Living with Fatty Liver and NASH
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Red palms/NASH/Nafld/Cirrhosis

Red palms/NASH/Nafld/Cirrhosis

Sorry if this is in the wrong category.

I'm often worried that I may have liver disease or something worse.

I had a full physical with my doctor at the start of january 2018.

Prior to my physical I would get some pain in my right side around my liver area, I still occasionally get some pain maybe once a week for a maximum of 30 seconds per occurrence.

Everything was fine after my physical except for my blood tests. My alt was 186, but all other liver tests like AST, Bilirubin etc. were normal.

I got my blood retested a month later, my results then were a decrease of ALT to 144, but my AST was one point above normal now and I think my bilirubin was also a little above normal. Another 2ish weeks passed, my ALT was still 144, but all my other liver tests were back to normal. I was sent to Ultrasound, but nothing abnormal was found. I got another blood test after a week. My ALT was now 126. I think I have NAFLD or NASH, but I fear something worse like cirrhosis or hcc, but my mind has a tendency to wander to worst case scenarios. I am overweight and have lost about 5 kilos due to healthy eating and 10000 steps everyday, at least I hope that is why I have lost the weight.

Yesterday and today I have what I think are very red palms and when I walk I have what feels like lumps under my feet.

I've attached a few pictures of my palms.

Do they look really red like you would get if you have cirrhosis?

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Gosh Halvis, you are taking us into areas where we can't go. Since we are patients and not doctors we can't give you real medical advice so you need need to work with your physicians. However, we can talk about the general case which may help you.

Your blood tests are a worry as the ALT score often indicates the death of liver cells. Lots of things can do that, infections for example or toxins of some kind. Have you been tested for hepatitis viruses? Right upper quadrant pain is common with liver disease but isn't proof. Red splotches can occur with liver disease but again don't prove anything.

It is important to know that ultrasound is not very useful for diagnosing liver disease. Also, what kind of doctor are you seeing. Ideally, you should try to work with a hepatologist, a liver specialist, if you believe you have a liver disease. Primary care and even many gastro docs are poorly prepared to treat the diseases of the liver.

If you can try to get a Fibroscan of your liver as the first step. It can measure fibrosis. Better would be a specialized MRI called an MRE, and a different MRI test that works well is the LiverMultiScan. It can be hard to get any of these but the gold standard is still the biopsy but you need an evaluation by a specialist to get most of them.

Diet and exercise will help you even if it is an infection but keep pursuing it as getting those questions answered is important.

Wayne

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I have not been tested for hepatitis, but isn't that quite rare?

I thought that only spread through sexual contact and drugs, but maybe I am mistaken, I have only ever had sexual interaction with one person (my girlfriend and she has been tested for all STI) and I have never done drugs.

My doctor seems to think there is no problems and that the high ALT is just random. He wants me to wait 1 month for another test. I think there is only one place in Norway that offers a Fibroscan and that is only reserved for people with hepatitis.

I am hoping to get an MRI if my ALT is still elevated next time I go for another blood test.

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Hepatitis is just one example as there are many diseases that can disturb liver function. Hepatitis is often without symptoms so escapes detection so it was really a suggestion of a type of possible problem to consider. Just a bit more background. There are at least 3 types of hepatitis virus and they are contracted in different ways so a lot of people are infected and don't know it. Your doctor certainly may be correct about your condition. Reading things on the internet can scare the heck out of you, but the diagnosis of liver disease is not simple. Sharp, short duration pain is sometimes associated with gallbladder or biliary blockage but one would expect the ultrasound to pick those up. You also can't forget that bowel issues, for example, can cause discomfort in that area One thing to consider is that liver disease usually moves slowly absent a toxin so it doesn't often suddenly put you in the hospital until quite advanced.

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Observe the palms for reddening. Palmar erythema looks like speckled patches of reddening spots on the palm, and is caused by changed sex hormone metabolism. Palmar erythema mainly affects mainly the outer edges of your palms along your thumb and pinky, and spares the central palm. •Other causes of palmar erythema include pregnancy, rheumatoid arthritis, hyperthyroidism, and blood problems. (from the web)

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I have cirrhosis and other liver issues as well. My palms are always red. Both my hands are always red not just palms. I of course can't tell you why your hands get red but I'm told mine are from liver disease. You should see a gastroenterologist or hepatologist. My ultrasound came back fine even tho I had cirrhosis , hep C and cancer. Ultrasound is not great at detecting liver disease and with your tests being even slightly abnormal you should have at least been referred to a GI. You have to be your own advocate. Do not allow you doctors to be lazy. Tell them your concerns and insist they try to at least rule it out. Best of luck to you

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