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What Does My Blood Test Report Indicate?
Brief Answer:
These numbers don't indicate cirrhosis by themselves.
Detailed Answer:
Hello and welcome,
Your liver enzymes (AST and ALT) are elevated but are not extremely high. They could be elevated from alcohol. I think it is less likely that they are elevate from "fatty liver" as your body weight is not excessive for your height.
At this point, it would be good to get some follow up. I would recommend:
1. Discontinue alcohol as it will not help your liver enzyme elevation right now.
2. Consider getting tested for hepatitis virus, although if you have not used IV drugs or had a transfusion years ago, in the US, this is less likely.
3. Either get your liver enzymes rechecked in 6 weeks, and if rising, have an abdominal ultrasound, or have an ultrasound now. I tend to just recheck the liver enzymes to see if decreasing or eliminating alcohol has helped.
Some medications, such as statins for cholesterol, can also raise liver enzymes. If you are taking any medications, talk with your doc about whether these might be contributing to the elevation.
So... you would need further evaluation (ultrasound) to evaluate if there is cirrhosis, but given that the enzymes are not that high, I would not worry about that just based on their levels.
I hope this information helps. Please let me know if I can provide further information/clarification.
These numbers don't indicate cirrhosis by themselves.
Detailed Answer:
Hello and welcome,
Your liver enzymes (AST and ALT) are elevated but are not extremely high. They could be elevated from alcohol. I think it is less likely that they are elevate from "fatty liver" as your body weight is not excessive for your height.
At this point, it would be good to get some follow up. I would recommend:
1. Discontinue alcohol as it will not help your liver enzyme elevation right now.
2. Consider getting tested for hepatitis virus, although if you have not used IV drugs or had a transfusion years ago, in the US, this is less likely.
3. Either get your liver enzymes rechecked in 6 weeks, and if rising, have an abdominal ultrasound, or have an ultrasound now. I tend to just recheck the liver enzymes to see if decreasing or eliminating alcohol has helped.
Some medications, such as statins for cholesterol, can also raise liver enzymes. If you are taking any medications, talk with your doc about whether these might be contributing to the elevation.
So... you would need further evaluation (ultrasound) to evaluate if there is cirrhosis, but given that the enzymes are not that high, I would not worry about that just based on their levels.
I hope this information helps. Please let me know if I can provide further information/clarification.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
You have been the most helpful. Thanks. I would say that this is more than likely due to alcohol because i drink a lot. I am about 25-30 pounds over weight from where i was 3-4 years ago. With this new information, would you still say that cirrohis is not likely given my enzymes arent to high? Thank you so much.
Brief Answer:
Some info:
Detailed Answer:
I think it is less likely, yes. But diagnosis of cirrhosis is not made on liver enzymes only.
So I would put that diagnosis aside for now and let's see if the elevation subsides - which in most cases, it will.
If you have been drinking a lot, perhaps you might need to detox slowly? If your body is used to frequent alcohol consumption, you can have withdrawal symptoms from discontinuing abruptly - agitation, insomnia, the shakes, and worse. So you might want to talk with your doctor for help with discontinuing. For example, a scheduled dose of benzodiazepines (such as lorazepam) can help this to go more smoothly without withdrawal problems.
Some info:
Detailed Answer:
I think it is less likely, yes. But diagnosis of cirrhosis is not made on liver enzymes only.
So I would put that diagnosis aside for now and let's see if the elevation subsides - which in most cases, it will.
If you have been drinking a lot, perhaps you might need to detox slowly? If your body is used to frequent alcohol consumption, you can have withdrawal symptoms from discontinuing abruptly - agitation, insomnia, the shakes, and worse. So you might want to talk with your doctor for help with discontinuing. For example, a scheduled dose of benzodiazepines (such as lorazepam) can help this to go more smoothly without withdrawal problems.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Ok. My billirubin came in at a normal level (0.61). Does that lab reflect early signs of liver damage? I know it will be high in the latter stages of cirrohis. Does that tell you anything more? Also i have consumed a lot and daily over the past few years but havent felt like or wanted a drink since these results this Monday. Thank you so very much. I am more tham likely one of those functional alcohlics and i have a family. Im just really nervous .
Brief Answer:
some info
Detailed Answer:
You are right that elevated bilirubin is a later or at more severe sign, and it is good that it is not elevated currently. That is a plus.
Your degree of liver enzyme elevation is not that uncommon and most of the time it is not cirrhosis.
So it has been 4 days since your last drink - that is good. Most of the really nasty withdrawal problems, such as DTs, happen within the first 3 days.
If you drink alcohol for nervousness (if I understood that connection right), you might want to consider an SSRI medication, if it has been an ongoing/chronic problem.
some info
Detailed Answer:
You are right that elevated bilirubin is a later or at more severe sign, and it is good that it is not elevated currently. That is a plus.
Your degree of liver enzyme elevation is not that uncommon and most of the time it is not cirrhosis.
So it has been 4 days since your last drink - that is good. Most of the really nasty withdrawal problems, such as DTs, happen within the first 3 days.
If you drink alcohol for nervousness (if I understood that connection right), you might want to consider an SSRI medication, if it has been an ongoing/chronic problem.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Last question. Right now i feel pretty normal in terms of symptoms. I do have pain in in the area of my liver, sometimes it ls a sharp pain, sometimes a more consistent dull pain. How irregular or uncommon is that? Is that in-line with something more serious?
Brief Answer:
May be gall bladder.
Detailed Answer:
Pain coming from the liver in and of itself is actually fairly unusual. And the pain is often felt in the right shoulder or back. In the right upper abdomen, pain is most often from the gall bladder.
If you are feeling pain there, and it has been going on for more than a couple of days, then it would be a good idea to get that abdominal ultrasound.
Was this pain the reason your doctor ordered the liver function panel?
May be gall bladder.
Detailed Answer:
Pain coming from the liver in and of itself is actually fairly unusual. And the pain is often felt in the right shoulder or back. In the right upper abdomen, pain is most often from the gall bladder.
If you are feeling pain there, and it has been going on for more than a couple of days, then it would be a good idea to get that abdominal ultrasound.
Was this pain the reason your doctor ordered the liver function panel?
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
It may be my gall bladder than because i havent experienced any pain in my right shoulder or back. But definitely in the right upper abdomen. So maybe that is nothing.
The labs were actually ordered because i suggested them. My Dr. was hesitant initially because we had done them as recent as 8/11 this year where they were 35AST/37 ALT so he didnt thinknit was necessary. Then he basically said why not and ordered the labs.
I had read that pain in the upper ab area could be a symptom of cirrhosis and that is why i mentioned it to you.
I was also a little comcerned because my enzyme levels could have increased even more from the time i gave the labs (week ago today) and when i received the results 3 days later, because i drank Saturday amd Sunday last weekend not really thinking anything was wrong. In those 3 days could the enzyme level have increased significantly?
Also do you see any issues with the pain in the middle to upper right abdomen??
Im sorry for all the questions but I cant tell you how helpful you have been. T
The labs were actually ordered because i suggested them. My Dr. was hesitant initially because we had done them as recent as 8/11 this year where they were 35AST/37 ALT so he didnt thinknit was necessary. Then he basically said why not and ordered the labs.
I had read that pain in the upper ab area could be a symptom of cirrhosis and that is why i mentioned it to you.
I was also a little comcerned because my enzyme levels could have increased even more from the time i gave the labs (week ago today) and when i received the results 3 days later, because i drank Saturday amd Sunday last weekend not really thinking anything was wrong. In those 3 days could the enzyme level have increased significantly?
Also do you see any issues with the pain in the middle to upper right abdomen??
Im sorry for all the questions but I cant tell you how helpful you have been. T
Brief Answer:
some info
Detailed Answer:
It's possible the liver enzymes might have increased briefly from the time you had the test until you got the results, but I would expect that rise to not be significantly consequential given that your enzymes weren't that extremely high prior to it, and so unlikely to cause much damage in the interim. More likely just a temporary fluctuation.
I do think your right upper quadrant and middle abdominal pain should be evaluated. I would suggest you go back to your doctor and tell him about it. It could be everything from gastroesophageal reflux to gall bladder problems. Your doctor will get a better idea by examining your abdomen for the location of this. If it's GERD (which is usually more midline, but not always) then an H2 blocker or proton pump inhibitor medication can be used. If it's in the area of your gall bladder or liver, then an ultrasound can help sort it out.
It is possible to have actual liver pain in the right upper quadrant, it's just that it is not that likely compared with other causes.
So given your persistent pain, do go back to the doctor to have a look. But please don't loose sleep over it if possible as most of these things are not serious, and your liver enzymes, while needing addressing by discontinuing alcohol, are not frighteningly high.
If you are willing, please let me know how you are doing after you are seen again. If this discussion is closed by then, you can write a new question with my name in the 1st line and it will be routed to me.
some info
Detailed Answer:
It's possible the liver enzymes might have increased briefly from the time you had the test until you got the results, but I would expect that rise to not be significantly consequential given that your enzymes weren't that extremely high prior to it, and so unlikely to cause much damage in the interim. More likely just a temporary fluctuation.
I do think your right upper quadrant and middle abdominal pain should be evaluated. I would suggest you go back to your doctor and tell him about it. It could be everything from gastroesophageal reflux to gall bladder problems. Your doctor will get a better idea by examining your abdomen for the location of this. If it's GERD (which is usually more midline, but not always) then an H2 blocker or proton pump inhibitor medication can be used. If it's in the area of your gall bladder or liver, then an ultrasound can help sort it out.
It is possible to have actual liver pain in the right upper quadrant, it's just that it is not that likely compared with other causes.
So given your persistent pain, do go back to the doctor to have a look. But please don't loose sleep over it if possible as most of these things are not serious, and your liver enzymes, while needing addressing by discontinuing alcohol, are not frighteningly high.
If you are willing, please let me know how you are doing after you are seen again. If this discussion is closed by then, you can write a new question with my name in the 1st line and it will be routed to me.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi. What about the AST to ALT ratio? Ive read that when the AST is lower than ALT, which mine is, is usually a sign of liver damage causes by alcohol. Ive read about a ratio of AST to ALT as well. If the ratio is not where ot should be does it even matter if my enzyme numbers arent significantly high??
Brief Answer:
Relationship of AST to ALT
Detailed Answer:
AST elevation has a stronger correlation with the liver inflammation being from alcohol use than ALT does, but both can be elevated with alcohol use.
Years ago we used to look mostly at the GGT enzyme as that correlated very well with alcohol use but GGT is also found in other organs so that test is not done as often. You can ask your doctor, when he reorders the LFTs if he'll include GGT also.
I am wondering if this is the article you were looking at? http://www.niaaa.nih.gov/
This is a good article and points out that cirrhosis can follow repeated episodes of alcoholic hepatitis.
The ratio you mentioned is useful but not 100% accurate. So I wouldn't worry too much about it.
The main things to do now are abstain from alcohol, and if you smoke cigarettes, seek help to quit that as it can compound liver damage. (Yikes - is there any organ cigarettes don't adversely affect?) And I think you will be pleased to see your enzymes go down. But if you are having right upper quadrant abdominal pain, do get that checked out in the meantime.
Relationship of AST to ALT
Detailed Answer:
AST elevation has a stronger correlation with the liver inflammation being from alcohol use than ALT does, but both can be elevated with alcohol use.
Years ago we used to look mostly at the GGT enzyme as that correlated very well with alcohol use but GGT is also found in other organs so that test is not done as often. You can ask your doctor, when he reorders the LFTs if he'll include GGT also.
I am wondering if this is the article you were looking at? http://www.niaaa.nih.gov/
This is a good article and points out that cirrhosis can follow repeated episodes of alcoholic hepatitis.
The ratio you mentioned is useful but not 100% accurate. So I wouldn't worry too much about it.
The main things to do now are abstain from alcohol, and if you smoke cigarettes, seek help to quit that as it can compound liver damage. (Yikes - is there any organ cigarettes don't adversely affect?) And I think you will be pleased to see your enzymes go down. But if you are having right upper quadrant abdominal pain, do get that checked out in the meantime.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi. Thanks for the info on the ratio. No i had not read that article. I actually read quite a few just to look for consistency.
So, i never have been a smoker which is good.
Just to clarify regarding the pain. It is not consistent, seems to come and go. Thay said, the pain is minimal and tolerable. Would pains in the right quadrant normally be more painful or is that the norm? Oddly enough, in the past 24 hours or so i have felt some sharp pains in my lower right back area. They come and go as well
Also, one thing i failed to mention is that i had an ultrasound appointment scheduled today. A couple minutes into the exam the women who performed the exam asked if i drank alcohol, she mentioned my liver was a little fatty. After the exam she said besides the 'fatty' there wasnt anything irregular that she could tell, liver size was normal and no red flags. She also reminded she is not a doctor and nothing is for certain. If my liver is just "a little fatty" what does that say (if anything) to you?
As always thanks so much. You have been great!.
So, i never have been a smoker which is good.
Just to clarify regarding the pain. It is not consistent, seems to come and go. Thay said, the pain is minimal and tolerable. Would pains in the right quadrant normally be more painful or is that the norm? Oddly enough, in the past 24 hours or so i have felt some sharp pains in my lower right back area. They come and go as well
Also, one thing i failed to mention is that i had an ultrasound appointment scheduled today. A couple minutes into the exam the women who performed the exam asked if i drank alcohol, she mentioned my liver was a little fatty. After the exam she said besides the 'fatty' there wasnt anything irregular that she could tell, liver size was normal and no red flags. She also reminded she is not a doctor and nothing is for certain. If my liver is just "a little fatty" what does that say (if anything) to you?
As always thanks so much. You have been great!.
Brief Answer:
some info
Detailed Answer:
I'm glad you had the ultrasound. Both alcohol excess and excess weight can cause "fatty liver" which is where the liver increases in fat which causes inflammation and thus elevated liver enzymes. This can usually be reversed with abstinence from alcohol. So you can rest assured that you don't have cirrhosis at this point but there is some inflammation, which we already know from the somewhat elevated enzymes.
Usually when scanning the liver they will also visualize the gall bladder. So if there was nothing to remark on there, you likely are also doing ok in that department.
I would go have the pain evaluated if it persists or gets worse. Otherwise, it is possibly gas or muscle strain.
some info
Detailed Answer:
I'm glad you had the ultrasound. Both alcohol excess and excess weight can cause "fatty liver" which is where the liver increases in fat which causes inflammation and thus elevated liver enzymes. This can usually be reversed with abstinence from alcohol. So you can rest assured that you don't have cirrhosis at this point but there is some inflammation, which we already know from the somewhat elevated enzymes.
Usually when scanning the liver they will also visualize the gall bladder. So if there was nothing to remark on there, you likely are also doing ok in that department.
I would go have the pain evaluated if it persists or gets worse. Otherwise, it is possibly gas or muscle strain.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks again. Yes this is a real life changing eye opener for me. If you dont mind what about her analysis makes you believe i am put of the woods for cirrohsis? Also, she was not a radiologist. Do you think most sonographers have a good feel for these things?
Brief Answer:
some info
Detailed Answer:
Yes, radiology techs who do ultrasound have a good idea of what they are looking at. They are trained, if they see something unusual, to go get or call the radiologist. And they see how their study is interpreted by the radiologist regardless, so they have constant feed back.
If your liver were cirrhotic, the size would be abnormal and there would be densities on the ultrasound, from scarring.
some info
Detailed Answer:
Yes, radiology techs who do ultrasound have a good idea of what they are looking at. They are trained, if they see something unusual, to go get or call the radiologist. And they see how their study is interpreted by the radiologist regardless, so they have constant feed back.
If your liver were cirrhotic, the size would be abnormal and there would be densities on the ultrasound, from scarring.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi again. I read that fatty liver disease cant be reversed but can be prevented from turning into cirhossis. I know tou mentioned that it can usually be reversed with abstinence from alcohol. Is there a difference between fatty liver disease and just having a fatty liver? I would like to hope that i can get my liver functioning normally again. The radiology tech mentiomed the doctor will probably have me change my eating and drinking habits. Do you think with that and my not significantly high enzyme numbers i can get my numbers back down and have a normal functioning live again??
Thank you very much. r
Thank you very much. r
Brief Answer:
Alcoholic fatty liver can be reversed if early.
Detailed Answer:
I think this journal article might help. Please scroll down to "Alcoholic Fatty Liver"
(http://pmj.bmj.com/content/76/895/280.full)
Just a request if you are willing:
If you close this discussion and post your further question as a new question (providing you have subscription for unlimited questions) and write my name in the first line of the question, then I will get paid for response (and you will not be charged further). Thanks!
Alcoholic fatty liver can be reversed if early.
Detailed Answer:
I think this journal article might help. Please scroll down to "Alcoholic Fatty Liver"
(http://pmj.bmj.com/content/76/895/280.full)
Just a request if you are willing:
If you close this discussion and post your further question as a new question (providing you have subscription for unlimited questions) and write my name in the first line of the question, then I will get paid for response (and you will not be charged further). Thanks!
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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