I'm new here and first would like to thank you for this wonderful wealth of information. I am 36, female and in decent health. I have been a daily drinker from 2010 til recently. I have cut back about 90 percent (around April of this year) and plan to give it up completely going forward. Back in the July - August timeframe, I began having some disturbing symptoms: abdominal fullness, skin changes, a few itching bouts. I went to my doctor and had a full set of bloodwork done. Can't recall everything but I know my LFTs were normal. I believe my AST was 18 and ALT was 12. I also asked for an abdominal ultrasounds and that also came back normal.
Last week I drank quite a bit of wine and 2 days later I began experiencing itching.... which has me concerned. If anyone could weigh in and let me know the chances of having liver damage after clear bloodwork and ultrasounds, I would appreciate it... Also, I'm concerned that the itching was a direct result of the binge, which leads me to think that I have cirrhosis and it was not caught... I am committed to giving up alcohol going forward. I just hope I have not caused irreparable damage. Should I pursue this further? It's been about 4 days and still a bit itchy but its a lot better than it was. Again, thank you.
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It's not impossible - you sometimes hear of cases - but it's very unlikely.
IF there is so much liver damage that there are symptoms then you would expect it to show up in other ways given how much the liver does.
But.... Firstly as a woman, and as a regular drinker you are definitely taking a great risk - and you don't want to be in a position where it's too late to repair as many of us here are.
So I would suggest you stop drinking now for a while - several weeks at least to allow your liver to recover, and then take it easy after that with lots of breaks. If you think you don't have the willpower to do this then go and get help - it's something you have to face and consider the need to stop drinking entirely.
Once off the alcohol keep an eye on your symptoms for a few weeks. It may be that your body is giving you a warning shot.
All by itself it's unlikely - only because you would expect to see other indicators of liver dysfunction as well but its possible it was inflamed and so struggling to keep up. If it was a warning the key is to allow several weeks to recover.
The thing is the only treatment for alcoholic liver disease is to stop drinking and hope the liver isn't too far damaged and can repair itself - medical science can't offer much in the way of medication to fix things so best to get ahead of the curve and cut the drinking out and then right down before it's too late. The liver is pretty resilient but there is a definite point of no return - and you'll have no warning that you're approaching it.
Anyway don't mean to sound dramatic. No reason to think you have a serious issue at this stage but do keep an eye on it.
PS - I just want to add something for clarity - there is a difference between inflammation and liver damage. Some things inflame the liver - including alcohol. It's only if the inflammation is severe or goes on for a long time that it turns to liver damage.
Liver damage is actually scarring and is called fibrosis. There are degrees of fibrosis depending on how much scar tissue there is. The final stage of fibrosis is called cirrhosis - which means that almost the entire liver is made up of scar tissue and the structure of the liver has changed - this cirrhosis is usually (after the very earliest stages) the point of no return.
The liver constantly repairs and regenerates itself and a person can live normally with a large part (up to 80%) of the liver out of operation.
The reason I mention this is because although the bloods are good and the ultrasound clear there could be a level of early fibrosis (well short of cirrhosis) people use cirrhosis and fibrosis interchangeably but cirrhosis is a level of fibrosis. With alcohol induced liver injury the liver can usually recover once the application of alcohol is stopped.
It's in case you have some fibrosis short of what would show up on an ultrasound that I am encouraging you to stop drinking as it is what you would have to do anyway.
I hope that helps in so far as it's an encouragement to be serious about the not drinking and to understand the rationale behind it.
I stand by everything else I said though - it looks like your liver is/was doing fine so no reason to panic or be too concerned. The 3 month abstention and checking seems eminently sensible to me.
Thank you for that clarification. Your explanation makes perfect sense. I am committed to a 3 month period of abstinence and hopefully I have dodged a bullet. I wish that fibrosis was visible on ultrasounds
Fibrosis does show up on the ultrasound but it has to get to a certain level. The ultrasound doesn't do well at picking up the earliest stages but in any case that level of fibrosis reverses once the cause is removed, so it's actually a pretty good tool but has its limitations.
concur with everything Mr X says and actually I had very similar symptoms i.e. itching after giving up alcohol-its happened a few times. I had high GGT though-all my symptoms disappeared afte 10-12 weeks abstinence. The fact you have no other symptoms is a good sign, This could also be fatty liver which at low levels doesn't show up in ultrasounds -this was certainly my case. I wouldn't be overly anxious at this point-cetainly moderate the drinkinking at least 2 nights drink free-appreciate its teh festive season looming. Take a long tem views-maybe in jan give up for 3 months and see how it goes. I'm a good deal older than you and have been drinking considrably longer.
Thanks, briccolone. Can I ask your diagnosis? Was it fatty liver or something more serious? Everything I read on the internet seems to indicate that itching equals cirrhosis.
My apologies. You said you had fatty liver in your previous post. It's nice to hear that itchiness can be a symptom of liver damage before the cirrhotic stage. thanks for your explanation. Definitely helps my anxiety level. Sometimes consulting dr Google is a bad idea.
Great... So if I do have done early fibrosis, it can be reversed by staying off alcohol? I was under the impression that fibrosis = scarring, which is not reversible. I understand that it the scarring has to cover the whole liver in order to be cirrhosis, but is my understanding that fibrosis is reversible correct?
that's the problem with google you can come to all sorts of conclusions-itching can be caused by lots of things-gallstones, certainly an inflamed liver with fatty ingress causes blockages of the bile ducts. This is what GGT is a measure of. I developed itching after stopping drinking alcolhol and this is quite often the case with mild hepatitis. I used to get the problem on the lower limbs-ankles/calves uppers of the feet. This should clear with abstinence. Mild fibrosis can definitely be reversed. Look at diet/exercise-all helps-losing weight if you're overweight. You have the advantage of relative youth-the liver should repair if you treat it right and you do have only one! Loads of good support on this forum.
I guess my concern is that my itching literally started after drinking too much wine (roughly 48 hours after). I hadn't drank for weeks before that. It's definitely clearing up days later but would I have fatty liver from weeks of abstinence? I guess it's a possibility. During my abstinent time I had no symptoms (except fullness). Don't mean to drill you with questions, just feeling anxious. I really appreciate your thorough responses.
depending on how long and how much you've been drinking it can take weeks/months to elliminate fat from the liver. I had been drinking a bottle of wine a day for more than 30 years before I started getting noticeable issues-minely digestive. Didn't get itching problesm until ceased drinking-I think very likely to alcoholic hepatitis which you will have if you drink excessively on a fatty liver. Everyone's different but as soon as my disgestive issues disappear(pale stools etc) I know my liver is recovering.
Itchiness could also be caused by the sulfites in wine. If you haven't been consuming one for sometime the sulfites could cause you to feel itchy.
Evening
I would say your body is starting to show stress from alcohol from what you are saying. Its not just your Liver that takes a beating, Pancreas, Kidneys, stomach, brain etc etc. Your fullness feeling sounds very much like Gastritis, where the stomach has become inflamed due to the alcohol constantly hitting it.
It usually takes decades of abuse to scar the Liver to the point of no return, F3,F4 scarring , F4 being Cirrhosis. The Liver is the come back king how ever, it can recover from F1 and F2 scarring and be like new.
There have been a few cases where despite clear bloods and ultrasound people have had Cirrhosis, but its usually "early Cirrhosis". You dont say how much you were drinking, a bottle of wine a night you would likely get away with, a bottle of vodka and you might need to get a Fibroscan just to be sure.
As you age the Liver doesn't bounce back as quick as your 20 and 30s, its now time for you to tone it down drastically. A year or 2 off would be great for your body to repair the damage.
Hope you're well. Quick question if you don't mind.
Could you point me to a medical source for F3/F4 being the "point of no return"? The latest research I've seen indicates that the process of fibrosis is reversible into the earliest stages of cirrhosis so that even F4 isn't necessarily irreversible if the cause of the insult can be stopped - so I'd like to be sure I'm not missing something.
Obviously that's not to gainsay the obvious point that earlier fibrosis is easier to reverse than extensive fibrosis.
I dont actually keep the links, but I do post alot of stuff I find on another site, mdjunction. Its been a while, but I follow alot of Hep-c patients and its a race against time to clear the virus before F3 starts. Thats why the FIrboscan chart starts going red at 12.4kpa. Once the scar tissue starts to bridge which is F3 you are in trouble, F4 is when the nodules start to appear and when the bridges start to bridge to each other. alot of doctors will call F3 Cirrhosis because this is the start of the progressive stage and will lead to F4 anyway.
I have found a couple of cases where a Hepc patient has recovered from late F3 to F0/F1, but most of them dont. Alcohol caused F3 is harder to recover from as far as I understand it.
You can learn loads about the Liver from Hepc patients, they usually have various biopsys, MRIs, FIbroscans to hand and its great to hear their recovery journeys. A clued up Hepc patient will know alot about the Liver.
Thanks for the info, my concern is that it's anecdotal.
None of the medical studies I've come across indicate that F3 is irreversible and in fact recent studies indicate that the continuum of recovery extends into the earliest stages of cirrhosis - before the usual complications establish.
I'll look into whether HepC is a special case - and I can understand that with a virus of that sort certain markers like F3 can be portentous - but as yet I haven't come across anything that definitively sets F3 as the point of irreversibility - in fact what I've seen contradicts that.
I'd be pretty wary of any doctor who confused F3 with established cirrhosis - it's bad enough that a lot of GPs will use the term cirrhosis to refer to the process of fibrosis - without them moving the clinical goalposts.
In the case of alcoholic liver disease I suppose my concern is that someone who is told that F3 is irreversible might well decide "it's too late - what's the point" and carry on drinking. My experience of alcoholics is that I would certainly expect this in a few cases - but I accept this can go both ways and it may for some be enough to stop them cold.
Thanks for the info though - do let me know if you come across anything specific. I'll keep an eye out for studies.
Its not anecdotal. I have read many papers now and there is some division within the field I would say. I have actually read a paper where the Liver doctor said F1 and F2 sometimes dont heal completely, he went on to say that the scarring doesnt progress if the cause is stopped, the scars become less of an issue over time as the blood flow smooths them, but the Liver will be damaged quicker the 2nd time around. There are recent studies that suggest if someone was once a heavy drinker the Liver is more sensitive to alcohol should they start drinking again.
but on the flip side, I recently watched a video involving 5000 patients and I remember him saying "I dont care how much F1 or F2 someone has, because it will heal, its the F3 and F4 when its a big problem" or words to that affect.
I also saw a dissection of a Cirrhotic Liver and to be honest I find it hard to believe that it could ever heal, even with half the damage this one had. Its shape was twisted and it had big bands of gristle, I have chewed on gristle and its very though lol.
There are some popular Hep-c boards and I can say with alot of confidence that F3 is to be avoided at all costs.
Thanks for your response, Ralph. I'm 36 and was drinking between a bottle and a bottle and a half of wine most evenings for the past 5 years. Do you think a fibroscan is necessary with clear bloods and US with no plans to drink in the near future? My drinking was after work only... I was never a round the clock drinker. A doctor I spoke with said that was important. In his experience he saw cirrhosis in mainly all day drinkers (from reading on this forum, I know that's not always the case). Do you think early cirrhosis is a possibility? I have health anxiety issues and the though of getting s fibroscan makes me quite nauseous.
Its the amount of alcohol on a weekly thats the biggest deciding factor I would say, but drinking in the morning would be sure to make the Liver struggle more. Also a good diet can delay the damaging affects. But In short if you drink too much for too long you WILL get organ problems no matter how well you eat or how physically fit you are etc.
Its around 10-20% of alcoholics who get Cirrhosis, some never do even on hundreds of units a week. Genetic factors are the likely reason. Women are more at risk, their Livers are 30% smaller and also fats in the body help a man absorb more. I make it that you were on about 100 units a week, that is risky for 5 years. I have heard of women getting to end stage Cirrhosis in short time, but they were drinking a litre of vodka a day for 5+ years, thats 260+units a week. There are some unlucky people who get it off half a bottle of wine a day, but this rare and likely have some genetic disorder regarding their handling of alcohol.
With your test results I shouldn't think you have done serious damage at this point. This could well turn out to be best thing that has ever happened to you, being terrified of Liver failure and what it does to you might be the kick up the back side that saves your life. It did save mine I haven't had a single drop for over 500 days now.
I have known 2 guys who were daily heavy drinkers for 20+ years and they ended up in hospital yellow and very ill, Alcoholic Hepatitis . They stopped drinking and are still alive and looking healthy today 15 years later! Liver inflammation and scarring are 2 different things. Normally alcohol cirrhosis is caused by 20-40 years of mild Alcoholic Hepatitis that the person didn't know about because they never got bloods tests to keep an eye on things. I knew one pub land lord that died of bleeding varices, he was in his mid 50s and a daily drinker for decades.
The average age of Cirrhosis is coming down, people in their 20s are getting it, but all the cases I have found they were drinking mind blowing amounts of alcohol 2 or 3 bottles of vodka a day for years etc.
Thanks again Ralph. All of these statistics make me feel a lot better... It's just so confusing. I guess some people can drink like rockstars for decades and others get sick much sooner. Just trying to determine how concerned I should be. I don't feel unwell (albeit anxious). I know my body is giving me a warning and I'm hoping it is just that- warning- not permanent damage.
well being of the fairer sex you have a smaller liver than men and here in the uk the weekly "safe" consumption would be 14 units which is bottles of wine per week! So-you've been overdoing it. Having read a few more of your posts I would go dry for 6 weeks and get retested and make sure you get the GGT readings. Ig the GGT readinsg are way out of range then go for the fibroscan then. all my liver tests have always been fine other than GGT which is an indicator of heavy drinking amongst other things.
Not sure if I had GGT readings before or not. Do they normally test GGT with standard blood work? My doctor wasn't concerned with any of my readings. I definitely plan on going dry. I suppose I'm nervous about what they do find if retested. I have had some alarming symptoms when I cut back earlier in the year; however, I haven't had the fatigue or nausea and feel generally healthy... although this has been causing me a great deal of anxiety. I guess I will get a few weeks of no drinking under my belt and take it from there? If my symptoms resolve with abstinence, should I still ask for those tests? Again, thanks for all of your input... it's really helpful. Just trying to figure out how concerned I should be.
Lots of good replies here, and I'm not one to advocate not getting as much understanding as you can but If you don't mind my saying you're in danger of getting yourself into a pointless panic..
No test you do - with any result (unless it points to a different cause of liver disease, like a virus) - is going to make any difference to what you have to do or what your doctors will tell you to do - which is to abstain from drinking.
The only exception would be if there was a reason to suspect you have full cirrhosis - which you have no reason to suspect - because then you'd need to be checked and monitored long term and make other adjustments.
So right now - regardless of the state of your liver, you need to abstain, and if you're concerned in a few weeks - I think your three month period made sense - get a retest. If the bloods are still good then get on with your life and either stay off alcohol or cut right down.
The minutiae of liver disease are fascinating but in danger of obscuring the simple facts in your case;
a) You're concerned you may have damaged your liver from drinking.
b) You bloods and ultrasound are/were recently good.
c) You should stop drinking for a while and get a check in a few months to reassure yourself.
The doctors and you will be relying on the liver's innate repair mechanism in the absence of alcohol to reverse any scarring that may have taken place. Irreversibility is only a feature of established cirrhosis because at that point the structure of the liver changes and so the repair mechanism is trying to repair something that is not structured properly - so it can't.
Duly noted. The last thing I plan on doing is drinking. The thought of it gives me anxiety. I thought about the alcohol withdrawal possibility also (PAWs?), as I didn't begin getting any symptoms (full sensation, skin changes and some itchiness) until I cut down by about 90 percent. I've heard that symptoms often occur when you remove the cause and give your liver a chance to recuperate. So it makes sense that many times symptoms start appearing when the "healing process" begins. I'm hoping that is the case with me.... an angry liver that is trying to detox and not damage. Since I've stopped the daily drinking, I've found that my body is becoming increasingly intolerant of alcohol when I do drink(as evidenced from my recent wine drinking... I'm still a bit itchy). Thank you for pointing out that there is nothing I can do short of quitting drinking and retesting. Logically, I know that, but sometimes I let anxiety get the best of me. Whether its alcohol withdrawal, some other problem or liver damage there's nothing I can do except move forward.
the symtoms you describe are pretty much identical to mine if you look at my first posts on GGT. I suspect you haven't got Paws but alcoholic hepatitis which often rears its ugly head a few weeks after stopping drinking-itching a very common side effect. I think you should be fine in a few weeks but keep us posted
Thanks, Briccolone. I thought about the alcoholic hepatitis possiblity too; however, I don't have any of the other symptoms. However, I don't really have any physical symptoms of PAWs either. It was easy enough for me to quit drinking, luckily. It is nice to know that someone else had itchiness without it being full blown cirrhosis. I'm still a little bit itchy, but I really don't know if it's because of anxiety at this point. I noticed that I only really itch when I think about potential damage and not when I'm absorbed in something or talking to someone. I guess if I do have alc hep it has to be a mild case that would resolve on its own? In any case, it's obvious that my body can't bounce back from drinking anymore and it's time for a hiatus. I'll keep you posted and thanks again.
Thanks, briccolone. I guess I'll ask for that test after a period of abstinence. Hoping my issues will resolve after a few months off the wine. I wasn't "dishonest" with my doctor when I went back in July; however, I probably was more guarded than I should have been. I guess that is something to keep in mind when I go back.
well here in the UK most doctors dont believe their patients drinking habits-quite rightly too as a lot of us lie or fain ignorance. I knew I was drinking too much for years. I'd be very surprised if you dont see a significant improvement relatively quickly-keep us posted.
First I'd say, there is nothing to a fibroscan...no more than ultrasound...it just that the sound is delivered in pulses that feel just like a finger tap as in the old fashioned doctors method , its echo sounding, basically.
I do think you should get a thorough investigation with a consultant and get a referral to a gastroenterology or liver specialist.
Don't wish to alarm you unduly but people are very very different...I certainly wouldn't wish to give you a false sense of security.
Going on my basic liver function bloods, its all ok, but I have Hep C, advanced fibrosis and HCC.
It was spotted by a consultant hepatic virologist...and may be just in time...I am now hoping (my only hope) for a resection to get rid of the tumour altogether.
I am also 69 and have given my liver a fair old hard time at various periods in my life...however, my point is, you cannot rely on having no symptoms and "normal" blood results.
Some conditions are shown up by sudden changes, rather than consistently normal results, tests over time are needed for safety....when you develop obvious symptoms of HCC, its too late .
Have you been checked for Hep C? A lot of people being found with Hep.C and no "at-risk" factors in their life-style.
Are you adressing the issues that made you take to drink in the first place? That is also very important.
I've never been tested for Hep C directly (only have had the bloods and ultrasound). It's crossed my mind though. Most of the issues that made me drink have been resolved and I decided to make a lifestyle change earlier in the year. I cut back by 90 percent before any of the issues. Believe me, taking a drink is the last thing that I want to do at this point. It's not the actual fibroscan procedure that makes me nervous. I understand it's not invasive. It's awaiting the results. I'm really hoping with abstinence the symptoms resolve....
They told me immediately...specialist nurse did it in about 60 seconds on the consultants room.
DO get a referral to the Liver consultant available for a thorough investigation and ongoing monitoring of your status. Do not presume that all will be well because the liver has remarkable powers of recovery....and all that.
Just re-read your reply, Pateo. Do they expect your Hep C to resolve and for you to make a full recovery? I take it the advanced fibrosis is still before the cirrhosis stage? Best of luck to you.
Hep C does not resolve of its own accord, so far as is known. MY story is that I had what has now been diagnosed as ME/CFS.
I was about twenty years getting the bum's rush from a large number of GPs and consultants alike, while being told there was nothing wrong with me ( go out and get a proper job)(its all in your mind) (subtext)
Eventually I got the diagnosis of Hep C purely by chance via the STD clinic which these days routinely tests all clients for Hep C. Not that I am promiscuous or something like that.
When my partner, now since 11 years, first moved in with me I asked her to have a check-up and obviously I had to do the same. I asked her to have an STD check-up not because I doubted her, on the contrary, but because women are unfortunately and innocently often infected by erring husbands and have no idea of it.
So I got my diagnosis and off to the liver specialists....I was offered the anti-viral Interferon but it has side effects not much different from the symptoms I had.
I was not made fully aware of the consequences, almost inevitable consequences of Hep C.
There was then a break of a couple of years as I changed hospitals and health trusts. Meanwhile I also found a GP on my wavelength and had the diagnosis of M.E ratified and was able to claim DLA successfully.
I suddenly though one fine day, I should get my liver checked up again and had a referral to gastroenterology at the new NHS trust; but not being actual Liver specialists, they got more interested in my Hiatus Hernia and Helicobacter so the Hep C was side lined until about 6 months ago when an actual Hepatic Virologist joined the consultancy team who fairly quickly spotted irregularities indicative of HCC in my routine ( very 6 months) blood tests.
Since then I am being fast-tracked and visiting the world class experts in London at Kings College Hospital. One shot of chemo has demonstrated that the tumour is significantly larger than first believed and this week I am going for an assessment as to my suitability for surgery.
Once the HCC alligator is shot, we hope, the lake will be drained: i.e. I will go on a course of anti-virals of which there are one or two new ones more specific to Hep C.
It sure won't go away by itself.
I believe the reason why Hep C is associated with drug or alcohol abuse is because this cohort is more likely to have medical attention.
Hep C and HCC is far more common in the Far East and Africa and kills a lot of people, there it is vectored by parasites.
In the West, I was informed ( in response to my question) by the (world class) liver expert that approximately 40% cases of diagnosed Hep C in the West have no associated at risk life-style.
Therefore a lot of people are being infected with Hep C by a cause or causes completely unknown...and certainly the risky life-style will make anybody more vulnerable to any form of Hepatitis.
I also have no definite idea how, when or where I contracted Hep C, but it most definitely was NOT from sharing intravenous needles with other junkies.
Fear is not our enemy, fear is our friend to protect us, provided we master it and let it guide us...not seek diversion nor let it paralyse us.
There is a lot of well-meaning advice here, but do not be lulled into a fool's slumber. There are just too many variables to get a definitive answer to your very real questions.
It is also my first visit and first post on here, talking to you, and I do believe I was lead here for this reason. I am only sorry there is no opportunity for private messaging on this site.
The fact is that you and only you know what you have to do.
Nobody else can guide you, as a unique individual with an unique genetic make-up and personality, your own innate wisdom is there for the asking.
A forum like this is one of Dr Googles main pit-falls for the gullible and unwary.
Your "anxiety" is your best friend...believe me.... you certainly do not read like a neurotic, but a very well balanced and sensible person.
Ask no questions and be told no lies...read only between the lines and that, carefully.
The question is the answer.
Any more questions? Ask a consultant Hepatologist.
Shamrock, I am sorry if my first reply was off-putting...I was under some tension as I was waiting to go to hospital for my tests, probably too much information?
Anyway, I was there and good result, now being reviewed for resection, my preferred alternative to prolonged chemo etcetera.
Anyway, I just wanted to point out to you that the British Liver Trust which sponsors this forum has an excellent booklet and other literature, help and support available. I found the booklet in the hospital at the week-end.
Great news on the good results, Pateo. I'll definitely give it a look! Still going to wait a few months before retesting, but the more knowledge, the better.
You have received some excellent advice on this forum and it is a great place to seek answers to worrying questions or issues that one might have and I recommend it highly.
I would also recommend that you watch this YouTube video by a guy who has set up a website called "Alcohol Mastery" to help and advise people with issues relating to alcohol. It is entirely NOT for profit.
He himself was a heavy drinker for over 30 years until he decided to stop altogether and made these video's by way of helping other people. They helped me to dramatically cut down my own alcohol consumption (I am 47 and was a 30-odd year heavy drinker).
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