I had fatty liver. Do I have chances of developing cirrhosis?

Patient's Query

Hello doctor,

I had fatty liver (due to being overweight: BMI - 28.1) 3 years ago.

I do not consume alcohol.

At that time the enzymes were 3-4 times elevated and had signs of fat in liver.

Then I lost weight and my liver enzyme levels improved.

In this last one year all my liver enzymes are normal.

I did an ultrasound and an ultrasound with doppler 6 months ago and they were normal.

However, today when I went to a specialist in osteopathy for leg pain, he by chance pressed on my liver area and told me that I have a rigid liver.

Do I have cirrhosis?

Answered by Dr. Vivek Chail

Hi,

Welcome to icliniq.com. I have read through your query and attachments in detail. (attachments removed to protect patient identity)

Please find my observations below.

Having gone through your reports in detail, cirrhosis is unlikely as your most recent ultrasound done on 1st December 2014 shows normal liver and doppler. Your liver function tests are also in normal range in the last one year.

Cirrhosis is an advanced condition in which the liver undergoes irreversible fibrosis and this occurs over a time period. Your results do not indicate cirrhosis in any way.

Kidney function is assessed by doing serum creatinine and blood urea levels. I suppose your kidneys were also visualized in December 2014 ultrasound and were found to be normal. To know more accurately about the kidneys I recommended doing serum creatinine test and blood urea. However it is most likely that your kidneys should be working normally. The kidneys are located deep inside and cannot be felt from the front side of abdomen, therefore it is not possible that your kidneys were felt.

It is possible that when he by chance pressed the liver area, your muscles in the anterior abdomen were contracted and mistaken for stiffness. With normal liver function tests and recent ultrasound scan being normal it is extremely rare for you to have cirrhosis.

There is a way to measure the stiffness of liver by ultrasound and it is called liver stiffness measurement by transient elastography.

Medical literature says that liver stiffness measurement has proved to be an useful and specific procedure to screen for cirrhosis in the general population and to detect undiagnosed chronic liver disease in apparently healthy subjects.

The above ultrasound technique is a special ultrasound method and you can get it done to for a more accurate evaluation of liver stiffness and clear your doubt.

Revert back to an internal medicine physician online for further follow up --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

Patient's Query

Thank you very much for your detailed analysis and answer.

My kidneys are fine. I am only worried about my liver. There is no fibroscan in my city.

I still have the following questions:

When he pressed on the liver area, I felt pain. I have felt this pain before, when I was pressing on that area. You have told that my liver is not enlarged based on the ultrasound result. Then, what could be the cause of pain I felt? I have irritable bowel and I am always bloated. Can the gas be the cause of pain?

As far as I know ultrasound (even doppler) cannot exclude cirrhosis very accurately. Hence, can I still rely on them?

As a pattern in my last 3-4 tests, AST and ALT are normal but AST is 3-4 points greater than ALT. I have read in the net that this condititon of liver progresses to cirrhosis (i.e, AST greater than ALT). I am not sure if this is valid for normal ranges also. It scares me.

I will be happy for your comments on these points.

Answered by Dr. Vivek Chail

Hi,

Welcome back to icliniq.com.

Please find my observations below.

The pain which you felt might have been due to irritable bowel as you have that condition. Another common cause is stone in gall bladder, since your ultrasound is normal, this is unlikely to be a possibility. Any problem in pancreas or jaundice causing pain will always cause abnormal liver function tests and this is unlikely as your most recent ultrasound and liver function tests are normal.

Cirrhosis takes years to manifest in most people and will not progress within 6 months. Doing ultrasound once in a year or two years is a good method to keep track of any changes in liver appearance. Doppler is also normal for you, therefore cirrhosis is still an extremely rare possibility and we can rely on your present test results.

If the AST becomes at least twice that of ALT and both are in the abnormal range in people who take alcohol, then they are at a risk of developing cirrhosis. As your levels are in normal rang, you should not worry about that.

Consult an internal medicine sphysician online for further follow up --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

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