Difficulty with Doctors - Fatty liver with symptoms

[Youngandscared]

Hi Everyone,

I posted on here a couple of months ago and had some good advice and i also called the BLT helpline who said that the issue needs looking into further but my gp is unwilling to look any further.

My most recent blood tests seem really good with nothing out of range, ALT-13, Albumin - 44, AP - 70, Bilirubin -5, platelets - 390. I had an ultrasound that showed diffuse echogenic changes consistent with fatty liver with normal portal vein, normal liver size and shape although i read ultrasound isn't that good at picking up on liver damage especially in early stages?.

However i am having a lot of symptoms that keep pointing to the liver but i cannot get my doctor to look at this as the LFT is ok.

I have pain in the upper right of my abdomen that goes through to the shoulder blade, digestive issues and belching usually worse a few hours after eating, 2 very small spider angiomas 1 on face the other on arm, tiredness, sleeping issues, slightly reduced kidney function and changes in stool consistency and colour.

I used to binge drink a lot when in the army but stopped drinking around 10 years ago i'm now in my mid 30s, i have also spent the last few years travelling for work and eating out 3 times a day everyday although i'm not overweight, don't have diabetes or any other health issues until recent symptoms. In the Last 3 months I have been eating healthy and getting more exercise however symptoms remain unchanged.

I have tried quoting BLT advice to the GP and the Nice guidelines on Fatty liver e.g. fibrosis tests should be done to asses damage but this falling on deaf ears and they just say my liver is fine... which could be the case, in fact i hope it is. when mentioning fibroscan, ELF test and fib 4 score the gp had never heard of any of these which worries me a bit.

I even paid for a private GP to try to progress this however they wanted to concentrate on digestive issues rather than check the liver more thoroughly.

Do you think I am worrying about nothing and the GP is right? if not how can i get them to look into this further? it s very frustrating.

any advice is greatly appreciated.

[Richard-Allen]

Sadly many doctors medical practises are struggling to deal with patients due to Covid-19. Most appointments are being limited to telephone consultations only. This is a worrying time for many people, as obviously spider angiomas can’t be viewed on a telephone.

As you’ll most likely know, while the liver is at the “fatty liver” stage, any damage being caused can be fully repaired and made good again. However, it can only keep doing this for so long until scar tissue begins to form. This sometimes is why some doctors are too eager to write off fatty liver as being unimportant as it can repair its self. “Oh, don’t worry it’s only mild fatty liver, you’ll be fine”.

I think in your case we can rule out alcohol as being a contributing factor, and you say you stopped drinking 10-years ago. However, finding out what is causing the liver to become fatty is always a good thing as prevention is always better than cure.

There are many reasons as to why a liver may become fatty, and having a good understanding of why this maybe is a good thing. However, don’t forget, a little knowledge can be a dangerous thing.

There are many videos available online covering this subject, but I find those by Dr John Campbell to be most informative, and he does use big medical words when explaining things. (John Campbell is a retired Nurse Teacher and A & E nurse based in England) this particular video may be of some help in understanding how the liver works and deals with fats: youtu.be/qIeS9SdjEmI(Not working as expected?)

Finally, several options are available to you when dealing with your registered GP. Firstly if you feel you are not getting the full support you should be getting, then most GP practises have a complaints procedure. Sometimes, we have to speak out if we feel we are being neglected. Being a grumpy old git, this comes quite natural to me these days. As long as you remain calm and polite you can make your point and make others take notice. I’ve been in your shoes before when you ask for a certain blood test and the doctor doesn’t think it’s necessary and says no. I then say, “Well then, in that case, can you please make a record on my medical file that I have requested an ELF test, and that this has been refused”. This then places the responsibility on the GP.

All GP’s have a duty of care towards their patients, they need to be aware of not only the physical aspects of treatment but also the mental health and anxiety that any none action may cause.

If you still have no joy or feel you're not getting the treatment you deserve, then maybe its time to change medical practices. By going the this NHS site, and typing in your postcode, you’ll be given a list of those doctors surgeries within your catchment area: nhs.uk/service-search/find-...

Most new patients who join a new medical practice will be given a full medical when they first join. So, this might be advantageous.

Lastly, there is always “HealthWatch”: healthwatch.co.uk/ sometimes things do go wrong, and HealthWatch can act as a “go-between”, between the doctor or hospital and the patient when things have gone wrong, or don’t go as planned. Once again, just type in your postcode to find your nearest HealthWatch office.

I hope some of this is useful for you. (I think I should point out here that these are my personal recommendations only. I can’t advise you medically as I’m not medically trained).

Best Wishes

Richard.

[Youngandscared in reply to Richard-Allen]

Thanks that is really useful and the video is really good too. I will watch some more of his videos purely because I like how he presented and it was really interesting.

I actually managed to get my gp to agree to write to a hepatologist on Friday, I don't know what they said in the letter or if it will make a difference but atleast its progress ( my guess is it was something like this crazy guy thinks there's something wrong with his liver lol). I am hoping that they do an elf test and everything comes back OK.

I didn't have the best diet pre covid due to working away all the Time, then up until Christmas i missed eating out so was still having 3+ takeaways a week and lots of snacks ( crisps biscuits and chocolate most days). I have also been given various antibiotics over the last few years which can apparently affect the liver so both of those may have caused the fatty liver or combined.

Thank you so much for the response it was really good and made me feel a bit better about things. hopefully it is just fat in my liver caught early enough the diet changes have the ability to rectify it.

[Hidden]

Why don't you call us again on the helpline and we can have a further chat.

[jazzjam]

Hi, you said the private GP wanted to go down the gastro route. Personally I would have done that. I am not medical but from what little I do know, problems with the liver can affect the bile process and issues with the bile area can cause the pain you are suggesting as can kidney stones. I know this as it is happening to me and has been for a while but for me they won’t do anything as yet. Spider angioma yes can appear as a liver issue as we all know but when you are looking at photos they are many different types that look so similar that relate to other things, mainly harmless things. You sound like you are taking good care of yourself but if this is persisting than I would go back to the private GP. Your NHS GP isn’t helping and of course there is the covid that is keeping them extremely busy. All the best.

[Youngandscared in reply to jazzjam]

Thanks for the reply

I am still going down that route but they are looking right at the other end and testing for bowl cancer which I think is very unlikely. I am following it up as I saw a specialist privately who said it needs to be ruled out.

The spider angioma thing is tricky I know and they are so small I could easily be mistaken but the doctors won't even look at them to confirm. To be honest I haven't pushed on this as its not the thing I want them to focus on.

Kidney stones were ruled out in ultrasound and my kidney function has been improving since Christmas so hopefully that issue is resolving on its own. With the pain I describe all doctors say it sounds like gall stones straight away but the ultrasound was completely clear so not sure, the private specialist said it could be intestines causing the pain as they pass through a similar place.

I will keep going down all avenues and report back if they find the cause of the issue.

Thanks again