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Date of last update: 10/15/2017.

Forum Name: Liver Diseases

Question: Focal Fatty Changes in liver & elevated ALT

 righsidepain - Thu Dec 25, 2008 5:32 pm

25 m
BMI 22.2
i have right side abdomen pain.
i never drink,smoke....i never eat junk foods.
i have a pinch of belly fat!
i don't have any disease ( like diabetes ....)
i went for blood test:

CA-19-9 12.15 U/ml <37 (is it absoulutely noraml??)
Bilirubin(Total) 0.6 mg/dL <1.4
Bilirubun(direct) 0.1 mg/dl <0.4
ALT(SGPT)-------> 57 U/ml <45 <-------- high
AST(SGOT) 31 U/ml <45
GAMMA GT (GGT) 30 IU/L <55
Alkaline phosphatase 88 U/l 50~130
HBsAg <0.01 Index <0.9 Negative
HBsAb 89.5 >11 Positive ( i have immunity to hep b )
PT-Patient 12.7 sec
Activity% 96.0%
PT-Control 12.5 Sec
INR 1.0
APTT-Patient 33 sec ( 29~ 42 )

i got worried and went for sonogram
everything was normal with my liver & liver size and gall bladder except :

the only medication that i take is Finasteride 0.5 mg ( not known to cause any liver problem )
& cod liver oil

should i be concern about focal fatty changes??!
should i do any other tests?!
please tell me....everybody said it is ok before and after tests...nobody seems to care and that's drive me crazy! because as a good engineer i am very accurate in everything!
 John Kenyon, CNA - Fri Dec 26, 2008 11:47 pm

User avatar Hello -

You appear to have a marginal fatty liver, which, although it should be rechecked on perhaps a semi-annual basis as long as it's present, is often either not serious or is totally meaningless. While you do have some right side pain, you haven't gone into much detail as to the character, frequency, severity, etc., so it's difficult to know if this is even related to the fatty liver. All your other blood work is normal except for the slightly elevated ALT, which fits with fatty liver disease. The CA19.9 is well within normal limits (actually very well within), so it's easy to see why your doctors are not presently concerned. I also understand why you, being an engineer, have a need to understand why things are not "according to spec." However, unlike most mechanical devices, the human body is a "soft machine" which in many instances has a much wider range of tolerances. This is something we have to accept as part of being the owner of a human body. Yours does appear (the liver, at least) to have some unremarkable deviations from textbook "normal", but "normal" has a much looser definition in medical circles than it does in "hard" engineering.

I hope this is helpful to you. Good luck to you and please follow up with us as needed.
 righsidepain - Sat Dec 27, 2008 11:37 am

Dear Dr.John Kenyon!
Thank you for your COMPREHENSIVE answer to me... I appreciate it.... :-)
Also my family asked me to thank you thousand times!!!
I will try to lose weight and increase my walking and running ....!
about the pain it is sometimes sharp ( not very bad , one time it woke me up ) & and sometimes it is very weak but it is present...!!! it doesn't increase when i eat ( i think ) but i think coffee increase the pain!!! it is more like itching...!! i am already scratching it...!!!!!
the only thing that concerned me about this was that i searched "fatty liver" {in quotation mark} in google and it returned about 1,230,000 results but for "focal fatty liver" it was only 1,160 and approximately 90% of them was tumor related ...!!!!!! thats why i was worry!!!
my only concern now is that the doctor did the sonogram on the RIGHT LOBE only!!! shouldn't he also examine the LEFT LOBE?!:)
also happy new year:)
Thank you again for everything!
 John Kenyon, CNA - Sun Dec 28, 2008 12:16 pm

User avatar Hello again -

You are very welcome, and please pass that along to your family as well. :)

Weight loss and restriction of fatty foods (and processed carbohydrates also) should be helpful in either correcting the problem or at least keeping it from progressing. I'm not sure what that pain sensation is you're getting, but if coffee seems to aggravate it, you'll have to consider whether or not coffee is worth the predictable discomfort. I think all us coffee drinkers find something about coffee we have to balance against the benefits of it.

The fact that your doctor only did a sonogram of the right lobe of your liver (the normally far larger part, admittedly) strikes me as a little strange. I'm wondering if this is what the report said specifically, or if it only mentioned the right lobe because that's where the focal fatty patches were noted. Sometimes when an imaging report is written some precision is lost in translation from the radiologist to the doctor to the patient. Perhaps this is the case?

Again, you (and your family) are very welcome. It's my pleasure to do what I can to be helpful here. And thank you for the happy new year wish! I wish you and your family the same in return.

Be well. Stay in touch.
 righsidepain - Mon Dec 29, 2008 3:02 am

Hello Dear Doctor John Kenyon :-)
Again thank you for your advice...
one of doctor asked for gall bladder & liver sonogram! and the doctor at sonogram station just did it in right side...!!! maybe he forgot..because he said "look at the monitor your liver is very are not at the age for liver disease or gall stone !" ...! heh!
but he wrote focal fatty changes in liver....!!!
The pain is something like Burning Sensation! i searched the internet and it was one of the early symptoms of Hepatitis C!!! my HCV Ab was I don't have Hepatitis C!!!
I will listen to you are advice...! i began low fat diet ( we already had low fat diet...because my father had a bypass surgery 6 years ago and because of his health all of us eat healthy low fat diet , the only high fat thing that i had during last year was a kind of cheese with at least 36% fat inside it , i love it and ate it religiously during last year every morning )! and i will increase my running walking activity...and i will repeat the tests in 3 months:) and i will post my result here..!!

thank you a millions of time for your kind help!!! thank you for your kindness and thank you for being VERY PATIENT WITH ME!:)
i also suffer from ADHD and it is hard for many people to be patient with me when i ask them questions!!!! heh...
happy new year again:)

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