hi everyone, I’m new here and just feel so totally confused, I know you can’t diagnose etc but just a little help and understanding would mean so much , I was diagnosed with fatty liver about 4 years ago, I was not told that it was severe until a few months ago when my Dr suddenly decided to re check it, no one really wants to tell me what the scan says, they just say it’s severe and bad, I had a fibro 4 index score done which was 1.19 and excluded advanced fibrosis, a week later another doctor did another test which was for the nafld score, this came out as f3 and f4. This really worried me, I am over weight and this test included bmi so could it be possible that the high bmi has just put me higher because it assumes it will be worse with weight, when all the other reads alone are ok…. I was stupid and then used the calculator on line for ast and alt and my ration was over 1.5 and put me as cirrhosis, I always assumed my reads were good, ast 23 , alt 15, albumin 40 platelets 265, now I have found out that the reads mean nothing really and can be low in cirrhosis as there is nothing left to scar… I think my dr is arranging a fibro scan but in the mean time I just feel so scared, surely cirrhosis would have shown on the ultra sound scan? I assumed fibrosis does as well but obviously not, I am in the process of eating healthier and exercising more, but I have this feeling of doom as if I have left it too late……I had three random nosebleeds in the summer and now I’m thinking was it connected, I have issues with palpatations and spiking blood pressure which I am waiting for a cardio appt, now I’m thinking is this liver connected as well, so sorry to go on, I just feel so lost and alone , thank you for taking time to read this xx
severe fatty liver : hi everyone, I’m... - British Liver Trust
severe fatty liver
Hey, the ast/alt ratio doesn't count if they are both in the normal range so please don't be worrying about that. I'm in a similar situation, told I had fatty liver a few years back and didn't do anything about it. I also have a high bmi. I drank way too much too. All we can do right now is be healthy and look after our livers.
Thank you Hayley for replying, I did hear that it only counted if it was out of range, but it does not say that anywhere on line so I was worried, thank you for confirming this, I just don’t understand why my blood tests are normal, does this mean my liver is severely fatty but works normally, it’s so confusing , hope you are ok though, have you had a fibro scan xx
Honestly I'm not sure, my levels have been slightly high for years and then I changed my habits recently and they have gone back into the normal range which my doctor is pleased about. No I haven't had a fibroscan, I had a ultrasound recently to look for gallstones and it showed i still have the fatty liver. My doctor then ordered a fib-4 and ast/alt ratio blood tests and said if these were off in any way then i would get referred for fibroscan, they came back normal so she just told me to carry on with lifestyle changes. wish I could get one though just so I know where I am at!
aww I see, my doc more or less said the same to me, she did the fibro score and said she will re scan me in a year, then the other dr made it higher on a different test so I think I’ll be referred, but who knows, like you though, I just need to know what my situation is xx
The AST/ALT ratio causes a great deal of confusion. It is only really used as a diagnostic tool when one or either of the results is significantly higher than upper limit of normal and it can be used to deduce which liver disease may be at play. As your numbers are within range it wouldn't really but looked at.
A wee excerpt from a medical page found on line:-
What the AST/ALT Ratio Reveals
The AST/ALT ratio is important because its pattern can tell a lot about the condition involved. Here are the general guidelines used to diagnose liver disease
An AST/ALT ratio of less than one (where the ALT is significantly higher than the AST) means you may have non-alcoholic fatty liver disease.
An AST/ALT ratio equal to one (where the ALT is equal to the AST) may be a sign of acute viral hepatitis or drug-related liver toxicity.
An AST/ALT ratio higher than one (where the AST is higher than ALT) means you may have cirrhosis.
An AST/ALT ratio higher than 2:1 (where the AST is more than twice as high as the ALT) is a sign of alcoholic liver disease.
However, a disease cannot be diagnosed by the pattern of elevation alone. How elevated the levels are also needs to be measured. This is described in multiples of the ULN. It is only when the levels are above a certain threshold that the ratio can be considered diagnostic.
Recap
The AST/ALT ratio is a comparison of the levels of the two enzymes. This measurement can point to liver diseases, but only if the enzyme levels are elevated several times above normal.
Normal results points to there being no ongoing liver inflammation - which can be both a bad thing in that a cirrhotic liver needn't also be an inflamed one or indeed in fatty liver it hopefully shows there is no NASH (Non Alcohol Related Steato Hepatitis) the more aggressive form of Non Alcohol Related Fatty Liver Disease.
Ideally in your circumstance a Fibroscan might be the ideal tool, normal bloods means your result should be accurate (false high figures can result from ongoing inflammation and if you have none of that then you should hopefully be able to rely on the result. A fibroscan can reveal your fibrosis score F0-F4 and hopefully also provid a CAP score which indicates the amount of fat in the liver and can provide a Steatosis (fat score) S0-S3.
You need to know what they are thinking is going on, if it is cirrhosis then you can still do loads to stop it progressing and even improve things. If it hasn't yet reached cirrhosis stage then that would mean you can potentially halt progress and reverse damage done.
The BLT has some excellent guides on NAFLD and a booklet on treating fatty liver disease with a healthy diet and exercise with good food ideas. They also released details of a study which indicated a Mediterranean Style diet is good for NAFLD.
Links to all these pages :-
britishlivertrust.org.uk/in...
britishlivertrust.org.uk/wp...
britishlivertrust.org.uk/ea...
Katie
hi Katie, thank you so much, that is really informative, you certainly know your stuff, I have so many risk factors , overweight, high blood pressure, diebetic, poly cystic ovary syndrome, the only thing that is good is my cholesterol and triglycerides…. I had cancer a few years ago, and really can’t bear the thought of facing yet another issue, i look at all my health issues and have no confidence to believe it could be just fatty liver, can severe fatty liver possibly still not be fibrosis, the links are very interesting thank you so much for sending them , hope you are ok xx
Fatty liver can lead to fibrosis and indeed cirrhosis. That's obviously why you are being sent for fibroscan so they can tell you what stage you are at.
Even if it does turn out to be fibrosis there is still lots you can do to keep yourself fit and as healthy as possible.
It's my hubby who has a diagnosis of liver disease. He has cirrhosis due to auto immune liver disease and has been diagnosed since April 2012.
Katie
Fatty liver can lead to fibrosis and indeed cirrhosis. That's obviously why you are being sent for fibroscan so they can tell you what stage you are at.
Even if it does turn out to be fibrosis there is still lots you can do to keep yourself fit and as healthy as possible.
It's my hubby who has a diagnosis of liver disease. He has cirrhosis due to auto immune liver disease and has been diagnosed since April 2012.
Katie
I’m so sorry to hear that your husband has cirrhosis, how is he doing though, I’m just so scared, I feel like I am literally at deaths doors, I have this hanging over me, heart issues and waiting to see cardiologist, now I have to have bladder scan and may need to see kidney Dr, Mentally I really feel like I can not deal with any of this, I’m scared everything is connected….thank you again for your help xx
It’s bad enough being tested for one thing, having several at once is just horrible. I don’t know anyone who wouldn’t be anxious but tests often rule things out and can give reassurance so I hope you get good news once the tests are done. The liver is a remarkable organ and if you treat it well it can repair itself so try not to worry. I know that’s easier said than done.
thank you so much for understanding, that means a lot, people tell me I worry too much and I tell them they would too if they had alll the things wrong that I have, I was diagnosed with a rare wheat allergy only in April and still trying to juggle that with diebetes, now I need to juggle liver diet as well, people really do not understand, so your kindness is much appreciated xx
You’re welcome. My kids are diabetic so I reckon your diet for that, with avoiding wheat, will be fine for your liver too. You’ve got a lot going on so be kind to yourself. Unless people have been through health stuff they don’t get it but there’s plenty of people on here who do
you are amazing, thank you so much, you are right, people don’t know what it’s like to have issues, one day they themselves may have things to worry about, then they will get it lol, Thank you again xx
hi Sophia. I’m in a similar situation.
I had a biopsy back in December because they thought I had AIH but came back as fibrosis due to fatty liver. (I’m over weight and used to drink a lot) doctor was very vague with me when I asked what level.
I felt confused and upset when I first heard that but now I’ve gave myself a kick up the backside and stopped drinking and exercising more 
I had a fibroscan last year which was pretty high 12.7.
I don’t no if this is any help but I wish you all the best xx
aww bless you hun, I have no idea how the fibro scores or numbers work, I hope you manage to deal with it all ok, you sound like you are already doing well so keep it up, I on the other hand have no idea about anything liver related xx
Have you spoken with a consultant and then had a specialist Liver nurse discuss this with you regarding reading and diagnosis? My GP is good. I had a lot of test scans, including a Fibro scan which put me at 39.2 Level 4 early cirrhosis.
no hun, it’s not gone that far yet, my dr has contacted them to see if I need a firoscan so I’ll see what they say xx
I’m sorry to hear you have cirrhosis but I’m glad it is early stage xx
"there is nothing left to scar" - People come here pretty often after reading up online. There are Terry's Nails, AST/ALT ratios etc. None are used alone to diagnose Cirrhosis. Your Platelets are great, these tend to drop with a scarred Liver. The one test to question is the "nafld score, this came out as f3 and f4." This is obviously not what you want. The nosebleeds could happen with Cirrhosis, but this would show in the bloods under INR numbers and people who I have seen suffer this have Platelets under 100 or even 50 and require transfusions. You are also showing no signs of current inflammation.
thank you so much, you have made me feel better about the platelets although even they have been dropping every year, let’s hope they don’t keep dropping, I do appreciate all the knowledge you have it makes me feel better xx
Platelets bounce around, mine from 230 -350 and I have no Fibrosis. Its when they get below 150 and start to get lower that you should be concerned. Your GGT numbers would be useful, your AST and ALT are not showing inflammation, which is very good news. A fatty Liver will typically pop GGT for long periods, but this doesn't mean there is serious damage, but a call to action in most cases.
I would say get a Fibroscan or even better and MRE to hopefully calm yourself. Some scarring you can live with and heal if you turn this around. Its the F3 and F4(Cirrhosis) that is permanent.
Nothing you have posted is of much concern, just the "doctor did another test which was for the nafld score, this came out as f3 and f4" What test was this ? A scan or bloods ?
aww thank you for putting my mind at rest smeg (your name makes me smile lol) wow how do you know so much even though you do not have fibrosis, I do worry because my crp and esr are high so that means inflammation in the body, but I guess it should be anywhere, I also get pain in my spleen area which worries me, the tests were both online calculators, the ultrasound sound scan showed severe fatty liver, so the first doc used an online calculator fib 4 index score consisting of my blood results and I came just under at 1.19 which excludes advanced fibrosis, when the other dr did a calculator she used the nafld calculator which includes bmi this then said f3 f4 so the bmi made it high I assume, just being a calculator is not personal to me and I do get that, they assume overweight means more damage , but it was enough to freak me out, I think the last dr was going to ask the liver people about having a fibro scan but not heard anymore, but it was only a couple of weeks ago , since then I have been up there with other issues so they are prob behind with me , thank you for you4 reassurance though, you did help to calm me down a bit , I can see that it might not be as bad as I think, and my dr did say a cirrotic liver would show even on normal scan, so if I’m in between as in fibrosis I will deal with it , my cholesterol and triglycides are really good total cholesterol is 3.2 (needs to be under 5) triglycerides are 145 ( should be under 1.85) xx
I was only told mine was severe a couple of weeks ago by the chronic fatigue team. Got to have blood test this week. Weight makes it worse as told by a surgeon yesterday. A fatty liver can be repaired xx
bless you sally, please let me know how you get on with your blood results, fingers crossed that all is ok for you and just need to keep an eye etc xx
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