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Forum Name: Liver Diseases

Question: Have I got cirrhosis of the liver?


 geordielad880 - Thu Jun 10, 2010 6:24 am

I would like some advice, since i was 18 i have been drinking heavily almost everyday 6-8 cans, i suffer badly with depression and panic attacks, i am now 26 years old, and in feb this year my doctor noticed elevated liver enzymes my gamma GT was 130 and ALT 76, AST 47, i stopped drinking from then, and had more blood tests done last week, and the results were GGT 76, ALT 47 AST-normal, i also have the following symptoms, pale stools, very dry mouth and eyes,and also very dry skin on the face, excessive thirst, white nails on hands, and white nails on feet, with red tips, and also really bad fatigue.
I have also had an ultrasound done, which was OK.

My doctor says that based on my blood test results, and ultra sound that i cant have cirrhosis, so what has caused my symptoms??? he said i would have swollen ankles and legs, and fluid on the abdomen, and spider navei, and jaundice if i had cirrhosis. He says my symptoms are no specific.

I asked if i could have a biopsy done, and i was told that my bloods and ultrasound were ok, so he couldnt refer me.

Can anyone please give advice, because im really worried and don't know what else i can do.
 Dr.M.Aroon kamath - Tue Jul 06, 2010 2:22 am

User avatar Hi,
Liver function tests need to be interpreted with caution. Abnormal values (especially those of AST & ALT) should be interpreted with an extra amount of caution.

Slight AST or ALT elevations (<1.5 times the upper limits of normal ref range) do not always indicate liver pathologies.

Unlike the biochemical values in general, serum AST and ALT levels do not follow a normal bell-shaped statistical distribution in the population. In the case of the typical bell-shaped statistical distribution, normal is defined as the mean of the distribution ± 2 standard deviations (SDs). Going by this definition, 2.5% of normal individuals will have values above the normal range. As the curve(for serum AST and ALT levels) is generally skewed, this results in more normal individuals stumbling into the 'slightly above normal' range.

Common causes of mild increases in AST and ALT levels is fatty liver disease seen most often in the context of obesity, diabetes, hyperlipidemia and alcohol abuse.

Gamma glutamyl transpeptidase(GGT) is too non-specific. May be raised in many disorders( liver and others). Guidelines published by the National Academy of Clinical Biochemistry and the American Association for the Study of Liver Diseases do not recommend routine use of GGT. These guidelines suggest that it can be useful in determining the cause of a high ALP.

In patients in whom the alkaline phosphatase (ALP) test values are elevated but, other tests such as AST and ALT are not, then a GGT test may be useful to determine whether the high ALP is due to a bone disorder or a liver pathology. GGT may also be useful in people with a history of alcohol abuse to monitor compliance with the de-addiction program.

Patients with cirrhosis usually show the following profiles.

Mild or latent (compensated):­
- Increased GGT (alcohol drinking must be excluded).
- often have normal or only slightly elevated serum AST and ALT levels and ALP.
- Elevated postprandial plasma bile acid levels(a newer & perhaps more sensitive liver function test).

Severe (decompansated)
1- raised serum bilirubin.
2- Fall in plasma albumin with elevated globulins.
3- Prolonged prothrombin time.
4- Aminoaciduria, increased plasma ammonia and reduced blood urea associated with development of acute hepatic failure.

Your symptoms, signs and liver function tests appear to be non-specific (just as your doctor felt). It is likely that alcohol misuse might have been be a very significant factor. Discuss with your doctor and consider ways of treating your problem with alcohol(if it still exists).
Best wishes!

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