I went to the Gastroenterologist today to follow up after my MRI. Here's a little history and the results of today's visit:
AST and ALT have been elevated for 2 years
Fatigue for many years
Bloodwork October 2015:
AST 113 (normal 0-40)
ALT 170 (normal 0-32)
Mitochondrial (M2) Antibody 118.8 (normal 0-20)
Alkaline Phoshatase 49 (normal 39-117)
Bilirubin .8 (normal 0-1.2)
Actin (Smooth Muscle) Antibody negative
Antinuclear Antibodies (ANA) negative
TSH 4.97 (normal .45-4.5)
Ultrasound October 2015:
Fat deposits in liver
MRI November 2015:
Fat deposits in liver
Hepatic vasculature and biliary ducts normal
Small cyst in upper left kidney
All organs look normal otherwise
Fatty Liver Disease - imaging shows fatty deposits in liver and blood work shows chronic elevated AST and ALT, consistent with FLD
PBC - although blood work shows no elevation in Alkaline Phoshatase or Bilirubin and imaging shows no scarring or evidence of damage to bile ducts, AMAs are still positive for PBC. The doctor believes that we got lucky and caught it early, and is quite certain that I have PBC even though other diagnostic criteria is not (yet) consistent with PBC. He did not feel that a liver biopsy would be needed for a PBC diagnosis, but I am to discuss it with the hepatologist in 4 months.
Fatty Liver Disease - the doctor said this is caused by alcohol and poor diet, but it is reversible. I am to avoid alcohol for 3 more months and have been referred to a nutritionist to assess my diet and help me lose weight (10-20 lbs loss would put me in the normal weight range). Bloodwork today including a repeat of liver function tests and a lipid panel. Follow up bloodwork in 3 months, then see hepatologist. Follow up MRI in 6 months.
PBC - starting Ursodiol tomorrow - 300mg three times per day. Hepatitis A and B vaccines ordered to further protect the liver. The doctor said do not take any additional vitamins or supplements without his approval. Bloodwork today including liver function, ALP, and Bilirubin. Follow up bloodwork in 3 months, then see hepatologist. Hepatologist will discuss possible liver biopsy and further studies. Follow up MRI in 6 months.
Osteo Check - Because PBC and osteoporosis often occur together, a bone density scan is scheduled for next week.
TSH Elevated - bloodwork today will test for TSH, T3 and T4. If abnormal, referral to thyroid specialist. The doctor said since I have PBC, he definitely wants to watch my thyroid closely. Especially since I have family history of hypothyroid, and my thyroid has slowed in the past in times of stress.
Kidney lesion - the doctor says it definitely looks benign, but they will check on it again during the follow up MRI in 6 months.