Blood Work/Symptoms Show Probabiltiy of Cirrhosis?

[Stephen-K]

Blood work is as follows: M born 2/4/76 - 5'9" - 185lbs diagnosed with IBS and Panic disorder for 7 years..Took Paxil for 6 years.Tear 2001 results weight- 190lbs: Sed Rate-1, AST-25(0-40), ALK PHOS-68(24-140), Total Bili-0.7(0.1-1.2),ALBUMIN-4.6(3.5-5.5),Globulin(CALC)-3.0(2.2-4.1),Total Protein-7.6(6.0-8.5)WBC-6.6(3.7-10.5),RBC-5.57(4.1-5.6),MCV-83(80-98),Platelets-301(155-385), glucose-93(65-115)
Dec 2002 quit chewing tobacco/ Gained 30LBs weighs 210lbs.--Stopped taking Paxil Jan1 2003 lost roughly 35lbs in 4 months due to below symptoms and anxiety over disease (cancer etc)
Presents with dyspepsia/Indigestion/Burping/problem swallowing due to excess mucos/ Possible reflux but no pain or burning/ 2003 results weight- 190lbs: ALT-92H(1-55), AST-42(1-45), ALK PHOS-61(27-142), Total Bili-1.2(0.1-1.5),ALBUMIN-5.0(3.8-5.0),Globulin-2.5(2.0-3.8),Total Protein-7.5(6.2-8.3)WBC-5.5(4.1-11.3),RBC-5.74H(4.2-5.5),MCV-85(82-103),MPV-8.0(7.1-12.1),RDW-12(10.8-14.8),Platelets-260(150-400),glucose-91(65-110)Ultrasound Following blood work found everything normal size and ok with the exception of a Fatty Liver. Spleen, pancreas and gallbladder perfect, liver normal size.Much stress in personal life anxiety made it hard to eat..lost mor eweight down to 169lbs moving to FLorida from CA..Experienced a period of time where I was EXTREMELY drowsy, sometimes experienced difficulty in choosing the correct words when speaking..(not sure if related to coming off of Paxil, anxiety, extreme stress ro multi-tasking, Also had a bout with itching on tops of feet and slightly on palms.Thought it was fleas on feet and legs. Extreme exhaustion around time we were to move. Regular spasms of muscles in arms, chest stomach etc..Stools went from extemely dark with constipation to lght brown/tan/yellow.Have occassional had blood on toilet paper in past every since i had IBS but now it was more blood and attributed it to constipation. 9-24-2003 :Get to Florida have Colonoscopy, Endoscopy and all come back fine with nothing except a hemmorhoid. Hep screens all negative, Cholesterol-181 with HDL-73 and LDL-94,Trigly-68- sed rate-4 - ALT-87, AST-36. Stree level drops as we settle in and I get retested 12-12-03:ALT-70(12-72),AST-33(10-40),ALK PHOS-79(30-120), Total Bili-0.6(0.1-1.5),Bili Dir-0.1(0-0.3)ALBUMIN-4.6(3.2-5.5),Globulin-3.4(1.9-3.9),Total Protein-8(6.5-8)GGT-25(8-61),Amylase-55(25-115),Lipase-268(114-286),Ammonia-19(10-47),Ferritin-142(22-322),ANA index-0.70,ANTI NUCL AB-Neg,Cerulopl-21,MYOCAR SCR-<1:20, PROTIME-10.3(8.8-11.2),INR-1.03(0.8-1.2)Sed Rate-11. Dyspepsia comes back following much stress, fatigued alot again, yellow bruises on right leg not known. Have ultrasound done and technician only looks at Panc,Liverand GB, all normal except "VERY Small faty infiltration". 3/18/04:WBC-5.3,MCV-82.3L,MPV-8.9L,RDW-13.2,Plate-223,ALBUM-4.6,Glob-3.1,TBILI-0.8,BILDIR-0.2,ALKPHOS-84,ALT-107H,AST-47H,GGT-28.Gastro/HEP observed-Rec Biopsy for"Comfort"-Internal Dr-Rec no biop

[surgeon]

You asked (in another thread) for my input. I'm no expert in hepatology, but I'd have the following comments: first, the liver test abnormalities are so minimal, and are associated with normal liver function in every other way, that it seems highly unlikely to have significance. There's really no indication for liver biopsy, other than peace of mind -- but in my experience, it's in those situations, where something is done that has slight risk, and really no indication, that problems such as bleeding seem to occur. I'd recommend against it. If it were me, I'd plan to have liver function tests every 6 months or so for a few years, and do nothing more unless they are changing in a significant way. I realize it's hard not to obsess when there are lingering questions. But I'd say that seems to be what you are doing. Finally, as I've said in other posts (always resulting in scathing from "paj"), the yeast thing is totally bogus in my opinion, and the doctor cited is regarded my scientests as a quack. In such matters, of course, there's never universal agreement. Bottom line: it sounds as if at the present time you don't have a significant liver problem, and followup monitoring is an appropriate reaction.

[Stephen-K]

RoxnSox....God bless you for replying..I would love any info you have to offer..If you are interested in my case all of the info is above...May I ask how old you are and what is your disposition towards NASh..In other words do you have trouble with obesity, are you diabetic, are you female middle-aged etc... Currently I fit into none of these categories though I have been experincing what appears to be a feeling of low blood sugar lately almost 3 times a week. Do you have any symptoms with yours and have you had the biopsy..What are some of your blood levels? Have you heard any stats regarding NASH progressing to Cirrhosis in those without obesitity, Diabetes Melititus, male in younger then 40. Also I have not drank a beer in over 7 years and in the past 7 years the only meds taken were Paxil and Xanax...Never took anything else..not even asprin...Have not taken any meds in over 1 year either. Most concerning is blood work...I have been told by 3 Dr.'s that I am letting my OCD take control because the WBC and platelet decline is still in normal range and nothing to worry about....

Anyway any inout would be great...Also where did you hear stuffy nose is related to Liver Disease? I have been stuffed up for over 6 years now..But I think that is mor eallergy related..Only link I have ever seen between stuffy nose and Liver disease is with Cystic Fibrosis..

Any input,
Stephen-k

[roxnsox]

Hello Stephen,  I would be glad to discuss NASH with you.  I have been diagnosed with NASH by the doctors at the National Institutes of Health and was treated there during a clinical trial.  I have access to Medical books since I work in a library.  Medical text books have to be updated and new editions issued every year to keep up with changes in the field of medicine.  NASH is considered a mild disease.  Doctors are not overly concerned with treating it yet.  I live with NASH every day and I know how hard it is.   Did you know that symptoms like stuffy nose and itchy skin is from liver disease?
Anyway, if you are still loggin on and reading posts, here I am.  

   Roxnsox (Alice)

[Stephen-K]

Again an answer that is lacking, but this time you did not even bother to examine the question..An example is that you recommend checking for ANA test..When I did list in my post : "ANA index-0.70" ..Also you mention Iron levels well a low MCV would be contradictory to an over abundance of Iron in the blood. What's more you state 3 times the normal range...If you are speaking of Normal range then you would see that of the 2 labs testing ALT one had a normal range high point of 55 which would equal 3x55 or an ALT of 165. This a far jump from a high of 107. Also the other lab, which is rated #5 in the Nation - florida Hospital Celebration, has a normal high point of 72 which would be 3x72 =216..again this is a far jump from 107. SO your indication that a liver biopsy is practical at 3's normal range high and you say near 100 would mean that the high end of the normal range you are referring to is between 30-40. Which is a range I have yet to see on any of the 4 labs that have done blood work on me. Also usually such indication to perform a biopsy for the reasoning you state would be that it is absent of any imaging test findings. I.E. My Fatty Liver finding would justify the ALT levels.

I was hoping for someone with knowledge of lab results regarding Cirrhosis trends etc..as well as an understandign of NASH stats to give me an opinon that showed they cared enough to actually think on the matter at hand instead of posting what is apparently a canned response.

I am sure that you are an outstanding person Kevin and that you mean well, but I must say that I wish that you would have at least been thorough in reading through my blood work.

I guess one could not expect more for $16 and I appreciate your time. I will continue to read the other posts from patients on here and hope that you can be prove instrumental in their cause.

God Bless,
Stephen-k

[Kevin Pho, MD]

You note mildly elevated iver enzymes as well as a colonoscopy, upper endoscopy and ultrasound.  The ultrasound comes back with small fatty infiltraion.  You also not discomfort in the left and right upper quadrant.  

Typically a liver biopsy is considered if the liver enzymes are 3 times above the normal limit (i.e. around 100).  You note some values close to this in the past (ALT of 92).  Hepatitis screen was negative.  

You can also test for iron levels to evaluate for hemochromatosis as well as an ANA level to evaluate for autoimmune causes (although this is more common in females).  

If there continues to be question as to what is causing the liver enzyme elevation, you can discuss a biopsy - at least to rule out serious causes.  This can be discussed with your gastroenterologist.  Other tests to consider would be an abdominal CT scan, 24-hr pH study (to evaluate for GERD) and gastric emptying scan (to evaluate for gastroparesis).    

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[Stephen-K]

Oh I forgot:

excessive thick mucos in throat when eating
Sometimes sudden shrtness of breath (though peak flow meter says I am fine)

These two have contributed the most to my lsing the 35-40lbs. I am back at 183lbs now though..Trying to get back down to 170LBS at 5'9"