I am a 38 female, struggled with excess alcohol consumption off and on for 10-15 years (lowest consumption= 1-2 drinks per day, sometimes more on weekends. highest consumption with PTSD 10 yrs ago and covid lockdown recently... 2-3 drinks per day on weekday, 5-6 per day on weekends).
6 weeks ago had unusual feeling of fullness in RUQ. Gave up alcohol completely, had blood test and liver ultrasound. Blood tests looked ok'ish: AST 23, ALT 32, billirubin 0.9 (range 0-1.5), platelets 332. MCV, hct, and neutrophils were barely out of range high: MCV 99 (range 82-98), hct 45.5 (35-45 range), neutrophils 71.1 (35-71 range). Ultrasound was not ok: diffusely echogenic with some focal fatty sparring at the gallbladder fossa (fatty liver / hepatic steatosis). Good things: Hepatic vein was patent with blood flow, contour of liver smooth, no ascites, spleen normal size. What's weird is it states "consistent with hepatic steatosis, but more advanced liver disease such as hepaticsteatosis with significant fibrosis/cirrhosis can not be rules out with this study" why? Is ultrasound not sensitive enough to distinguish between fatty liver and fibrosis? Or does it mean that they suspect cirrhosis?
I've been waiting 5 weeks for a specialist to explain this to me as my reg dr would not tell me anything about the report. I've read at least 100-200 pages, blogs, articles, publications about what this all means since then and think I'm loosing my mind at this point. I realize I need to wait and hear from a medical professional, but my anxiety is so high, and getting worse as I get closer to the appointment (started talk therapy, but it's not helping yet).
As for other symptoms, I only noticed some very small red veins on my cheek and around my nose once I went looking for them (need to stretch my skin to really see them). I haven't drank any alcohol for 6 weeks, but sometimes I swear I feel twinges in my liver even though the feeling of fullness has gone away after 2 weeks of abstinence.
Wondering if others have gone through similar experiences and if anything they did helped reduce stress and anxiety? I'm a little chubby these days (BMI probably about 26), so also started exercising the last 2 weeks. I mostly hate exercise because it's boring, but do it because I'm terrified at this point. I also keep reading about blood tests being fine with cirrhosis, and have wondered why even do a blood test at all?!? Is this true? Or is this some internet scare tactic and is a rare/outlier occurrence?
Any thoughts, advice, shared experiences appreciated!
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Catlady1000
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A routine ultrasound scan will not detect any stage of fibrosis. The specific blood tests are Fib-4 score blood test or an Enhanced Liver Fibrosis (ELF) blood test. A specific scan called a FibroScan also estimates fibrosis.
Hopefully the consultant will consider ordering a fibrosis test when you see them. Abstaining from alcohol and a healthy balanced diet will help your liver function.
Thank you for your reply... My Fib 4 score is 0.5 and I've read < 1.5 indicates minimal fibrosis and > 3.25 significant fibrosis. But I'm not sure the NPV of < 1.5 if the liver disease is caused by alcohol. I've read APRI and Fib 4 are more validated in NAFLD and HCV, so am not sure if a low score is that meaningful for ALD.... Thoughts?
When diagnosing, its really important to look at all the diagnostic test results together. The consultant hepatologist will do this and provide the guidance you need.
A standard ultrasound can cannot detect fibrosis, and in the UK elastography such as FibroScan or fibrosis specific bloods tests are used.
There are also new advances in measuring fibrosis, here is an extract from our liver disease tests explained publication;
Elastography
There is a technique similar to ultrasound, known as elastography, or transient elastography, which doctors can use to measure the stiffness of the liver. Healthy liver tissue is soft, so if stiffness is detected, fibrosis (scar tissue) may be present. The most common name for this kind of test is FibroScan. Tests such as FibroScan can’t diagnose specific liver diseases but they can give doctors an idea of how badly the liver is damaged.
Sheer wave elastography (SWE)
This is a more advanced version of the technique described above, which uses a focused ultrasound wave to give radiologists a clearer picture of how ‘elastic’ (soft) the liver is. The waves travel slowly through healthy liver tissue and faster through scarred areas.
Acoustic radiation force impulse imaging (ARFI)
This is another imaging technique. It works by ‘pushing’ the tissues in the body to assess their stiffness – softer, healthy tissue is more easily pushed than stiffer tissue, which may indicate fibrosis.
This is good to know. I was under the impression that fibrosis can show up as increased echogenicity (which could also mean fat), and that they can detect impaired blood flow, which could mean more advanced fibrosis.
Hi Catlady, i am just back from my liver expert and like you I am a thirst for more information. Lets address a few things, liver enzymes are only a general marker on liver damage and probably more relevant in acute stages of damage when they can spike, other than that the bad news is folk can have advanced liver damage but still show normal levels or slight abnormalities, in this regard ALT and GGT are more specific, markers such as AST are not quite as liver specific, what was you GGT level. I am not a medical expert but have studied a lot myself on various testing. OK and this is just my opinion and its not an exact science, but try and get a fibroscan, it picks up more than a normal ultrasound in that it measures both fat content and more importantly the elasticity of your liver. A lot of people have simple fatty disease and dont know it, its only when it moves to NASH and cirrhosis when it may show symptoms or abnormal bloods. I had CT, MRI contrast, old fashioned ultrasound and they showed all clear, but my bloods were abnormal, I had the fibroscan and there you go. If you are talking about drink ie alcohol then that would more likely be AFLD ie alcholoic Fatty Liver Disease if thats the trigger, the good news for you is that give up the drink, pay attention to your diet and you can reverse that, if it has moved on through NASH and maybe cirrhosis then you can still manage it. Some people i know have had AFLD, gone off the drink, exercised more, lost weight etc and have pulled everything back. I am also going to say that the spider veins you talk about may also be due to some health anxiety, many people that drink have small broken capillaries on there face especially on the cheeks and the corner of the nose, i too have had those fshow a smooth, non enlarged liver is a good thing, and where MRI and normal ultrasound is good is early detection of tumors etc so that is also good news. it is also a sign of aging, god forbid ha, so I seriously dont see reason for panic there. But you do need to get a scan that shows how much elasticity is in your liver, ie the scarring or fibrosis content Good luck, Im sure you will be ok and remember, at your age especially this is manageable for you, you got this, head up.
Sorry excuse my grammar, I meant that the fact that your scans showed a smooth, non enlarged Liver is a good thing, as when it scars is when it becomes tough and less elastic, imagine squeezing one of those stress balls but with lumps in it. So a smooth liver is good news from an imaging perspective.
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