Fatty Liver and concerned.

[Rigenie3]

I have had elevated liver enzymes for a while and was brushed off as simple fatty liver. Recently, I’ve had nausea that was told by my GI doc that is was possibly gallbladder. I had my gallbladder out and it was infected, but still have some nausea.

Through all of this I am petrified it’s my liver. My bloods have been normal for over a year, 3 ultrasounds and only showed increased brightness on 2, my surgeon assured me that my liver looked fine during surgery and my FIB4 and NFS are .80 and -2.2.

Is it safe to assume my issues are gastro and not liver. All my docs are sick of me asking about my liver, but I read nausea is an early sign.

I’m 46, with a belly, but no diabetes. My cholesterol is normal.

Tanks for any insight and God Bless all of you.

[nash2 Partner]

Things like that can make you crazy.

OK, asking us if it is safe goes beyond what we are capable of, but perhaps a little perspective. Those blood tests basically give you a probability. In your case they say it is very improbable that you have advanced fibrosis and that is probably your greatest fear. That was really confirmed by your surgeon.

It doesn't mean that you don't have fatty liver or NAFLD. The fact that 2 ultrasounds suggested it is reason to think about it. So a betting person would say that you are not ill but you probably are at risk due to fat in the liver. A key fact is that ultrasound is very poor at detecting fat until the liver is at least 30% fat. So how concerned should you be. Most fatty liver problems develop over years to decades so you probably aren't in immediate danger but a thoughtful response is appropriate. That involves losing the weight and exercise, of course, something you probably heard before but time to take it seriously. Fear is your enemy but the odds are that you have plenty of time to make changes. Of course, to confirm that you might have to seek an opinion from a hepatologist and perhaps get a Fibroscan.

Nausea has many mothers so while it certainly is a frequent symptom of liver disease a lot of things can cause it. Some people are very sensitive to changes in the liver chemistry as they develop fatty livers but it doesn't prove anything by itself.

Wayne

[Rigenie3 in reply to nash2]

Thank you! So you’re saying the surgeons visualization is significant reassurance?

[nash2 Partner in reply to Rigenie3]

Well, it is safe to say that if you had cirrhosis or serious steatosis, meaning your liver was more than 66% fat, the surgeon could see that. The tests are saying you don't have advanced fibrosis. They don't say you have a perfect liver and they don't say you are wrong to be concerned just don't be scared to death. If it was me I would get a fibroscan as a next step or talk to a hepatologist. The thing to understand about primary care docs is they don't worry much about fatty liver so you do have to be your own advocate. For them you have no signs that warrant additional testing. You have enough information that you should take losing weight seriously so you don't progress to fibrosis. Here is a link that might help.

fattyliverfoundation.org/na...

[Rigenie3 in reply to nash2]

I’ve read your story and you’re wonderful. Thank you again. I am certainly always thinking about liver health these days. My paranoia comes from the many years of mild enzymes that we told it’s no biggie. Obviously, the world knows different now. All the these conversations were with my GI doc who is well regarded in our area. That said, he’s only a gastroenterologist and not a hepatologist. They have a Fibroscan at their other office but felt I was screened appropriately with the bloods, scores and nothing sinister during surgery. He’s an older guy and likes to talk and not be talked to.

[Ballymahon2]

Trust your doctors

[nash2 Partner in reply to Ballymahon2]

With liver disease you need to understand the training your doctor had. Many docs were taught that fat in the liver was benign. True enough until it isn't. Since we have no pill for doctors to give they don't screen for advancing disease until symptoms appear which is often at stage 4. Too many docs say fatty liver is not a problem so it is a prudent thing to understand your doctors view of liver disease. Your advice is correct as long as your doctors have proper training otherwise you could be at risk.