Fatty inflamed liver- but only AST is high?

Digestive health
1

Hi. So I'm 35 and had some abdominal gassy pain that wouldn't go away for a few days- got a liver panel blood test and my results were all normal except for my AST being a little high- normal range is 10 to 40 and mine was 57. Then I had an ultrasound the next day because doc thought my pain/discomfort sounded gallbladder related- well everything looked fine except he said my liver is a little inflamed and he said I have fatty liver. He thought the symptoms I came in for though were GERD and prescribed me PPIs. The doctor didn't seem too worried about it- I asked if I should cut back on drinking and he shrugged and said "you could" then referred me to a GI specialist re: the GERD and liver thing.

I drink wine every day and have for years... I last had this blood test a year ago and everything was in range. Not anymore, I guess. I'm wondering if I already have caused permanent damage. Wouldn't my other numbers be high too? I've been more tired than normal and have a very dry mouth for like 5 months... could that be caused by liver problems? I get diarrhea when I drink too much or on an empty stomach, but I thought that's normal cuz I'm irritating my stomach when I do that (and I have IBS). My GI appt is in 2 weeks, but in the meantime, I'm freaking out. Is there anyway this could already be cirrhosis with my numbers??? The diagnosis he put in my chart from the last visit says "Hepatic Steatosis". I google it and it says "fatty liver". It sounds worse than that! I'm just totally freaking out. I need some feedback please.

Alkaline Phosphatase 46 U/L 

40 - 150 U/L

Bilirubin, Total 0.6 mg/dl

0.2 - 1.2 mg/dl

Bilirubin, Direct 0.3 mg/dl

0.0 - 0.5 mg/dl

ALT (SGPT) 35 U/L

0 - 55 U/L

AST (SGOT) 57 U/L

10 - 40 U/L

Protein, Total 6.8 g/dl

6.4 - 8.3 g/dl

Albumin 3.4 g/dl

3.5 - 5.0 g/dl

A/G Ratio, calc. 1.0 

>1.0

I've been cutting back on my drinking since I found this out- hoping by next week I will be tapered off to no wine at all.

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'Steatosis (fatty liver) is an accumulation of fat in the liver. When this progresses to become associated with inflammation, it is known as steatohepatitis.*'

* Another name for this is NASH.

https://patient.info/doctor/steatohepatitis-and-steatosis-fatty-liver

It is at the stage now where it should be taken seriously. The GORD may be caused by daily drinking, which can start off as gastritis and move on to GORD. Alcohol inflames the lining of the stomach, hence the PPI to restrict the build up of acid.

It would be useful to know how much you drink each day, plus what your weight is and what it should be and your dietary lifestyle. The liver produces and stores the energy for the body, so a poorly liver can leave you fatigued and lacking in energy.

It is good that you are seeing a gastro, because your GP seems to have a very laissez faire attitude. Your GORD may mean the need for a gastroscopy. I would discuss in detail with the gastro the situation regarding your liver. Do not sit through this process as a passenger, you have to take control. Ask what the situation is, what needs to be done etc. Prepare your questions beforehand and write them down, because you will not remember them on the day and also get distracted by other events.

3

Thanks for the reply and the advice. 

I'm 5 foot 7 and weigh 165 lbs. I used to be around 145 for a long time but as my drinking increased, so did my weight. I had been drinking about 2 bottles of wine a day in the past year. 

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'I last had this blood test a year ago and everything was in range. Not anymore, I guess'

'I had been drinking about 2 bottles of wine a day in the past year.'

Can you see a link there? Now, before I carry on, I'm not medically qualified, but I have been in hospital for liver failure caused by alcohol and had a bleed on the brain also caused by alcohol, with a long stay in hospital. So, I am not judgemental, but I have a fair amount of experience of being a patient and what goes on.

Two bottles of wine a night is a lot, even more so for a women. Your liver is suffering and it is the alcohol that is causing the problem. Whilst you might have a little bit of weight, it is probably not enough to cause non alcoholic fatty liver, yours is most likely down to alcohol. If you told your GP honestly how much you were drinking, I am horrified that he didn't vigorously tell you to cut down.

You need to cut the alcohol right down, to give your liver a rest. I don't think you are at the stage of anything irreversible, you just need to give your liver a rest. As a side issue, because of the amount that you have been drinking.

As a side issue - I think that you will find it hard to stop. Alcohol changes the brain over a period of time and changes the balance. We cannot feel relaxed, enjoy ourself and get to sleep without it. We suffer anxiety, suffer insomnia and only start to relax and feel comfortable once the wine/beer releases the endorphins and dopamine which make us feel so much better. If that happens, there is medication that can help change this process and make it easier for you.

My advice is, to please be honest with the gastro on your drinking, it will help him to help you. One test that is missing from your results, that we always have in the UK is GGT, but does seem to not get done in the US (which from your answers, I assume you are). It is one of the best tests for seeing if alcohol is the problem.

5

I lied to the GP by omission- he asked if I drink a lot and I said, "I've been known to drink a lot.... just when I'm stressed out." The fact is that I am ALWAYS stressed out and drinking has been my band-aid. I have some serious existential dread issues and am terrified of dying- so it's pretty stupid I've been slowly killing myself, trying to numb myself from my anxieties. And here I am, anxious as ever because I'm afraid I'm dying because of being an idiot. I deserve this. I've been requesting full blood panel about every 3 years since I started drinking daily- and if all checks out, I would just keep on going. But this past year I've been even more anxious and depressed and doubled up. 

I'm already noticing my anxiety building by cutting down my drinking- I have been using Benadryl to fall asleep. My stomach has been irritated for past month in one way or another and I'm afraid of this new liver diagnosis so I AM quitting. I am already down to 1/2 a bottle and by Monday I should be totally on dry land It is a lot more difficult than I imagined it would be. I'm definitely going to see a psychiatrist in the next week or so re: my anxiety disorder. I used to be on meds for it but didn't like how they numbed my emotions. So what? I would have been better off staying on them. I've always been a self-medicator. But I want to live, so... no more.

Thank you so much for the blunt response and advice. Yes, I am in the US... and my diet is pretty normal. I don't eat a lot of fast food or bad stuff. I know I've gained the weight from the empty calories in the all the wine. I've already lost a few lbs in the past week just by cutting back. 

Any more thoughts or feedback, send them my way! I will update this thread after I see GI doc too. 

6

Oh, and yes- I intend to be completely honest with the GI doctor re: my alcohol usage. I am pretty scared right now and I want to do whatever I can do to make this better.