Liver pain - what disease is this?

[Mihain]

Hi there,

I have a problem with the liver and I do not know what disease is that.

Let me explain how all started.

In the winter of 2017-2018 (1 year and half ago) I had a lot of problems respiratory tract infections (pneumonia, bronchitis and colds) and I took several rounds of antibiotics (2nd generation cephalosporins and levofloxacin) and several other medicines (like ibuprofen - not too much - maybe 1 pill of 200mg at 3 days) and many herbs.

Then in March 2018 I’ve had bacterial prostatitis and I had to take 1 month of levofloxacin. Also, my GP gave me indomethacin (for several days) so that I can urinate better. Needless to say, indomethacin din not improved the condition...

All have passed, and I did not had any respiratory problems nor prostatitis in the past last year.

In April 2018 I have discovered a good salmon in our neighbourhood store and I have started to eat a lot of it (about 2-300 grams) every day. Unfortunately, I cooked it by frying in oil. After 1 month I develop gastritis (probably my stomach was weakened from Ibuprofen and too much fried oil has raised the acid …).

I started to take Pantoprazole for 3 weeks and Sucralfate. The stomach pain has reduced significantly, but not entirely. I took a break … and after 2 weeks the stomach started to hurt again. I tried some herbal medicine, with no significant effect.

In August 2018 I started to take Ranitidine (150mg in the evening), because I read that PPI have too many side effects. After 5 weeks of ranitidine, I started to have a very strong pain in the right side of the abdomen where the liver is located. No other symptoms, just the pain. I stopped Ranitidine, and the pain has disappeared. After 1 week, I resume Pantoprazole (because the gastritis was still there). After 1 month of Pantoprazole, I again had strong pain in the liver area. I stopped the Pantoprazole and the pain has disappeared. Also, the stomach condition has improved significantly.

In November 2018, I was ok. I followed a simple diet: potatoes, carrot, chicken breast, banana.

I December I said that I’m cured and I can eat anything what I want. Bad mistake, after 3 days the stomach pain was again present.

During this time, I have lost weight (about 9 kg in the last year) so I started to eat white chocolate to gain weight again. After 3 days of white chocolate [200g per day] the strong liver pain was again there. The pain was more severe if I bend forward. It felt like I had a wound there.

At the end of December I went to a lab of to do some blood test for liver. The values have been:

Gamma GT = 93 (normal interval [0-55])

ALT = 70 (normal interval [0-45])

AST = 35 (normal interval [0-35]).

My GP was on vacation, so I had to research more by myself.

I took silymarin (150mg/ day - not very constant) since August 2018, but with not too much effect.

After the first blood test I started to take Quercetin. The pain has disappeared very fast. After 1 week of 3x 500 mg of Quercetin, the pain in the liver area was almost nonexistent.

I repeated the blood test after 1 week, this time with more parameters:

Gamma GT = 124 (normal range [0-55])

ALT = 82 (normal range [0-45])

AST = 32 (normal range [0-35]).

Direct Bilirubin = 0.17 (normal range [0-0.2])

Total Bilirubin = 0.48 (normal range [0.1-1.2])

B and C hepatitis = negative.

So, the Quercetin has improved my symptoms significantly, but [some] of my blood tests became worse. I stopped Quercetin.

At that moment I was novice in that field and I have not realised that I need more blood tests.

I started to take Silymarin [300 mg/day], Essentiale Forte [6 pills per day], Liv52.

After 2 weeks (to another blood test lab):

Gamma GT = 67 (normal range [0-50])

ALT = 39 (normal range [10-60])

AST = 30 (normal range [10-50])

ALP = 274 (max value 270)

Albumin = 4.9 (normal range [3.5-5])

Eosinophils = 6% (max normal value is 5%); but I had this value 6 years ago too.

So, my blood tests have been improved, but some are still outside the normal range.

My GP ignored me telling that the values are not pathological.

I also did a stool test for H Pylori and was negative.

Also, I went for a upper gastroscopy and I was diagnosed with mild antral gastritis and no H. Pylori. They gave me Nexium, but I refused to take knowing the liver pain from Ranitidine and Pantoprazole.

In the meantime, I have started to read more and I did tried various kind of medicine.

SAMe, L-methionine, NAC = all good, reduce the liver pain and improve blood tests, but I get pain in the stomach from them and I cannot take them for too long (several days).

ALT and AST are usually inside normal range, but Gamma GT and ALP never decreased below maximum value.

I suspected that I have intrahepatic cholestasis, but I did not had other symptoms [no itching, urine has normal color, no yellow eyes].

Also I did a test for Bile acid in serum and the score was 1.4 (max value 10) … so, maybe is not cholestasis.

I went to an ultrasound and the liver is enlarged [16 cm in diameter - I understand that normal size is 14 cm], but no other problems there.

No gallstones found at ultrasound.

I tried TUDCA for 2 days before getting stomach pain from it … and even if the liver pain has disappeared, the blood test have jumped out of range (ALT jumped to 80, Gamma GT jumped to 90, direct bilirubin jumped to 0.4).

I also tried Medrol (Metilprednisolon) … only 1 pill of 16 mg because I got a serious stomach pain from it.

2 days after Medrol, the ALP has decrease with 30% from the previous value!

Now I’m on phospholipids (3x 600 mg /day) and silymarin (3x 150mg / day) and much better than in December 2018. But I still have some small pain in the liver area.

Also, I cannot tolerate Ranitidine (I get liver pain after 1 pill). I got liver pain even after 2 pills of Sucralfate (this drug goes to liver too?! )

Stomach is better since I started to drink water with Ph 8.8.

Also eat a lot of oatmeal.

Last blood test (from March 25, 2019) looks like this:

Gamma GT = 87 (normal range [0-50])

ALT = 43 (normal range [10-60])

AST = 21 (normal range [10-50])

ALP = 221 (max normal value 270)

Direct bilirubin = 0.18 (max normal value 0.25)

HDL cholesterol = 59 (normal range [40-60])

LDL cholesterol = 147 (optimal < 100)

Lipids = 700 (normal range [400, 700])

Glycemia = 73 (normal range [70-115])

Prothrombin time = 25 seconds (normal range [13 - 17]). I recall that whenever I had an open wood it took more time to stop the bleeding.

What disease is that?

What other tests should I make to understand the problem?

Cholestasis? If so, why Bile acids in serum are so low? Why it does not respond to TUDCA?

Autoimmune hepatitis? My ALT and AST are in normal range.

Fatty liver? In the past I have ate a lot of chocolate trying to get some weight (now I have 65 kg at 177cm, BMI = 20.7). One year ago I had BMI = 23.6. I recall that I had some very mild liver pain after eating chocolate in the past … but the pain would have disappeared after stopping chocolate.

I cannot eat sugar anymore. I cannot eat white bread or pasta because I get liver pain.

Or what else can be there? My GP says that blood test values are not patologic … but why the liver hurts?

I also had Hepatitis A, like 30 years ago.

I did consumed alcohol only occasionally (that is 4-5 drinks per year).

Please help!

[Hidden]

Hi Mihain

Welcome to the forum.

We ask that followers do not post test results and personal information with a request for medical advice. No one on the forum is medically qualified to be able to diagnose or advise you on the cause of your pain.

This forum is here to share experiences and provide support to each other and we would advise against posting any test results or asking for specific medical advice. This is not a medical forum and should not be used to try and make diagnoses or replace advice from your own medical practitioners who have a much wider view of your health and test results.

We have a lot of general liver health information on our website that may be of use to you, see link below;

britishlivertrust.org.uk/

We hope you find the forum a supportive place to visit.

Trust1

[Roy1955]

Probably time to stop doing all those tests!

[Katiesgran]

Seems like you are rather obsessed with your health and self treating with not enough skill to do so. I would strongly suggest you stop all tests. You stop all medication unless advised and prescribed by a doctor and that you make an appointment to see a doctor. Let them make the diagnosis, arrange tests if necessary, and prescribe. I would keep off google too as it seems to be counter productive.

Hope you feel better soon.

[Mihain in reply to Katiesgran]

Hi,

I have already visited 4 doctors + my GP, but got no advice. Two of them asked me to do more tests for some viruses (like Epstein-Barr, or hepatitis E) which I do not think I have, so I will not do those tests ... Another doctor suggested autoimune hepatitis (which I do not think I have because ALT and AST are in normal range). And the gastro-doctor gave me Nexium even if I told her that I had liver pain from other PPI and Ranitidine.

I have only become obsessed with my health since few months ago (since the liver start to hurt) ... Until then I did not care too much ... Usually I went to the GP which in most times prescribed antibiotics for sore throat or for respiratory infections ... which now I understand was a terrible mistake ... but Google has helped me to overcome respiratory infections / sore throat with no antibiotics. This winter it was the first time when I had no sore throat and no respiratory infections even if my entire family has been very sick (my mother was in hospital with acute bronchitis, couching blood) ... everything thanks to Google !

thanks for understanding,

[Mihain]

Hi there,

I have more new details about my case.

Gastritis has been fixed (with diet only. Again I've been stupid to take medicine when diet was a very easy solution (but it took 1 year to find the correct diet).)

But for liver area, things went only worse with only minor improvements. In the worst case the direct bilirubin has been 2x maximum and GGT has been 3x maximum. ALP has been 1.2x maximum. ALT 2x maximum.

I did a MRCP and a small bile duct stricture has been detected in the left hepatic duct (just before it enters in the common hepatic duct). But no dilatation.

Picture is here (on my Google Drive):

drive.google.com/open?id=1h...

All tests for autoimmune diseases are negative.

I do not have inflamatory bowel disease.

I have a very good appetite and I do not feel tired.

Could this be the problem of pain in that area and abnormal liver enzymes?

Sometimes pain goes to the right side of chest and then on the right upper back.

I have noticed that if I eat fat I get better. Is this because fat helps with bile flow?

thank you,

[Hidden in reply to Mihain]

Hi,

As we posted 5 months ago, this is not a medical forum and no one is trained to assess your test results. We appreciate you are worried about your health but would suggest that you discuss your concerns with your own doctors who have access to your medical history and are best placed to safely advise you.

Kind regards

Trust1

[ThreeSmiles]

Please re-read Trust1 ‘s post above. Please don’t post results as we are not medically trained. Suggest you follow your doctors’ advice.