Patient's Query
Hi Doctor,
I am a 46-year-old male. I underwent gastric bypass surgery 7 years ago. At that time, my weight was 540 lbs; currently, I weigh 300 lbs. About 5 years ago, I began consuming hard alcohol (mainly vodka) on a weekly basis.
Around three weeks ago, I started experiencing a tight, bloated, and tingling sensation extending from my chest down to my pelvic region. There is no real pain, but it feels as if a wide band is wrapped around my torso, with associated numbness. I also notice a burning and tingling sensation that runs down my inner thighs to my ankles. The intensity varies from day to day. I often feel fatigued, and at times it’s difficult to get up from a chair due to weakness, though once I am up, I can perform daily activities normally.
I stopped drinking two weeks ago. My appetite is fair, and I eat daily. There is no nausea, vomiting, bleeding, spider veins, or yellowing of the skin or eyes. My bowel movements are normal in color and frequency, with no blood in stool. I have not experienced hallucinations or memory loss. My urine is occasionally dark yellow or brown and cloudy. I have always been somewhat pale. My sleep is regular, and my weight has remained stable, though I feel that my muscle mass may have been replaced by fat.
My gastroenterologist believes the symptoms may be related to malnutrition secondary to my gastric bypass and ordered blood tests. Based on my own research, I am concerned about possible liver involvement. I would like to understand whether my laboratory findings and symptoms can help determine the stage of my liver condition, and whether this requires immediate hospital evaluation or imaging (CT scan).
The flagged abnormalities from my lab report include:
RBC: 3.64 (Low; Ref: 4.14–5.80)
MCV: 108 (High; Ref: 79–97)
MCH: 38.2 (High; Ref: 26.6–33.0)
RDW: 16.3 (High; Ref: 12.3–15.4)
Serum Creatinine: 0.56 (Low; Ref: 0.76–1.27)
Serum Chloride: 94 (Low; Ref: 97–106)
Serum Calcium: 8.4 (Low; Ref: 8.7–10.2)
Total Bilirubin: 9.5 (High; Ref: 0–1.2)
Serum Alkaline Phosphatase: 241 (High; Ref: 39–117)
AST: 196 (High; Ref: 0–40)
ALT: 61 (High; Ref: 0–44)
Vitamin D, 25-Hydroxy: 4.4 (Low; Ref: 30.0–100.0)
I have started Vitamin B12 injections, Vitamin D3 drops, and oral Vitamin B1 and B-complex supplements to address deficiencies.
Could you please advise whether these findings suggest a serious or advanced liver issue, if immediate hospitalization or imaging is necessary, and what further steps I should take?
Thank you.
Hello,
Welcome to icliniq.com.
I understand your concern regarding the abnormal laboratory findings.
Based on your reports, you do require a CT scan of the liver, and I also recommend consulting your gastroenterologist urgently for possible hospitalization.
Your symptoms of tingling and numbness are most likely due to vitamin deficiencies. Since you have started vitamin supplementation, these symptoms should gradually improve over the next few days.
The burning sensation from the chest to the abdomen could be due to alcohol-associated gastritis, which needs prompt management, especially considering your history of gastric bypass surgery.
Given that your liver test results are significantly abnormal, you require immediate supportive treatment and further evaluation. A CT scan of the abdomen is essential to assess the extent of liver damage.
The findings and your history suggest the possibility of alcohol-induced hepatitis, but chronic alcohol use over several years can also cause cirrhosis, which is a long-term, irreversible condition.
Acute alcohol-related liver injury (hepatitis) can often improve with medical therapy (sometimes including steroids).
Chronic liver damage (cirrhosis), however, is permanent; treatment focuses on symptom relief, and liver transplantation may be the only definitive cure in advanced cases.
At this point, it would not be appropriate to recommend specific medications without confirming the diagnosis. However, based on the severity of your liver dysfunction and the need for further investigation, I strongly recommend immediate evaluation by a surgical gastroenterologist.
Probable cause: Chronic alcohol consumptionRecommended investigations:
CT scan abdomen
Coagulation profile
Differential diagnosis: Liver cirrhosisProbable diagnosis: Alcohol-induced hepatitis
Follow-up:For more detailed evaluation and guidance, please consult a medical gastroenterologist online at icliniq.
Thank you.
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Answered byDr. Kagathara Happy Kumar Devkaranbhai
Medically reviewed byiCliniq medical review team
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