Elevated LFTs, Bilirubin and RBCs - please provide input.

[66Forever]

First thank you for reading this and taking the time to consider my issues. I’m really concerned that my fatty liver, which I’ve had for 15 years has brought on cirrhosis or liver cancer.

I am 49 and overweight. I had normal bloodwork six months ago but now have a bilirubin of 1.4, AST of 76, ALT of 116. Red blood cell number was 6.0. I had Covid 6 weeks ago and took care of my daughter with Flu A two weeks ago (I didn’t get sick, but developed a pronounced sour stomach). I do still have some mild upper right abdominal discomfort. I had a normal ultrasound seven years ago and have had two abdominal ct scans (4 years ago and 6 months ago) that both only noted hepatic steatosis. Naturally I’m having another ultrasound in a few days. Any thoughts or insight will be much appreciated.

[Nonotnash2022]

I am glad you are getting it checked out. I t sounds like you will know ore shortly. It's vital to have a good diet. I was told that by losing 10 percent of your body weight was a great start.

[geneticnash]

Stay positive, take care of yourself and your family, eat healthy and exercise. It's really all any of us can do. Stress is bad, so try to let it go.

[nash2 Partner]

Hi 66

Blood tests and ultrasound aren't very good for diagnosis of NASH. The fatty liver you've had for a number of years can lead to fibrosis so it is good you are getting checked. Something you might consider is calculating your FIB4, a score that is pretty good at showing if you don't have fibrosis. Low scores mean a very low probability of advanced disease. Higher scores suggest that more testing is needed. Here is a link to the calculator. Your doc should be familiar with this as it has become part of suggested screening for liver disease but a lot of them haven't adopted it yet. If you end up with questions try to get a liver stiffness test. That is the one you actually need. FibroScan is the most common tool for measuring it.

fattyliverfoundation.org/fi...

Wayne

[66Forever in reply to nash2]

hi Nash2 - thanks for your reply. My FIB4 score is 1.81, but my ultrasound found surface nodularity indicative of cirrhosis. I hope somehow I am in an early enough stage to lose weight and exercise and still live for a while.

[66Forever]

So my scan indicated hepatic steatosis with surface nodularity suggestive of underlying cirrhosis.

[nash2 Partner]

Hi 66

So you need to be evaluated by a liver doc and you need to know your stiffness score, but you probably have advanced fibrosis but early enough to manage successfully. You definitely should get on a good lifestyle and exercise track. Just to frame it for you my FIB4 was over 3 and my liver stiffness was 21.5 at diagnosis with a score of 12 being cirrhosis. Today, I've lost 70 pounds from my peak weight and my stiffness score is 9.6 or a high F2 in NASH. With good management you would seem to be at a point where you can live a pretty normal life if you stop it here but get real testing to be sure where you are. Good luck

Wayne

[66Forever in reply to nash2]

Thank you for your reply and hopeful words. I’m going to try to do what I can. I’ll be seeing a liver doctor soon. Please have a Merry Christmas!

[66Forever in reply to nash2]

Hey - I appreciate your help. I’m still trying to process this. I don’t drink but I am technically obese. Does the “surface nodularity” ever improve with diet/exercise?

[nash2 Partner]

Not much, it is caused by the liver trying regenerate but being held tightly by bands of scar tissue so it gets lumpy. The fibrosis can soften over time but it is slow. The key thing is to stop progression. If your chemistry is working that is the important thing.

[66Forever in reply to nash2]

Hi Wayne,

Should I avoid coffee? I’m finding mixed messages by Goggling (which I know I shouldn’t do) so I thought I would ask you since you have a lot of experience.

Bill

[nash2 Partner in reply to 66Forever]

coffee is beneficial, my doc prescribes at least 4 cups per day, but it needs to be paper filtered. The filter removes two chemicals that are harmful. Caf or decaf makes no difference. There is some evidence that black is best as dairy may block some phytochemicals.

[Herman7275]

I am 69 yrs, positive active person, been diagnosed since 2019, fatty liver , fibrosis F-3,ALT no/22, T. Bilirubin .8, Alkaline 51. liver stiffness8.9kPa, medianratio of 28%