Fatty liver ?

[JD4020]

Hi. While I've been a type 2 diabetic for

Some time, nafla never discussed, I once

Asked, and told no. For a few years my

Platelets have been down, told it was

Itp. Had labs pulled and showed ast, alt

Slightly elevated, same with bilirubin.

Triglycerides were high. Started on stating,

I decided to loose weight, couple months

Later, lost 30 pounds, triglycerides, liver

Enzymes normal, bilirubin almost double.

Labs now show ptt/inr elevated, noncongatted bilirubin elevated, but

Congatred normal....ultrasound showed

Liver on upper level of normal size, and

Very eccogenic, and enlarged spleen.

Told fatty liver and Gilbert disease (and

I'm middle aged).

Any ideas or impressions ?

What next ?

[nash2 Partner]

Hi JD

Well, we have to walk carefully here because we aren't doctors and can't really give you medical advice so I'll address this in a general way. You have been told that you have a fatty liver and it could be quite fat since it is based on an ultrasound. So it is fair to think that you are at risk to have NASH, which is the condition where scar tissue is forming. NASH typically causes platelets to drop and INR to increase so it is reasonable to look at this more closely. The best next step would be to get a FibroScan test somewhere or to see a hepatologist for a proper diagnosis. The disease is often silent or without real symptoms until quite advanced so with your history we would recommend that you seek a specific liver workup to make sure you understand your situation.

Good luck Wayne

[nash2 Partner]

Hi JD I can't give you medical advice, but my experience was somewhat similar and I learned I had cirrhosis in 2015. My suggestion is to get an evaluation by a hepatologist. Those things don't prove you are cirrotic but you are in the bullseye statistically so sooner is better. Something to be aware of is that primary care and gastro docs often diagnose liver disease late. Good luck.

Wayne

[JD4020 in reply to nash2]

Nash2, thank you for your reply. I went

To the GI appointment my go made.

First, he told me I had Gilbert disease,

Which supposed to explain elevated

Bilirubinemia.

Questioned about enlarged spleen,

Was told that it is a common.

Then I voiced my concerns, my nafld

Score is f3 f4.

He said continue to loose weight, come

Back in 6 months and retest labs.

He suggested to do either fibroscan

Or fibrosure. Upon reading I learn

That people with Gilbert's are not to

Use fibrosure, due to incorrect

Bilirubinemia .

Even if fibroscan (225 miles away)

And fibrosis or cirrorsis found,

No change in treatment and

Come back in 6 months !!!

In that event I ask of clinical

Test...he said he has sent 4

People, and they were not

Accept or enrolled.

[nash2 Partner in reply to JD4020]

Hi JD

It does get confusing. That sounds a bit like my experience with a gastroenterologist. He told me not to come back. It took me several years to get a referral to a hepatologist where I got a Fibroscan and learned that I was seriously cirrhotic even though I hadn't had any real symptoms. I had to drive over 300 miles to see a hepatologist. I'm glad I persisted because if I hadn't by now I would be in end stage failure. We all have a different path so I can't give you specific advice but this has been my experience.

Wayne