Approximately 3 years ago I was diagnosed with NAFLD after bloodwork for a routine endoscopy due to acid reflux issues. Since my diagnosis my doctor has performed an extensive array of labs and scans from ultrasounds to CT scans to Fibroscans.
At the time of diagnosis I was drinking a lot of alcohol on the weekends and zero alcohol during the week. My doctor kept telling me my elevated liver enzymes were not due to alcohol abuse so I continued to drink alcohol, but a significantly reduced rate. I made other lifestyle changes and for 2 years the labs were continuing to improve and I felt great.
Then approximately 12 months ago I started to develop the occasional pain in my abdomen, on my right side, and under my right shoulder blade. Initially my doctor suspected gallbladder or pancreas issues and he sent me for a CT scan, MRCP, and HIDA scan. All came back normal along with normal pancreas labs and fecal elasticity tests.
At that point I cut out all alcohol and started focusing on eating a lot healthier. Since then I have lost about 20lbs, abstaining from alcohol has never been easier, and I feel better than ever aside from the pain in my abdomen, on my right side, and under my right shoulder blade. In fact, the pain has gone from intermittent to almost a constant dull ache with the occasional sharp stabbing pain in that area. I saw a surgeon last week who said it definitely was not my gallbladder and both of my liver doctors keep telling me that it can’t be my liver even though I have an extremely fatty liver. I have seen an orthopedic doctor who does not see any spinal or muscular issues either. I have also seen a rheumatologist that doesn’t believe I have an autoimmune disease in spite of a positive, but low ANA titer.
My fibroscans show a severe level of fat in my liver and a steady increase in stiffness every 6 months. Due to my score being below 7 they keep telling me I am in the normal range and there’s nothing they can do, but I feel like my body is telling me otherwise. I’d like to also add that my Mom died of liver failure at age 60 and I’m 39 so I’m trying to do everything I possibly can to be there for my children when they get older.
Is it possible/likely that my liver is very inflamed and pressing on the capsule that causes pain? What else can we do to determine this? My CT scan is over a year old so I asked my doctor to send me for another. Is there something else we can check? Is it time for a liver biopsy?
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Fly6584
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The moderators are probably going to edit your post to remove blood test results as none of us are doctors and can advise based on test results. If you want specific advice on this the British Liver Ttust helpline can support.
I seem to say this a lot but once more for the cheap seats at the back - there are no pain receptors in your liver. Your liver, gallbladder, pancreas and spleen all sit inside the glisson's capsule. If you have URQ or shoulder blade pain then there is inflammation around one of these organs and if consultant has already ruled out pancreas and gallbladder then it could be spleen or some kind of inflammation around your liver. A fibroscan can't tell the difference between inflammation and stiffness so a very high fibroscan scores could be inflammation - the max score on a fibroscan is 74 and my husband measured 64.4 mainly down to inflammation. If you think you need a biopsy rule out something malignant, unless you have other symptoms relating to cancer e.g. significant weight loss etc, pain is not a marker for this being something sinister.
Continue to eat well, exercise, abstain from alcohol and follow your doctors advice. They will tell you when it's time to ask for a biopsy.
Based on what you've written (results wise) it doesn't appear you have much ongoing inflammation but yes a very severely fatty liver in the S3 - Steatosis Grade 3 range - more than 67% of your liver is affected by fatty change. Have they ever commented on the physical size of your liver after your scans? i.e. has any comment noted an enlarged liver?
As you say this could indeed be the Glisson's Capsule and thereby referred shoulder pain - but potentially from liver enlargement rather than inflammation.
The treatment involves you doing all you can to reverse the fatty build up in your liver by continued abstinence, healthy diet and exercise. All the specialists have looked at your scans and bloods and ruled out other causes - diagnosis seems firm in fatty liver.
BLT have pages of excellent information on NAFLD and a downloadable leaflet about how you can treat it.
l used to have a pain just like you described just below my right shoulder blade i had a enlarged liver and spleen but since my transplant they went straight away i had de compensated liver due to excess beer
All I can advise, is do what the doctors say and keep positive. I am living a totally normal life now with a kpa score of 75. 12 months ago I was in resus with liver failure.. stay positive
I no it sounds silly but I've herd ov people panicking over tramped wind !!! Especially in the shoulder area. Hope it's just sumert daft like this pal. Try n b vigilant with doctors you can understand!!!!!
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