Decreased Attenuation on Liver

[newwoga]

I am a female in my late 20's and have had digestive problems (IBS symptoms) for about 5 years. I am not over weight, I eat pretty healthy, and exercise. (I did use to bing drink quite often in high school and colledge, but now only have 1-4 alcoholic drinks a week. no drug abuse) I have had gas, bloating, upper and lower quandrant pain, brain fog, allergies, joint pain, menstrual irregularities, noise sensitivity, itchy skin, ect.  I feel like a hypocondriac.  I saw a GI Doctor 2 years ago and had many tests ran.  I was diagnosed with IBS.  Nothing else fit, all tests said I was otherwise healthy. I saw a family doctor recently and had many blood test ran.  One blood test came back with slightly elevated amylase. It was at 118. A CT scan was then done from my lower chest down.  Everything looked good.  The report did say this, " decreased attenuation next the the falciform ligament which is believed to represent area of focal fatty infiltration and is of no clinical significance".  I also had a 1cm cyst on kidney.  Anyhow, the family doctor said that the decreased attenuation area was very normal and of no concern since I don't have alcohol or cholestorol problems.  
I do drink herbal teas often like detox tea and stomach teas.  I  tried taking herbal remedies for my mentrual problems before, but that seem to make things worse.  

My question is in regard to the decreased attenuation.  Should I have concern with decreased attenuation (does it effect the functions of the liver)? Is it really normal? How do I know if fatty infiltration has occured or will occur.  And is it reversable if it is a problem?
Thank you

[newwoga]

Thanks again for your comments...Is it true that the birth control pill can cause fatty liver or liver damage in some cases? Does alcohol consumption while taking the pill effect the liver more?

[surgeon]

decreased attenuation in only a small area, especially in the way and location described, sounds like nothing significant: Fatty infiltration, when it means anything, typically involves all or most of the liver. And even when it does, it's most often simply a finding of note, but not of consequence. The falciform ligament sort of divides parts of the liver, and it's possible even that some of what is being seen is artifactual, meaning just some shadowing due to the crossing of the planes. If the radiologist says it's of no significance, I'd say you can feel comfortable that it's of no significance. Those folks tend to error on the side of being alarmist, not the other way around.

[dduston]

Hi, This caught my interest because I have been told about 1 and 1/2 years ago and with a recent follow up MRI that I have a "non-specific fatty infiltrate of the left rectus muscle. But I DO drink alcohol. I drink about 4-5 beers each day. Now, my problem is - I went back to the doctor because I get a buldge (I thought it was a hernia) coming out of my left rib area. (like a third breast almost! - could it be the rectus muscle from my first MRI?) I have no idea what to do? They recommend all kinds of ultrasounds  and CT or bone scans to be done. Could it be just the liver acting up? and not really the rectus muscle? Why would the buldge come from out of my chest like that? I had a MRI done that showed, the nonspecific fatty infiltrate of the left rectus muscle (again) , this time in addition: "fluid-fluid" level within the gallbladder, either gallbladder sludge or gallstones, slightly thickened posterior fundal gastric wall, and rib pathology is a consideration? Is that from the alcohol and is it related to the same type of this this person prior to me spoke about?

[kevinmd]

If only the amalyse is elevated - I assume then the other liver function tests were normal (AST, ALT, Bilirubin, Albumin, GGT).  If this is the case, your liver should be alright.  An elevated amylase is a nonspecific finding by itself.  

It is impossible to be 100% sure what the decreased attenuation is without a biopsy - I do not think you need this.  I would go with the radiology report suggesting fatty infiltrate.  

I wouldn't worry too much about the CT finding.  I recommend following up with your physician in 6 weeks and repeating the liver function tests.  

Thanks,
Kevin, M.D.

[newwoga]

I am sorry if I am asking too many question? I am just nervous about my doctors non-concern..
Does a CT scan show if the liver has fatty infiltration?  or is does it just show decreased attenuation??

and Is decreased attenuation OK and normal,especially if it means fatty infiltration.  

Thank you

[newwoga]

Thank you for responding so quickly.  I had tests that checked my liver function because of my symptoms. They only thing that was abnormal was my amylase. It was 118 and high limit was 100. Anyhow, I am going back in 6 weeks to get my amylase checked again.  My pancreas was normal in the CT scan.  My doctor said that where I don't have an alcohol problem or high cholestorol that the decreased attenuation was of no concern.  So you are saying that decreased attenuation usually means that there has been fatty infiltraton.  Could I have fatty liver and still have normal liver function blood test results?  I am also wondering if you can have decreased attenuation and not have fatty infiltration.

thanks for your help

[newwoga]

I am assuming it is healthy and normal to have possible focal fatty infiltrate of the liver when liver function blood tests come back normal.  

[kevinmd]

Decreased attenuation can be caused by many things.  Without a biopsy we can only speculate.  From the radiology report, it is likely an area of fatty infiltration.  To determine whether it affects liver function, blood tests to evaluate liver function would have to be performed.

Thanks,
Kevin, M.D.

[newwoga]

Does the decreased attenuation neccesarily mean there has been fatty infiltration, and if not does the decreased attenuation affect the livers function???

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

Fatty liver is an excessive accumulation of fat (lipid) inside the liver cells.  There are many causes.  Here is a brief list:

Obesity
Diabetes
Chemicals and drugs (such as alcohol, corticosteroids, tetracyclines, valproic acid, methotrexate, carbon tetrachloride, and yellow phosphorus)
Malnutrition and a diet that is deficient in protein
Pregnancy
Vitamin A toxicity
Bypass surgery of the small intestine
Cystic fibrosis (most likely accompanied by malnutrition)
Hereditary defects in glycogen, galactose, tyrosine, or homocystine metabolism
Medium-chain aryldehydrogenase deficiency
Cholesterol esterase deficiency
Phytanic acid storage disease (Refsum's disease)
Abetalipoproteinemia
Reye's syndrome

Alcoholic fatty liver is rarely diagnosed clinically because most patients are asymptomatic and do not seek medical attention. The only complaint may be mild tender hepatomegaly. Liver tests are generally normal or modestly elevated, and jaundice is unusual.  Alcoholic fatty liver is reversible if alcohol use is stopped.  

Fatty liver may develop after a single large binge and does not predict progression to hepatitis.

If the fatty liver is due to other causes (see above), they will have to be properly appropriately treated to improve the fatty liver.    

I assume that you had liver function tests performed.  If they are normal, periodic tests can be done to monitor liver function.  If the liver function tests remain completely normal, it is unlikely that there is a serious liver disease present.  Fatty infiltration can be detected on imaging studies such as ultrasounds and CT scans.  

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.