our new report mostly confirms what you already know, that you're suffering from fatty liver disease. And because it affects your blood flow, you have some additional alarm. But it shouldn't worry you, it's to be expected given that our doctor friends are getting better and better diagnosis techniques in their constant battle with disease.
Just some quick basics. Your liver has a dual blood supply system: hepatic artery and portal vein. The flow is roughly 25% arterial, and 75% portal, with the primary oxygen supply provided mainly from arterial blood, and nutrients (plus possibly some not so good stuff) extracted by the GI digestive processes provided in the portal blood along with a little bit of left-over oxygen in addition. The arterial blood is pumped at high pressure, and the portal blood at a lower pressure - and this lower pressure is where the trouble begins, once chronic liver disease progresses.
So some simple examples of flow impedance issues. A normal pressure gradient (through the liver), a drop from the portal vein across to the hepatic vein (HVPG), is about 3 to 5 mmHg. As the lobular resistance (a variable combination of fibrosis and/or tissue compression) increases within the liver, bad things begin to happen. Clinically significant portal hypertension (PHT) starts at around 8 mmHg, And ascites begin to happen above 12 mmHg. There are other manifestation as well of course.
With this new test of yours, the doctors are measuring the flow of blood through your liver as your heart continuously beats away, which is quite a complex problem. For each heart beat, the net blood flow, a combination of arterial and portal blood, is outputted through the hepatic vein only. But, the flow at any instance, during a given heart beat, will be a time-varying ratio of some artery flux, and some portal flux. The net, integrated result of flow, per unit time, is a very complicated waveform function of peaks and valleys - some flow outwards from the liver (hepatofugal) and some flow inwards toward the liver (hepatopetal). And of course, any internal resistance to this flow will alter the final shape of the net flow curve. So the doctors know what a healthy liver waveform should look like, and when someone's measured flow differs (like yours did), they can detect it and also know what's likely causing it.
When a liver is chronically diseased, there are a number of ways that blood flow is impeded through each of the many liver's lobules. The primary resistance of course is fibrosis. And this provides not only a resistance, but also possible shunting routes that can bypass the hepatic sinusoids all together, thus greatly reducing the hepatic function. But the other type of resistance is due to compression of the hepatic cells, being swollen with inflammation/edema and/or steatosis (fat). This causes congestion within the lobule's sinusoids, and this can also increase the flow resistance.
So in your case, you have a known fatty liver, and the grade/stage can only be estimated by your previous ultrasound reports and by using some guidance with serum/clinical data. Given your previous tests, your doctors don't seem to think you have advanced liver disease, otherwise they would probably diagnosed you with NASH (a combination of fatty infiltration along with hepatocytic degeneration).
This is confirmed by your new data in this report. Your liver's fat/fibrosis is likely mild -> liver is normal in volume and there is only a slight increase in reflectivity. Clinically significant PHT or higher will cause your spleen to enlarge, this has been ruled out -> your spleen volume is normal. Also, very high PHT will cause your liver to "weep" as the water within the portal vein blood is pushed out due to osmotic pressures, creating ascites and a swollen belly, this has been ruled out -> no free intra-abdominal fluid. The mild hepatic flow changes could simply be due to the fatty compression with your lobules and/or mild fibrosis -> flattening of the flow curve and loss of systolic flow reversal and triphasic aspect of the flow curve. There maybe a little amount of fibrosis present but there isn't anyway of knowing this unless a liver biopsy is done, and most doctors tend to avoid this now days.
So this new report appears to reiterate what you already know. Hopefully you have a new diet plan that your currently working on along with some exercise. Fatty liver can be eliminated quite quickly wrt many of the other chronic liver disease etiologies. So take care and be well.
Really great detailed answer! Thank you so much!
That was very informative. Thank you!