HomeAnswersMedical Gastroenterologyalcoholic steatohepatitisI had lower back pain recently, and the ultrasound scan showed enlarged liver. What should I do?

Why does my ultrasound scan show an enlarged liver?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. K. Shobana

Published At April 7, 2022
Reviewed AtApril 7, 2022

Patient's Query

Hello doctor,

I had pain in my back mostly the left side, which prompted me to consult a doctor. I had lower back pain recently, and the doctor recommended an ultrasound scan. He found the liver moderately enlarged. Then he asked for blood tests. The pain was not unbearable. I have been taking Losartan 50 mg every day for high blood pressure. I have also attached the reports for your reference. Please could you give me your opinion on this?

Thank you.

Hello,

Welcome to icliniq.com.

Thanks for writing in, and I understand your concern. Based on your reports (attachments removed to protect the patient's identity), you do have an issue with the liver. Your liver is swollen due to fat infiltration in it, causing derangements in your liver tests. Your liver test suggests alcohol intake, so if you are using alcohol, it is alcoholic steatohepatitis. You need to avoid alcohol and at the same time need some exercise to decrease your weight by 10 % at present. If you follow my advice, then nothing serious will go on.

Regards.

Patient's Query

Hello doctor,

Thank you for your response.

I do not drink. The last time I drank was five years ago, when my son was born. I had stopped drinking and smoking. My weight is only 163 lbs. Would you please let me know further regarding this?

Regards.

Hello,

Welcome back to icliniq.com.

If you are not drinking, it is a non-alcoholic fatty liver disease (NAFLD). I know that you do not have much weight compared to your height. You seem to have an ideal weight but considering your liver test, lipids tests, and blood pressure. I suggest you exercise regularly and reduce your weight to 70 kg. Lastly, try to avoid high carbohydrates diet.

Thank you.

Patient's Query

Hello doctor,

Thank you for your response.

Do you think a current infection is causing the high gamma-glutamyltransferase level (GGT) level of 516 U/L and elevated alkaline phosphatase (ALP) level of 356 U/L? Please give me your suggestion on this.

Regards.

Hello,

Welcome back to icliniq.com.

I do not think that there is an infection. Your blood counts are not suggestive of any infection. It is just fat infiltrations in the liver which is causing these derangements and an increase in the size of the liver. Start what I advised earlier and repeat these liver function tests (LFT) after one month.

Thank you.

Patient's Query

Hello doctor,

Thank you for your response.

Could you please advise any medications that I should take for cholesterol or those high LFT readings?

Regards.

Hello,

Welcome back to icliniq.com.

For cholesterol, I would be just in favor of exercise and no medications at the moment. For LFT levels, I suggest you start capsule Vitamin E 400 mg one tablet twice daily for three months. It will help a lot with your fatty liver disease.

I hope this helps you.

Regards.

Patient's Query

Hello doctor,

Thank you for your response.

I read on the internet and saw that these could also cause high GGT and ALP. Could this possibly be a reason? Are you able to rule out autoimmune damage to the liver or some other causes like:

- Bile duct stones.

- Sclerosing cholangitis (primary or secondary).

- Bile duct stricture.

- Drug and toxins associated with cholestasis.

Regards.

Hello,

Welcome back to icliniq.com.

Yes, you are right. These can cause such a rise in these enzymes, but your ultrasound scan is normal, which rules out most of these things, and the rest of the blood tests are also not suggestive of any such disease. Hence, I do not think you have any of the above conditions.

I hope those answers your query.

Regards.

Patient's Query

Thank you doctor,

I am back again. My specialist here ordered a retest of LFTs and some other tests (which I have attached here). May I get your opinion on them? Many thanks.

Hi,

Welcome back to icliniq.com.

I just reviewed all your tests, and I am happily sharing the news that your tests are normal and there is no issue with them. Your LFTs are also good now. Nothing to worry about.

Regards.

Patient's Query

Thank you doctor,

What would you think about low iron levels and the FIT test showing blood?

Hi,

Welcome back to icliniq.com.

This iron deficiency is mild, and positive FIT should be repeated after some time, and if positive again, then colonoscopy should be done. At this moment, there is nothing serious. Thank you.

Patient's Query

Thank you doctor,

I went for the endoscopy and colonoscopy just to be sure. Please see the pictures attached.

The findings are,

1. Tubulo-Villios anal lesions at the anal canal and

2. Gastritis.

Can I get your comments on how serious this is?

Many thanks.

Hi,

Welcome back to icliniq.com.

I reviewed both of your reports with images. This gastritis is not significant and will improve with the prescribed treatment. This anal canal lesion also looks benign, but I will be more interested in seeing this lesion's biopsy report to rule out something serious. Get back to me with the biopsy reports once available.

Regards.

Patient's Query

Thank you doctor,

I need some comments.

1. I am sending my biopsy report.

2. If they are benign, I guess they need to be cut out? Do these lesions look big? It is hard to tell from the photo.

3. What sort of operation do they perform?

Thanks.

Hi,

Welcome back to icliniq.com.

If the biopsy is benign, there is no need to remove these, as you are not symptomatic. Also, it looks small and not bigger. But all these things depend upon the biopsy report. If removal is needed, it is usually done with cautery via a small operation. If you have any further queries, you can ask any time.

Thank you.

Patient's Query

Thank you doctor,

One more question. How many lesions are shown in the picture?

Hi,

Welcome back to icliniq.com.

It is a single lesion only.

Patient's Query

Thank you doctor,

Please give me your full opinion on this report. Kindly focus on colitis and condyloma acuminatum. Thank you.

Hi,

Welcome back to icliniq.com.

I reviewed your report in detail. This colitis is not important, and it is not significant. This anal lesion called condylomata needs treatment with medications. It is not a serious issue. The good news is that there is no cancer.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Mian Shah Yousaf
Dr. Mian Shah Yousaf

Medical Gastroenterology

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