In November 2012 I was diagnosed with NASH. At that time, here were signs of fat on the liver and my enzymes were elevated 3-4 times . After that time, i lost weight and my enzymes reduced with time.
I had an ultrasound with dopler on November 2014 and it was totally normal. From that time to today, I had done 3 tests with the following results:
Test 1 (December 12, 2014)
INR: 1.1
ast: 27 u/l range( 17-59)
alt: 23 u/l range (21-72)
ggt: 16 u/l range (15-73)
bilirubine direct: 0.3 mg/dl
bilirubine total: 1.2 mg/dl (range: 0.2-1.3)
platelet count: 161 10^9/l,, range (166-308)
Test 2 (February 10, 2015)
INR: 1
ast: 22 u/l range( less than 38)
alt: 19 u/l range (less than 41)
cholestrol: 177 range (less than 190)
trigilcerin: 61 range (less than 180)
ggt: 16 u/l range (15-73)
bilirubine direct: 0.21 mg/dl
bilirubine total: 0.58 mg/dl (less than 1)
platelet count: 173 10^9/l,, range (150-450)
glucose : 92, range (55-100)
Test 3 (April 19, 2015)
INR: 1
ast: 23 u/l range( less than 38)
alt: 19 u/l range (less than 41)
ggt: 18 u/l range (less than 60)
ggt: 16 u/l range (15-73)
bilirubine direct: 0.18 mg/dl
bilirubine total: 0.36 mg/dl (less than 1)
platelet count: 179 10^9/l,, range (150-450)
3 days ago I was at an osteopath for a leg pain problem and by chance he pressed on my liver area and said I have a stiff liver. Then, I was stresssewd and today went to my family doctor and he also palpated me and said it seems normal, did not feel a specific stiffness.
I have an ultrasound on Monday to make things sure.
My question is this: Given the fact that my ultrasound was totally normal 6 months ago and the fact that my liver enzymes were normal in all 3 tests from that time to today, is it possible that liver became cirrhotic?
I will be happy for your comments.
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Hello. Firstly you have done really well to lose the weight and your body has responded - now you have normal liver enzymes. What you must bear in mind, the liver has many functions, and any liver problems are best diagnosed by a liver specialist - certainly not by an osteopath or even a GP. Liver firmness is normally measured by a fibroscan - this might not even be suggested now that the liver enzymes are normal as was the ultrasound scan. If you have worries about your liver you should further discuss with your GP and ask for a specialist referral - who diagnosed the original NASH? Was that by a liver specialist? Meanwhile keep up the exercise levels and a sensible eating plan.
the doctor who said it is nash was gastroenterologist. i have health anxiety problem unfortunately. my liver enzymes are normal over last year.
hi there
Your enzymes indicate you have stopped the inflammation of your liver and no further damage should be occurring. The other numbers mean you liver is carrying out its function very well.
But none of the bloods actually measure scarring of the liver. An ultrasound is the quickest and simplest test for the liver, it isnt very good at seeing early damage, but it should rule out Cirrhosis. The best test available is the Fibroscan, its designed to check the liver for stiffness and then the stiffness is converted into a likely stage of scarring.
Your numbers seem normal. The problem with the ultrasound is that it depends on the skills of the operator. You may want to request a CT scan or an MRI. Having said that you could have some fibrosis, but cirrhosis usually goes hand in hand with esophageal varices and also with some ascites. Do not jump to conclusions, your numbers are improving. Furthermore, additional signs of cirrhosis are: jaundice (Yellow skin and white area of the eyes), pruritus (itching), nails clubbing. I want to make clear that I have no experience on this, I base my opinion on my father's liver disease and my research on the topic.
Let's just say that I wish I had your liver results. I very much doubt that something can be wrong in such a short space of time unless you've come in contact with a chemical that has caused it or you've been drinking a bottle of vodka for breakfast every day.
If I was you I wouldn't worry too much. Get an ultrasound scan if you believe you have fatty liver but looking at the LFT above I can't see it myself.
As for that palpating thing? Hardly very scientific is it.
After my scare, I believe it's important to look at the bigger picture. Do you feel in good health. We don't know your background or if you have ongoing issues not mentioned. If you feel well, have no symptoms then stop worrying unnecessarily. Obviously you may have other issues because you have had 3 tests, but my results aren't as good as yours and I'm in good health, and refuse to worry about it and I won't let it ruin my life.
I hope your ultrasound puts your mind at rest and let us know how you get on.
Just for your info, my ggt was 410 in Dec, 300 in Jan and 260 in Feb. Blood test yest hopefully will be better again.
dear all, thank you very much for your support and comments.
i was in peace and was thinking my liver is getting better till the osteopath said like that and made me very depressed. on monday, i will have a ultrasound and i hope there will be no shock news.
Hi there.I've went over your labs and they look very good.There is absolutely nothing suggestive that your liver is cirrhotic.In cirrhosis usually( but not always) AST And ALT And Alkaline phosphatase will be mildly elevated with AST being higher than ALT. This inversion is even more pronounced in alcoholic disease.Your transaminases (alt,ast)are both low and in range suggesting no cirrhosis or inflammation of hepatocytes.Your bilirubin and INR are in normal range so your liver is functioning well and synthesizing proteins.It would help to know what your albumin level is and your alkaline phosphatase.I suspect based on your labs that they would be good.Your GGT is also low so you're not abusing drugs or alcohol.I calculated your APRI score based on your last lab and you scored a .34 which is very good.Anything less than .5 rules out Significant fibrosis or cirrhosis.All of this in combination with a normal last ultrasound makes it obvious to me that the probability of your liver being cirrhotic is highly unlikely.There is nothing in your recent labs that suggest you have anything to worry about. Initially I thought your platelet count was low but it's in the normal range and it's ratio with your AST points to no serious liver damage at all.You may have some minor fibrosis but it can go away with time if you avoid alcohol and keep your weight down.The only absolute way to prove a person has cirrhosis is in an autopsy because even a biopsy can give you a false negative.Liver disease is hard to diagnose until it's advanced.A fibroscan is a test you need because it measures liver stiffness. anything less than 6 is strongly suggestive of no fibrosis at all.It appears you are very lucky. Congratulations on the huge improvement.
thank you very much for your supportive comments also.
my albumin level in last test was 50.5 (normal range 35-52), alkaline phosphatase: 77 (normal range: less than 130). My platelets in more than 10 tests ranged in the interval 147-179 so far (in one test it was 225, though). I never drink alcohol and my liver problem was due to NASH. Ast and Alt are normal in my tests over one year, however ast is a little bite always greater than alt in last three tests. I am not sure if this is important when they are in the normal range.
Because they are both in normal range(actually low) tells me your liver is okay.If your AST was above normal range along with the alkaline phosphatase I would be concerned.the higher ratio of AST to ALT when both are above normal is a red flag.Your's are low and in range.All 3 synthetic functions are great with INR,bilirubin and albumin.Cholostastic enzymes(ALP,GGT)are great and so are your transaminases(alt,ast).All the evidence points to a healthy liver.i am certain your next ultrasound will come back normal. worst case scenario is mild fatty liver but I doubt it because your ALT is so low. Let me know your next results. My numbers are much worse than yours and my gastroenterologist says I have mild fatty liver but no liver damage. I'm not convinced in my case.take care and keep me updated if you'd like.Also you should get a fibroscan although your doctor may not feel it's justified .
I will let you know the results. It is tomorrow. Though many supportive comments by you and others indicating that I do not have cirrhosis, what osteopath said really depressed me. You know when you have a health problem and related anxiety, you magnify negative things much more than positive things and tend to believe negative ones.
Normal volume of the liver. Increased slightly leverreflectiviteit as seen in steatosis. No galwegdilatatie.
Normal view of the gallbladder and the pancreas.
Normal volume of the spleen. Normal view of both kidneys.
No free intra-abdominal fluid.
Normal hepatopetale flow in the portal vein and the vena lienalis at normal flow rates in the vena porta.
Hepatofugale flow in the hepatic veins, with flattening of the flow curve and loss of systolic flow reversal and trifassich aspect of the flow curve in the hepatic vein, pointing to increased liver stiffness.
decision:
Increased slightly from leverreflectiviteit seen in steatosis, and Doppler flow findings compatible with increased liver stiffness.
I don't think your problem is as big as it sounds. I don't understand that medical terminology I. Your assessment. first time I heard such wording. a fatty liver of any sort will show up as brighter than surrounding tissue in ultrasound and will increase liver stiffness a bit. I would push for a fibroscan since this will give you a numerical reference to actual liver stiffness.Early fibrosis may reverse.I think the key here is moderate excercise,healthy eating and keep your weight low and you'll be fine.
sorry about this, not what we wanted to hear. How ever it could be some F2 Fibrosis which can be reversed. With your good labs you have halted any more damage, surely? I would now demand a Fibroscan to give any scaring some actual numbers to work with.
Are you seeing a Hep-doc? if your not you should now see one to get the best advice on what your next plan is.
my family doctor said the hepatic vein flow change is very common with fatty liver and said no need for a fibroscan. however, i do not trust anymore to doctors. they were not as expert as an osteopath.
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Elevated Bilirubin - ALT
Elevated liver enzymes 
Elevated ALT
AST/ALT Ratio
