For the last five years I’ve had intermittent liver pain ranging from the bottom right of my rib cage, up to the point just below my nipple and across to my sternum.
I’ve had 3 liver function tests which were all normal according to my GP and 2 ultrasound scan - again both normal.
I’ve been a drinker for 20 years (age 40) but only evenings and generally only beer - although most days.
The pain now seems to be worse but the GP doesn’t seem worried. Should I be? Should I pay for a fibroscan if the doctor won’t agree to one?
Any advice would be welcome.
Thanks
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farranccc
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Have you stopped drinking now that your worried I would be willing to bet that if you had normal test results in the past you are probably ok. Has this been enough of a scare to make you stop drinking for good I hope it has. I'm always surprised when people say it's only beer as if that makes a difference alcohol is the same weather beer wine or liquor. Stop drinking and take care
I would love to say that I have stopped drinking completely but I have gone from a few most days to 1 small glass of wine in the last 2 weeks which is a miracle for me. I am determined to stop longer term but like so many on here there is a huge amount of social pressure.
If I had cirrhosis or fibrosis would it definitely have shown up on the liver function tests or ultrasounds?
Thanks for your reply - really appreciated
Ultrasound will usually show cirrhosis, but this typically is observed through architectural changes (nodular contour, enlarged portal vein, presence of ascites, enlarged caudate lobe). The "coarse echotexture" of fibrosis may be seen & reported, but can also be overlooked, as the relatively bright echo of alcoholic fatty liver can make this difficult to resolve.
Advanced alcoholic liver disease will usually show up in labs in active drinkers, though labs often normalize with abstinence or moderation of alcohol consumption. It's best to look at all 3 liver labs (ALT, AST & GGT) and sometimes all of these are not included in routine blood work. GGT is often moderately elevated in daily drinkers, but typically shows up into triple digits in active drinkers with advanced disease.
A phenomenon known as a "De Ritis ratio inversion" where AST floats substantially above ALT is also a red flag for advanced alcoholic disease. AST can also become elevated up and over ALT by exercise or exertion, so false positives are common when liver labs are within normal range.
The combination of a substantially elevated GGT, along with a substantial and persistent De Ritis inversion (over more than one test) is the best red flag you will get for early stage alcoholic disease from labs alone.
A normal ultrasound combined with normal or only slightly elevated GGT with no De Ritis inversion occurring in an actively drinking patient should give some peace of mind advanced alcoholic disease has not yet occurred. When you're experiencing symptoms (pain), it might be wise to listen to what your liver is trying to tell you!
Wow this is a lot more complex than I thought. Based on what I have read I understand that my GP probably wouldn’t have ordered GGT and if he did I don’t know the result. But based on what you have written I might be ok? (In as far as it might not yet be advanced cirrhosis)
One symptom I forgot to mention is intermittent frequent urination. Some days I’ll go 10-15 times and other a more normal 5. It is always a normal light yellow colour.
It sounds to me as though your liver is starting to react to the amount of alcohol you have been consuming. If you want to give your liver the chance to recover you must stop drinking now. If you continue to drink you will cause more damage which will be harder to reverse and the more you continue to drink the more addicted you will become so the harder it will be to give up. So you will end up fighting not only potential liver problems but also addiction.
Thanks Laura - I know you’re right but it is difficult to quit completely. I am strong willed and I know I can cut back to a few drinks now and again if I chose too bit it feels like I need to knock it on the head now.
I have a really bad feeling that I have done too much damage now
I completely understand it's tough. But if there is a fair amount of damage your GP / specialist will probably tell you you must give up completely. The fact you have cut down so much as a fantastic start and proves you really can live without it and that you don't need it. See how you go but if you need help dont struggle alone there is help out there
Did you get both ALT & AST? If there's no inversion (AST substantially over ALT) in an active drinker, this is certainly an optimistic sign any disease is not end stage (cirrhosis).
GGT is the most sensitive marker for inflammation and is a good tie-breaker if a questionable/minor De Ritis inversion is seen. Normal GGT in an active drinker usually = Happy Liver. Not a foolproof stand alone diagnostic, but when combined with an unremarkable ultrasound should be comforting your liver hasn't already turned to stone.
GGT is a dirt cheap test. No reason your GP should object to ordering this, but if he/she does, you should be able to get it done privately without breaking the bank.
Thanks everyone - I really appreciate you giving up your time to reply to me - you’re very kind.
Metanoia - I am not sure what tests were done most recently but I went in complaining of RUQ pain and the GP felt my abdomen for signs of liver swelling (none present) and said she’ll order a full set of blood tests including liver function and ultrasound. The lady doing the US said it all looks fine and no sign of fat deposit or enlargement and when I saw the GP she said the bloods were all fine. What would be the standard tests that she would have done? Probably alt and ast?
All of that said, the pain gets worse within an hour of having any alcohol and gets better when I abstain so pretty much have to accept my liver is damaged.
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Metanoia does this DeRitis inversion apply to AST/ALT that is in a normal range?
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I've seen a persistent 2:1 De Ritis inversion within normal range in someone with confirmed cirrhosis, but false positives become much more likely when both are in normal range. Even moderate exercise or exertion can bump AST briefly higher within normal range creating a false positive inversion within normal ranges.
I've also seen several cases where alcohol related Vitamin-B deficiency caused an abnormally low ALT (single digit) that created a false De Ritis. Vitamin B-6 is required for ALT enzyme. When ALT is single digit or low teens and AST is mid normal (20s-30s) this is usually a false positive.
This is where I like to look to GGT as a tie-breaker. Normal GGT usually means happy liver, particularly in active drinkers and those early in recovery. A De Ritis inversion with normal GGT is likely a false positive.
If your labs are in range it isn't a concern, it's considered normal. AST over ALT can also occur when your on medications like Paracetamol. I had an AST over ALT when I was sick from my medication. It went back to normal about six months after I got off of it. Then my fibroscan was a 4.7. There are instances where it can mean inflammation, but not irreversible damage. AST is also found in muscle tissue, bones, kidneys, heart, ect. When it comes to the liver, AST is released from zone III near the central venual where mitcondrial damage takes place releasing AST. That's the same place where toxic substances are metobolized. Hence, why we see AST elevations with certain medications and alcohol. Best thing to do when starting to have these concerns please Farranccc and you already know it but would like to reiterate is to stop drinking. The damage may not show up now, but if you're having symptoms. You're body is telling you there's a threat. It's much easier to stop now and live a happy life then continue on and cross that road. Also, alcohol causes changes with the cells at the DNA level. Therefore, lots of damage can be occurring, but not visible.
If your tests and scans are fine then that usually means that your liver is fine. If the standard LFTs are ok then there is no real need to do the other tests, e.g. if ALT is normal no point doing GGT or AST as they will have no diagnostic significance. As others have said already, go easy on the grog and you should avoid actually getting the disease you fear you may already have.
One of my favorite sayings when it comes to liver diagnostics is: "When all else fails, sometimes we simply have to trust our doctors". Hopefully your doc has had some experience with drinkers & liver issues, & your doc's own instinct should be pretty good.
If he/she told you you really should give up alcohol completely, I would strongly consider his/her advice. Some drinkers can moderate safely, but many tend to slide back into old habits. You should know if you can successfully do this within a couple of months. Moderation in all things, and to thine own self be true!
In the USA, ALT & AST are standard in basic labs, but GGT isn't. In the UK & EU, ALT & GGT are usually done, but AST sometimes isn't. A good doc evaluating possible liver issues would probably order all three, but the only way to know for sure is to ask for a copy of your labs.
You really need to get the actual results from your doctor and post the numbers. I have had high GGT for over 10 years but my GP practice just record it as 'normal for patient ' and don't act on it. Private tests show high ALT too but my NHS labs don't include it in their liver profile test so my doc doesn't take it into account. Do you have any other problems such as asthma or COPD? If so you should read up on alpha1 antitrypsin deficiency and make sure that's not an issue. I would suggest taking milk thistle and stopping drinking at least for a few months to see if it helps.
I have been a drinker for over 10 years (not everyday but up to 8 when I do about 4 times a week). In that time I have abstained completely during 2 pregnancies most recent being 18 months ago. I had a ct amd ultrasound 6 months ago amd all fine. My lfts done 6 weeks ago were also fine and I had been drinking when they were taken as taken to hospital for something unrelated. I constantly worry about my liver despite my test results as have not pain so much as an awareness of something on rhs upper abdomen. I also has costocondritis on that side. Doc said yeaterday he couldnt feel any liver inflammation. Should I be worried or am I just being stupid????? .😞😞😞😞
Please note, the 'liver disease tests explained' publication is in the process of being updated but there is still very useful information in there. For all specific guidance, please discuss with your own doctor.
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Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Private ultrasound? 
300 lft?
My LFT readings versus normal 
Ultrasound today....
