Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group liver disease revisited

starting in the winter / spring of 2011, my liver enzymes started going up a bit, in particular ALT, and AST a little.

i have to have an ultrasound done every year to make sure a gallbladder polyp stays small; for the last 5 years it has.

now the liver is showing up in the ultrasound as well: fat infiltration, yadda yadda yadda...........

my new rheumy was the first to notice the liver enzymes going up......bless his heart!

and my gastroenterologist isn't making the assumptions that the GP, naturpath, and endocrinologist have been making. instead he is ordering all the proper blood work to rule out as many causes of liver disease as possible.

i bought this book written by cleveland clinic on liver disease.

can not emphasize enough how glad i am to have my gastroenterologist. so lucky to be in such good hands.

he assumes nothing that can be tested, measured, ruled in or out.

he's the one that did the colonoscopy up into my illeum and found the inflammation and small ulcers to help with my spondyloarthropathy dx.

yes, i'm rather concerned about my liver; who wouldn't be. but at least i'm in good hands.

rather than writing the assumptions here as to what is causing the problem, will just wait for the blood test results. then we can tackle the problem head on.

One thing that isn't often considered but really should be is secondary amyloidosis - especially if liver and/or kidneys are a problem. (Secondary goes for those organs). Liver biopsy isn't a great idea if thats suspected either - too much risk of bleeding in secondary A. Best to get an abdominal fat biopsy. I get really suspicious of reports of generalised fatty infiltration on ultrasounds of livers - that might be the most common thing, but you can't diagnose by ultrasound - all it does is show echogenicity (relative density)

thanks cemc. i'll ask you more questions when it gets to a point of needing to make more decisions.

for now, it looks like my GI doc is asking for a very thorough panel of blood work. i didn't realize how many things can affect the liver til i read up on all those tests. many of those things are rare, but good to rule them out when its a simple blood test especially.

the things that run in my (mother's side of the) family: inflammatory arthritis, metabolic syndrome --> diabetes / heart disease, and liver disease. thus i bet its all connected. being on all the various drugs i'm on probably isn't helping any, since my aunt, who was dx'ed with cirrhosis of the liver at the age of 50, told me to just make sure i stay away from drugs that can affect the liver. oh well, too late for that, but hoping i don't have to give up my drugs.

as for the liver biopsy: the GI doc did talk to me about that possibility. but i'll worry about it when and if the time comes.

as for ultrasound: that's interesting. i'll have to go read up on it, see what it says. though this was the first time that any mention of the liver not being normal was reported. then again, we never asked the radioloigists to comment on it.

thanks for all your knowledge, greatly appreciated. i'm just learning. never something i thought i'd have to learn about before i ever reached 50.

treating fatty liver disease with vitamin E (and C):

my GI doc mentioned this, but said to hold off (till testing was complete).
in other words, don't go adding in too many variables.
but if this were to work? i'm already doing EsterC, so adding in E could make sense.
but like with anything, also things to be cautious of (blood thinning, stroke); still, it looks promising.


http://www.ncbi.nlm.nih.gov/pubmed/16245220

http://www.cbsnews.com/stories/2010/04/29/health/main6443900.shtml

http://www.eurekalert.org/pub_releases/2010-04/nyph-vee043010.php

http://www.liversupport.com/wordpress/2010/05/is-vitamin-e-wise-for-liver-health/

http://www.nutritionj.com/content/2/1/9

I've been interested in whats going on in my liver, in spite of mostly normal blood tests (cholesterol tending a bit high, but up and down). 6 years ago had an upper abdo ultrasound and they spotted what they said was a haemangioma. No treatment, no follow up. Then end of last year had another US and I think the same thing, same place was described as a fatty nodule - max length nearly 3 cm. Had a three month follow up and it was pretty much the same, so not cancer, and fatty nodule confirmed. Then 6 months later they did what was going to be the final check on it and it had virtually disappeared - or that was what was reported. However what the radiologist was saying was that it had merged into the background and now the whole liver was showing a fatty appearance. So the report really doesn't reflect the change - its not that the nodule has gone, its that the whole liver now looks like that. Given that my liver tests are still fine (or were a couple of months ago) I can't see that "fatty liver" is actually a good diagnosis, but here its been written off as "normal". I'm just so hoping the rheumy will pursue the secondary amyloidosis testing a bit further as I also have stage 3 chronic kidney disease.

Hope you get yours sorted though. Livers are important things

i bought and read this book:

http://www.amazon.com/Cleveland-Clinic-G...9971&sr=1-1

good practical info.

was reading how one can have a fatty liver but not inflamed, not diseased. its all a continuum. i still have a lot to learn though and this book is helping me.

you might find it (or something similar) useful.

as you stated, "the liver is kind of important." i like mine and would like to hold on to it. i'm rather possessive in regards to my organs.

Hi Sue, I was just reading your post. And think I have something in common.

I went to doc about 2 weeks ago and said that I have been having pain under ribs. She examined me and when she pushed under my right rib I nearly screamed it had never hurt so bad.
Was sent off for ultra sound and when she was checking kidney are was extremely painful and also under right rib. Strangly she never checked under left rib.
Results were Porta, normal. Spleen , normal. Pancreas , normal Kidneys , both kidneys are normal in size and echotexture. Aorta & IVC, normal.
Gall bladder not seen as Post operative

CBD, Mildly prominent and measures 11mm however the lumen is echo free.
Liver, Normal in size and shows moderate increase in echogenicity suggestive of fatty liver.

I am still having pain under ribs. When i sneeze I feel like I am going to explode.

I had such a miserable night last night between the back pain and the tight/ uncomfortable feeling in my chest. I actually had a dream that someone came and took me to hospital.

Cheers Carol

sorry you've been in such pain.

do you think the pain "under the ribs" could be costo? i know sometimes the intercostal muscles / tendons / ligaments get so tender.

but sounds like you think the pain is coming from an organ?

as for fatty liver. how are your liver enzymes? mine are now elevated. so i have two pieces of data showing problems: enzymes and ultrasound.

i think we all have different style preferences. i tend to err on the side of caution and thus am appreciative of a doctor that rather than assume, is having me go through the whole panel of blood tests to evaluate the liver more thoroughly, and is even talking biopsy if it comes to that.

plus i have a family history of a grandmother dying from cirrhosis of the liver and an aunt dx'ed at the age of 50 with cirrhosis (neither from alcohol) - i just don't want to end up there myself.

first "simple" course of action is weight loss. i'm trying. i did lose about 8 lbs over the summer, but a few pounds have already come back on. i eat very healthy, but do need enough food to prevent migraines and gastritis. and i exercise, but not as much as i would if i didn't have this spondy. you know how it goes i'm sure. but weight loss really is step one.

Thanks Sue for reply. With blood tests doc has put it down to "fatty liver" and, yes I do need to loose weight. Which is something so hard when you are exhausted from the simplist of things like taking a shower. I washed my dog yesterday and then slept for 3 hours afterwards.

What is the old saying...... Life was never meant to be easy. Take care
Carol

Hi Sue. I too have had a bout of liver issues lately that haven't been resolved. I've had high liver enzymes since my regular GP starting checking out the bad back pain I started to have(before we found the AS) One of my numbers was in the hundreds. He never acted too concerned. I don't drink and had a newly aquired 50 lbs or so wrapped around my stomach to neck. Still don't know why that happened? Once I was referred off to the rheumy dr, he was far more concerned and sent me to the Gastro clinic. I saw the experienced NP that diagnosed a fatty liver. She did no imaging, just went off my story off weight gain/elevated enzymes.
Then this year comes. I drop 25 pounds in 2=3 months. Lots of stomach pain. GP does a colonoscopy/endoscopy, ct scan, ultrasound etc. Finds an enlarged liver, and another blood marker (smooth muscle?) that concerns him. Just got done with a biopsy on 11/10. No results yet.
I hope something comes up soon. So I too can tackle it and get my health and happiness back. I wish you well in tackling your liver issues. I did not mean to hi jack your post. Just maybe my story can help yourself or others. Thanks, Jason.