Is it Cirrhosis and encephalopathy?

[bluekiteflier]

I have mild hepatomegaly since 7 years. I have undergone several tests as per my health checkup, and Physician has confirmed nothing seriously wrong, and advised me not to worry and continue to remain sober However, because of my minor symptoms and the ammonia level, and information on the web worries me for encephalopathy.Could you help me in:

-If Encephalopathy is suspected, then also suspect is associated cirrhosis, and portal hypertension? But USG says No portal hypertension.
-What could be the reason of high ammonia? Will long term smoking cause ammonia to increase?
-Do High ammonia levels not reflect/ co-relate in associated blood reports of kidney and liver? All my other blood tests are normal.
Symptoms present: Minor fingers shaking (occasionally)/ Minor dizziness (occasionally)


Sonography reads the following:
LIVER:
Size: Enlarged, 17.o cm
Parenchyma: echogenic, no dilation of IHBR and IHPR
Any Mass: No mass, No nodularity
GALL BLADDER: Normal with sludge, No stone
PANCREAS: Normal, no mass, No Oedema
CBD: 4 mm
SPLEEN: 9.6 cm, normal, no mass
PORTAL VEIN: 11 mm
SPLENIC VEIN: 9 mm
KIDNEYS:
Size: RT: 10.3 cm
LT: 11.1 cms
Stone: Normal, No stone
Pressure effect: Mild pelvicalyceal fullness
Cortex and medulla: well diffn between cortex and medulla
URETERS: No ureteric stone
BLADDER: Partially full, no mass, no stone
FREE FLUIDS: No free Fluid
BOWEL LOOPS: Dilated Loops ++
PARA AORTIC L NODE: No mass lesion
ADRENALS: Norma;
Conclusion: Fatty Hepatomegaly No E/O portal hypertension

LFT
SGOT: 24.00
SGPT: 36.00
S. ALKALINE PHOSPHATASE: 76.00
BILIRUBIN
TOTAL: 1.00
DIRECT: 0.60
INDIRECT: 0.40
S. PROTEIN:
TOTAL PROTEIN: 6.10
ALBUMIN: 4.10
GLOBULIN: 2.00
A/G RATIO: 2.05

BIOCHEMISTRY:
BUN: 8.00
FBS: 91.00
S. CREATNINE: 0.80
S. URIC ACID: 5.30

HAEMATOLOGY
PLATELET COUNT: 2.20 lac/ cu.mm
PROTHROMBIN TIME
PT: 17.90 SEC
CONTROL: 13.00
INR: 1.40
Blood Ammonia Level: 135

Thanks!!

[Thomas D Schiano, MD]

ammonia levels are well known to be falsely elevated.  i think that you're fine.

[bluekiteflier]

Hello Doctor,
A question sir:
i have moderate hepatomegaly, and thankfully, no serious complications till date. Alcohol abstinence will remain the single biggest contibutor to my liver health. Having said that we all are aware how incredibly difficult it is for alcoholics to do that. So while my battle against the bottle continues, i do slip into the bottle, say once a month. I consume about a whole 1 litre of whisky over 2 to 3 days. And am in depression for the rest of the month. You cannot imagine how it feels not to be able to give up something you want to. I shall be seeking professional assistance for my battle soon. Having said that, is there anything i could do to help my liver(apart from abstinence) , a special diet or a suppliment or a medication maybe? I exercise a lot (run abt 4 miles a day). I do a sonography of whole abdomen and monitor the portal vein (presently at 11 mm) doc tells me it is ok tiill 13 mm above which i may get portal hypertension.
Is there any specific blood test that i could monitor on a monthly basis? I know abstinence is best, but is so incredibly difficult. So is there a distant second best option that may atleast minimize the insult thta i inflict on my liver?

thanks,

[bluekiteflier]

Hello Doctor,
A question sir:
i have moderate hepatomegaly, and thankfully, no serious complications till date. Alcohol abstinence will remain the single biggest contibutor to my liver health. Having said that we all are aware how incredibly difficult it is for alcoholics to do that. So while my battle against the bottle continues, i do slip into the bottle, say once a month. I consume about a whole 1 litre of whisky over 2 to 3 days. And am in depression for the rest of the month. You cannot imagine how it feels not to be able to give up something you want to. I shall be seeking professional assistance for my battle soon. Having said that, is there anything i could do to help my liver(apart from abstinence) , a special diet or a suppliment or a medication maybe? I exercise a lot (run abt 4 miles a day). I do a sonography of whole abdomen and monitor the portal vein (presently at 11 mm) doc tells me it is ok tiill 13 mm above which i may get portal hypertension.
Is there any specific blood test that i could monitor on a monthly basis? I know abstinence is best, but is so incredibly difficult. So is there a distant second best option that may atleast minimize the insult thta i inflict on my liver?

thanks,

[bluekiteflier]

Hello Doctor,
A question sir:
i have moderate hepatomegaly, and thankfully, no serious complications till date. Alcohol abstinence will remain the single biggest contibutor to my liver health. Having said that we all are aware how incredibly difficult it is for alcoholics to do that. So while my battle against the bottle continues, i do slip into the bottle, say once a month. I consume about a whole 1 litre of whisky over 2 to 3 days. And am in depression for the rest of the month. You cannot imagine how it feels not to be able to give up something you want to. I shall be seeking professional assistance for my battle soon. Having said that, is there anything i could do to help my liver(apart from abstinence) , a special diet or a suppliment or a medication maybe? I exercise a lot (run abt 4 miles a day). I do a sonography of whole abdomen and monitor the portal vein (presently at 11 mm) doc tells me it is ok tiill 13 mm above which i may get portal hypertension.
Is there any specific blood test that i could monitor on a monthly basis? I know abstinence is best, but is so incredibly difficult. So is there a distant second best option that may atleast minimize the insult thta i inflict on my liver?

thanks,

[Thomas D Schiano, MD]

i highly doubt that your liver would be incurring any severe damage with normal liver tests.  i think abstinence will itself do the trick in preserving good liver health.  good luck.

[bluekiteflier]

Thank you Dr. Thomas.
Now since the ammonia levels have come out to be normal, do you think I could do something (apart from staying sober) to help my liver? Any testing you recommend to check the quality of my liver?

-And also a quick question for you, sir:
Suppose the ammonia levels WERE high, will the damage in liver not manifest in some other parameter as well? (maybe urea, BUN, creatine, etc.?) Is it possible that simply the ammonia levels are high and all other parameters are normal?
Some literature on web calls the Liver Function Tests as "Dead Liver Tests", the reason being, they say, is the LFT will continue to be normal unless serious, irreversible damage is already happened in the liver. Since LFT is the primary, first line test to assess the liver health, this could be a problem. Also it is said that even in case of cirrhosis, the LFT continue to be normal, or mildly elevated.
To cite a example, doctors study lipids and other markers, do a TMT and 2D echo on my heart and tell me that my heart is in good shape. The same is for kidneys, and for some other disorders like diabetes. But for Liver, what could a good mix to tests, that can tell me the state of liver?
I regulary do the LFT, the Kidney function test and sonography to check and assess the state of my liver. I do not have any hepatitis. So is it possible that some serious damage to my liver is happening and these three tests fail to notice it?

Thanks for your time, Sir.

[bluekiteflier]

here is a update ...the lab called up for ammonia results, saying a repeat measurement of the same sample gave ammonia count of 25 and not 135!

Have to go to a repeat test tommorow.

I presume that will change the picture!