Do I Have Alcoholic Liver Disease?

[HPierce]

I am 47 yr old male. I WAS a heavy weekend drinker (18-20 glasses wine total every weekend only - never drank at all during wk) for 8 yrs. This yr, stopped the weekend wine and drink little–trying to get healthy. In last 5 yrs I have had liver function tests done 6 times in routine checkup, as I take Zocor for cholestorol (all good 7 yrs)  ALL 6 times all LFTs were normal incl ast,alt,bilib,alb, alk phos   he test were 6 mos.-1 yr apart and most recent 2 wks ago, wi/all normal results:AST 23 ALT 23 etc -  all continue w/in test range normal.  No obvious symptoms of liver disease. I feel great.  Also feel better about myself now that I have cut WAY back on drinking, and lost a lot of weight. In most recent physical, all normal (including All LFTs again, EKG, no occult blood, normal prostate. BUT, my hemoglobin and hemocrit  came out slightly lower than test range (hgb 13.9, & range is 14.0-18.0) and hct 41.7 & normal of 42.0 -52.0. All other CBC is in range normal, including Platelet, MCV, MCH, MCHC, WBC, RBC, etc. My doc says to take an iron supplement for 6 wks and test again, as these numbers are so marginal. He said he is 99% certain that the next CBC will come back AOK, but I’m in a panic. In addition to cutting back on my drinking, I have dieted to lose 40 pounds over the past year - and am at my normal weight for the first time in 20 yrs.Done with diet and vigorous daily exercise & cutting back on the wine.Doc thinks this may be related to diet and nutrition, but I'm NOT a vegetarian. My calories were cut way back during weight loss diet.  I also run daily on a treadmill and lift weights 3-4 times/wk. I’ve read on the web that one can have liver damage and even CIRRHOSIS even with normal enzyme levels. How likely is it that I have an alcoholic liver disease despite the normal enzyme levels for years?  Should I be concerned about this marginally low hgb and hct level?  What else could have caused this? Do you agree w/doc that next blood test will likely be OK?

[HPierce]

Thanks for your reply.  Let me be clear.  My doctor's ONLY concern about my liver and only recent to check enzymes each year is due to the Zocor medication.  These enzymes have been all perfect every time they have been done.  So, other than my past weekend drinking (see original), I have NO reason to suspect Cirrhosis.  The only thing that worried me was the marginal anemia, which my doctor is retesting in six weeks.  

My biggest question is in your opinion, what is the LIKLIHOOD that I have any Alcoholic Liver Disease, considering all of my numbers have been normal for five years?    My doctor sees no reason to do any futher testing on my liver, however I just want to know if the based on the marginal anemia alone, I should strongly suspect Cirrhosis after five years of all liver function numbers being normal.

Is it likely or not likely in you opinion?  Either way, I am following up with my doctor in six weeks.  Thanks.

[Kevin Pho, MD]

If there is continuing concern about liver disease, imaging the liver should be done.  An ultrasound or CT can suggest cirrhosis, and if suspected, a biopsy can be considered to confirm.  

Regarding the marginal anemia - this is within the range of lab error and should be repeated.  If still low, I would consider a lower and upper endoscopy to exclude a source of GI bleeding.  

These options can be discussed with your personal physician.

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.

Kevin, M.D.
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