How reliable is an ultrasound for detecting alcoholic liver cirrhosis?

[African1]

Hello, anyone here to help me understand

Am a 25 year old male, been drinking heavily for the past 10 years, until 7 months ago when I developed skin itching, green veins all over my palms, upper right quadrant pain, white spots on nails

I went to see a GP, who ordered LFTS, all enzymes were normal, but AST:ALT ratio was 1.18, bilirubin was high 3.9mg/dl, albumin 47g/l, also had an ultrasound which showed that the liver seemed normal in size, echotexture and normal spleen, and biliary tree.

Was told I have nothing to worry about, but I still think I might have cirrhosis, anyone to shed more light? I'm new here

.

[AyrshireK]

An ultrasound would be highly unlikely to describe you having normal liver size and echo texture if you did indeed have cirrhosis since it markedly changes the echo texture shape and size of the liver. Also, having normal spleen etc it would all seem to indicate no serious liver damage.Doctors will normally not look at the AST/ALT ratio when these numbers are in range and without any indication of any advanced liver disease - no doctor will base a diagnosis on the ratio alone.

High bilirubin can cause itching but this is normally when the liver is really struggling and yours doesn't appear to be. (Green veins on your palms, white spots on nails are not really recognized liver symptoms).

I don't know whether fibroscan is available to you in your country but it might be a good tool to give you absolute clarity that there isn't anything major going on. Fibroscan gives a kPa score which can indicate degrees of fibrous tissue in the liver and provide an F (fibrosis) score on the Metavir Scale where F0 is normal to F4 being cirrhosis and also a CAP score which indicates degrees of fatty change in the liver.

If you had a clear fibroscan too you could be reassured that all was ok. That being said it is time to stop drinking and live healthier to prevent further damage to your liver or stop your liver becoming damaged.

Katie

[African1 in reply to AyrshireK]

Thank you so much Ayrshirek,

I stopped drinking right away, after noticing the symptoms, 7 months into sobriety now. I have no interest in ever drinking again, I surely regret all those years

It's just unfortunate that Fibroscan is not available in my country...

But I have hope, that if I take care of myself really well by leading a healthy lifestyle, I will be okay.

Kind regards to you

[Onesmallstep1969 in reply to African1]

Drinking coffee helps a lot. Look it up.

[Fibro2021]

On ultrasound may not notice changes at the stage of small-nodular cirrhosis of the liver, which is characteristic of alcoholic liver disease (ALD). Fibroscan or liver elastography is more helpful in this situation.

[Cud2020 in reply to Fibro2021]

I didn’t realize some instances of cirrhosis would be missed on Ultrasound. Is it commonly missed? I have had intermittent pain in upper right abdominal area for over a year but ultrasound came back normal in July. I’m concerned b/c I’m 44 and had been a heavy drinker in my 20’s and 30’s. Only recently started cutting back to moderate amounts the past 5 years. Found out recently my grandmother died of Cirhossis when she was only 52 so I’m certainly more concerned now. Assumed it would be caught in Ultrasound but now I’m not so sure .

[Roy1955 in reply to Cud2020]

99. 9% of the posts on here that say the negative bloods and scans are wrong are being made by people with health anxiety.If you told them blood was red they would say its blue!

If tests say your livers healthy then accept it.

[Cud2020 in reply to Roy1955]

Thanks Roy. I would like to believe that but at the same time it would be unbelievable if my liver isn’t damaged from the years of drinking.

[Fibro2021 in reply to Cud2020]

You can take a Fibroscan and allay your doubts about liver cirrhosis. It's not hard to do now. As a rule Fibroscan clearly shows liver cirrhosis, the degree of fibrosis is more variable.

[Cud2020 in reply to Fibro2021]

Thanks, I have a GI doctor appt on Tuesday so I’ll ask about this test. Not sure they use this in the U.S. May only rely on MRI CT and Ultrasound here.

[chrisw740 in reply to Cud2020]

This link is a starting point. The page takes a little time to load. Good luck at your appointment.

echosens.com/find-a-fibrosc...

[Cud2020 in reply to chrisw740]

Thank you, it looks like they do have these tests in NYC, where I live.

[African1 in reply to Fibro2021]

Thank you fibro 2021

Unfortunately, they don't do Fibroscan in my country

[MINTVCX in reply to African1]

Bilirubin is pretty high but as you said all other tests are ok (also PTL?) Indeed high level is sometimes the indication of fibrosis but typical in F4 (cirrhosis) but I think then other tests would be bad (PTL, INR, albumin etc. ).The other possibiltity is Gilbert's Syndrome which is pretty common condtion which is harmless. You can do genetic test to confirm it but not sure it would possible in your country. But please check this with your doctor.

[African1 in reply to MINTVCX]

Thank you for your reply, I checked my liver panel result, under bilirubin, it shows;

Direct bilirubin: 0.3mg/dl

Indirect 3.6mg/dl

Platelet count was 201 10^g/L

[MINTVCX in reply to African1]

Indirect is high while direct normal which is exactly when someone has Gilbert's Syndrome (also me). But to be 100% genetic test should be performed. Or biopsy to rule out possible other causes. But maybe your doctor based on your current tests can diagnose you with this syndrome.Other thing is your alcohol drinking. You wrote 10 years but for liver it is worse to drink everyday (even smaller amounts) than for example twice a week heavily. Anyway you can have some inflimation or even fibrosis from your drinking but it is not definitely. You should stop drinking a lot regardless your current liver status.

[African1 in reply to MINTVCX]

Thank you MINTVCX

I wasn't really drinking everyday, sometimes I would stay for a week without drinking,

I wasn't dependent on alcohol, even when I stopped (7 months ago) I never had withdrawal symptoms

Just that I was drinking way beyond the recommended limits...

I started feeling much better after stopping alcohol,

A little fatigue here and there, but physically am alright, I exercise almost everyday, the pain seems to be improving too..

The most unfortunate part is that obtaining a diagnosis in my country is a hard thing, I live in Malawi

Medicine is not that advanced here, no genetic testing for Gilbert's Syndrome is available, No Fibroscan

Liver biopsy is very expensive too, I can't afford it

[MINTVCX in reply to African1]

I see. In my amature opinion you have indeed Gilbert's Syndrome and about having it is nothing worry about because it is harmless. About your damage from alcohol I would say it is not your case. But check this with your doctors (hepatologists the best) and follow their advice. Good Look and stay healthly.

[Legend]

Just new to this site, very close friend had Blood test, Ultrasound & MRI all were inconclusive until she had a Biopsy test which is the gold standard for cirrhosis checks and came back very mild scarring - so yes, not 100% unfortunately.