate and phosphate levels. These are of no clinical significance.
The kidney and liver function is regarded as normal as are the markers for bone and muscle disease.
The calcium essential for bone strength were within the range as were the gout and diabetes results.
The triglycerides are normal. The cholesterol appears to be well controlled with statins."
So, I guess I should finally be relieved. There is no figure for red or white blood cells, platelets, or clotting time, but these were all fine in September, so I'm not worried about those.
My energy and appetite are better, and I have put on weight again, so I guess it's all good.