New- need help with ultrasound meaning and next steps- scared!

[4tamo]

Ultrasound: New Here ...

What does this mean...Nash and not NAFLD ? If Nash what stage? Can anyone tell me what means? What exactly does steatohepatitis mean: fat, inflammation, scarring- all 3??? How bad??

What do i do next as primary says benign disease?

Pancrease: obstructed but visual segments normal

Liver: Echogenicity: increased rchogenicity; steatosis; Foca findings: None

Portions of liver parenchymaa obscured by overlying bowel gas and soft tissue

Intrahepatic IVC:,in general patent; not overtly dialated

Gallbladder: absent

Extrahepatic bile duct: 8mm

Intrahepatic bile duct: not dilated

Spleen: Partially included; normal size shape

Impression: Steatohepatitis; similar to report 1/26/21 that was incidental finding of notable fatty liver.

Here were my blood labs that led to ultrasound test: (diff over 2 weeks -worse)

On 4/1:

ALT: 42 high

AST: 31

ALP: 157

Bilirubin: 1.4

On 3/19

ALT 28 high

ASP 20 normal

APL 119 normal.

Bilirubin 1.3 high,

b12 1207 high ( norma. 812)

[nash2 Partner]

There is a lot of difficulty diagnosing liver issues. Lots of docs make it hard to understand. Up to a point fatty liver is considered to be benign and docs ignore it and then it is fatty liver or steatosis. Ultrasound can't detect low levels of fat so you probably have significant fat which caused the increased brightness, echogenicity, seen by the ultrasound operator. The question is whether you have NASH or steatohepatitis. That is when the liver is being damaged and has inflammation and that is not a benign condition. Lots of people, including docs, throw those two terms around carelessly but steatosis is the early stage and steatohepatitis is the disease stage. Your doc has said both. My advice is to refer yourself to a liver specialist and get a proper workup. You need to find out specifically how stiff your liver is and what is causing the changes in your blood tests. You want to make sure you don't have a viral infection as just one possibility. Those are worrisome but not terrifying results so you need to take it seriously but try not to freak out.

[4tamo in reply to nash2]

Thank you.

I have a gastro who supposedly does liver too. Have a colonoscopy scheduled with him late July ( since then I got these blood labs). Do I go to him or should I go to a hepatologist?

[nash2 Partner in reply to 4tamo]

My view is that anyone with suspected NASH should refer to a hepatologist as that is active liver disease and they are the experts

[4tamo in reply to nash2]

So my primary who ordered the tests said new since 2018; not worse than incidental CT in January. January CT said notable fatty liver (incidental finding) but the ultrasound said steatohepatitis plus all liver enzymes.

My primary said do not worry about it. Do not need to do anything;?just do not let get worse.

So now really confused as ultrasound say steatohepatitis...which I think is worriesome. Should i just self refer to a hepatologist?

[nash2 Partner in reply to 4tamo]

ultrasound can't detect steatohepatitis so that is a red flag that your care team may not really deal with liver disease. Personally, I'd try to be seen by a specialist to get it resolved so that I really knew the condition of my liver.

[4tamo in reply to nash2]

Thanks for your insight. I am going to make an appointment with a hepatologist. I want an accurate baseline too.

[cclemins in reply to 4tamo]

My husband's gastro doctor refered him to a Liver specialist. This doctor knew a lot more about liver disease because that was is speciality

[4tamo in reply to cclemins]

Thank you. I have an appointment with liver specialist next week!