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Forum Name: Gastroenterology Topics

Question: I would like some direction as what to do next?


 memorylane4ever - Sat Feb 28, 2004 7:34 pm

:?: I am 28 yr old female with elevated ALT of 101, AST 47, RBC are elevated, Ferritin is 304. My ultrasound of liver showed that it is enlarged, and maybe fatty liver. i do not drink, I am not overwieght, but my abdomen is enlarged, and seems to be getting bigger. I swell in the hands and they are always red, I also showed on fasting insulin 49 on results. WBC's were fine, bilirubin was good. I just really don't know what all this means. The soonest the hematologist can see me is 6months due to pt overload here in Alaska. What could i be dealing with? Do I have reasons to be concerned. These ALT & AST levels I know have been up for 10 yrs... But never this much. I have had Hepatitis tests and they all have been negative. Been tested for all of them 3x. I've had a normal ANA. So what is happening? Please let me know what you think all this could mean.
 memorylane4ever - Fri Mar 05, 2004 5:26 am

Look I am really scared, with all that has been going on in my family with the kids and their new dx's, and I am aware now that I need to have a liver biopsy done... I am truly scared.... :cry: Today I found out that Hemocromatosis was ruled out, and now I am seeing that the direction could be toward AIH.... I guess I thought since all the other hepatitis screens were done that one was included... So I was wrong,, and now I am even more scared, can't sleep, I guess my biggest FEAR here is that since this has been going on for at least 10 yrs that I know of, how far gone is my liver??? And will I be here to take care of both of my sick babies??? Please respond :cry:
 Dr. Tamer Fouad - Fri Mar 05, 2004 10:55 am

User avatar Given your history of diabetes it is no wonder that you have a fatty liver especially if you are overweight. It could be a condition known as Non-Alcoholic Steatohepatitis (NASH). Steatohepatitis is caused by fat deposits in the liver. In the USA, about two-thirds of the population is considered overweight and among these people, about twenty percent could develop fatty liver, or steatosis. NASH is one of the known causes of chronic elevated liver enzymes. It may also be responsible for elevation of serum ferritin.

This is just one theory. Ask your diabetologist what he thinks of all this.

Regards!
 memorylane4ever - Sun Mar 07, 2004 2:30 pm

Well I geuss I have a few more comments and questions concerning all of this.. I am aware that Fatty liver is something that is commomly seen in over weight patients and in diabetic patients. I am not a full blown diabetic, I only have high blood sugars when ever I have a flare up..... In 1994 thru 2001 I only weighed about 110- to maybe 120...... I am a little over weight, at this point in time, I didn't even start gaining weight till the middle part of 2001 after my husband died, and son was dx'd with type 1 diabetes. I have never gone over 163, and now I am finally loosing some of this weight, but for me to loose allot isn't really good, because I am very muscular due to being very athletic, and it makes me look ill..... So I could get down to 130 and probably do really good, and that is what i have been working on in the gym 3x a week. Been running 6 miles on these days, feeling great! Now I guess my concern is if I was having these liver problems for 10+ yrs, and back not to long ago I was nice and thin, what was happening??? Why has my liver been having issues, and is this due to a family hx of autoimmune dieases? I know I will be having a liver biopsy done pretty soon, and yes I am very scared, I wasn't feeling well 3 yrs ago, my skin would get jaundiced, joints would ache, and now in the past yr or two my stomach has had allot of fluid in it..... Now by blood work something hasn't been right for along time. I have been to an endocrinologist 2x and they have said A1c is 5.5 and no signs yet of full blown diabetes. I am getting in shape to prevent this from happening, but still the long unanswered question has been LIVER???? I have sent for my blood results from 1994 from the National Blood Banks of America, and they confirmed that yes they found something wrong with my liver back then and that I can not ever donate blood again. I guess I am just alittle confused about all the questions of fatty liver or something else...... Now on all the literature I have read concerning fatty liver it seems the only true way to make a proper dx of fatty liver is by liver biopsy, so before a true dx can be made to the fatty liver condition, isn't this somehting that need s to be done? And with all that the medical hx is showing is it truly possible for this to be AIH??? That part scares me.. Because if I have had AIH for 10 yrs, my fear is how much damage has been done to my liver and can the damage be turned around? I know this is allot of info, and even may be not have any barring on what is happening, but I thought maybe you would or could shed some new light on this for me. Thank You Doctor for all your time. LJOnes
 Dr. Yasser Mokhtar - Sun Mar 14, 2004 6:35 pm

User avatar Dear Memorylane4ever,

Non-alcoholic steatohepatitis is usually a diagnosis of exclusion.

If you have had autoimmune hepatitis for the last ten years, the only thing that would quantify the damage would be a liver biopsy. However the liver has tremendous reserve and you can have liver function tests done and these would be the liver synthetic abilities and these include the ability of the liver to produce certain proteins to help clotting reflected in the body ability to produce a blood clot tested by a test called the protime and the ability of the liver to produce one of the major proteins of the blood called albumin. So if you have normal liver functions, it means that your liver is still working and so no need to panic. There is also a function called the excretion function of the liver which is reflected by the ability of the liver to excrete bilirubin, so if your bilirubin is normal, this means that your liver is still working well.

Usually an ultrasound of the liver will also show if the liver is cirrhotic, the term used to describe ongoing destruction of the liver and the trials of the liver to regenerate and it gives a certain picture on the ultarsound. And since your ultrasound did not show that, i think that if you had autoimmune hepatitis, the damage most probably will be negligible.

The most common causes of elevated liver enzymes are drugs or things in the environment that could affect the liver enzymes like chemicals that you could have been exposed to. Lots of medications can do that even if you don't think they do.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 memorylane4ever - Fri Mar 19, 2004 4:56 pm

Well sitting here trying to feel better. I ended up back at my doc's office last Thursday with URQ pain severe, and jaundiced bad. So he sent me immediatly over to the hospital to have an ultrasound done. I have now had as of Wed. of this week 3 liver biopsys, and removal of my gallbladder. i have had gallbladder disease now a while the surgoen said, and it had to come out. My liver shows Portal Hepatitis, what ever that means, my ALT on admittance to the hospital had jumped now to 198. They said my numbers looked real bad when I came in, but they are looking better now. They went ahead and did the liver biopsy to find out more about what is going on with that. I wondered if you had a clue what Portal Hepatitis is? Is this something to worry about? Thaknx Lyn
 Dr. Yasser Mokhtar - Sat Mar 20, 2004 10:55 am

User avatar Dear Memorylane4ever,

Sorry to hear about this event.

Portal hepatitis is a descriptive term of the place where the liver is inflammed.

The liver consists of liver cells, a collection of liver cells supplied by one branch of the portal vein forms what is known as a liver lobule. Between these liver lobules run 3 structures (a branch of the portal vein, branch of the hepatic artery and a bile ductule), the collection of these 3 structures constitute what is known as the portal tract.

Inflammation of the portal tracts is referred to on liver biopsies as portal hepatitis and i think it is related more to chronic hepatitis (and i want to say milder froms) whatever the cause might be.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped and keep us posted.

Yasser Mokhtar, M.D.
 memorylane4ever - Thu Mar 25, 2004 5:52 am

Ok so I don't know much about all this:

Necrosis of my liver
Moderate Fibrosis
Steatohepatits of Liver (NASH)
Found signifigant Nuetrophils ???

Ok so what does all this mean

I don't drink, I'm not a diabetic, I don't take any type of pills at all, I mean after surgery I had allergic reactions to everything they tried to give me, morphine, hydrocodone, percacet, demerol, the only thing I could take was Ibeprophin.. So saying that you can guess why I don't take meds,, i can't even take asprin, I'm allergic.. So why NASH, and what does this mean for the future??? Please help me understand what I am dealing with.. Lyn
 Dr. Yasser Mokhtar - Thu Mar 25, 2004 3:27 pm

User avatar Dear Lyn,

- Necrosis means degeneration and death of liver cells
- Fibrosis scarring and this means that the liver is trying to regenerate itself and in the process, scar tissue is formed.
- NASH stands for Non-Alcoholic SteatoHepatitis which means that there is some kind of liver damage which is not related to alcohol, the most common risk factors are diabetes, obesity and high lipids in the blood. It manifests itself by the presence of fatty infiltration of the liver cells.
- Presence of neutrophils means that there is inflammation in the area where they found.

You are not diabetic, nor overweight, but you never mentioned anything about your lipid profile, so this needs to be checked and you need not to take any medication that could affect your liver including tylenol or anything that contains it.

You have mentioned the possibility of autoimmune hepatitis in previous posts but you only mentioned that ana was negative but there are others tests that also need to be done namely smooth muscle antibody and anti-lkm1. Is this still a possibility after the results of the biopsy?

You will have to discuss with your hepatologist the biopsy results and what they mean in the context of your clinical presentation and what your options are as regards to treatment.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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