Hello Karen,
your liver enzymes are raised, no doubt about it. The normal values should be:
AST 0-31 Yours were 91 Now 31
ALT 0-20 Yours were 49 Now 28

Not drinking any alcohol will bring these enzymes back into line.
The rate you were drinking at is more than sufficient to land you into cirrhosis territory especially if you are predisposed.

The following are the stages of alcoholic liver disease. Note that it is symptomless and difficult to detect.

1. The commonest and mildest form of liver damage is a fatty liver. This can be identified by blood tests, and is reversible with abstinence from alcohol.

2. The next step cannot be identified by blood tests, but a liver biopsy will show inflammation in addition to the excess fat. This is called steatohepatitis. In severe cases, jaundice may develop. A diagnosis of acute alcoholic hepatitis can then be made (see below).

3. At the next stage, fibrosis (scar tissue) is present. Again, this cannot be detected by blood tests or routine scans.

4. Cirrhosis occurs when the fibrosis reaches the stage when the normally soft liver is divided into thousands of pea-sized pockets of liver tissue, wrapped in fibrosis. Once cirrhosis develops, the prognosis partly depends on whether or not you continue drinking. People with compensated cirrhosis meaning they have no symptoms and who then stop drinking, have an 80% chance of being alive after 10 years.

Once symptoms of cirrhosis start being noticed (they are mostly nasty!) the liver is said to be decompensated and becomes medically untreatable and most often fatal. Average life expectancy at this stage is 3 years. A liver transplant is the only accepted way of survival.

A good doctor will normally be able to feel scar tissue on a diseased liver and may look at it using U/S or CT scan.

A liver biopsy will confirm cirrhosis one way or another.

Irrespective of what you have, the fact your liver enzymes are raised means that you are poisoning your liver and you are running the risk of serious medical problems if you continue drinking.

As for being an alcoholic or not, I only know two definitions:

1. If you drink habitually
2. If you drink more than your doctor does :-)

If worried, you may want to get a liver biopsy done.

I hope this helps,

Craig

I'm sure you will get a lot more responses to your questions from the knowledgeable people who hang out here.

Are you overweight?
Did you get the full liver panel?
Are your platelets normal?
How about bilirubin and proteins (albumin specially) ?
I don't think cerevisiae/ igg antibodies indicate cirrhosis, but diseases like colitis and beet's.
Did your GI say anything at all about cirrhosis?

Karen, My experience was similar, about 5 mos ago following a routine physical I was worked up for and diagnosed with cirhosis. I am now waiting to see if it has progressed.
You are right and must stop the drinking altogether. After trying to stop for a long time the Cirrhosis word made it easier for me to stop. It is no longer "I shouln't drink" it is "I can't drink".
The ultrasound will help with the diagnosis and I have yet to get any tech to tell me ANYTHING after a diagnostic test. Also the whole idea is scary enough w/o trying to decipher squiggles made by drs much less trying to read the films yourself (tried both of those too).
The others that will be responding can give you a much better idea of test results, what they mean and what to expect. I can only tell you to sit tight, stay positive and wait for the results of what will probably be several tests. A good sense of humor can keep the mind from wandering to far ahead. I can tell you from 5 days of experience this is a great place to ask questions. Let us know. tbonz
P.S. NO ALCOHOL

I am not overweight...I am 119lbs, 5'7", and pretty muscular. The second blood test was a full liver panel and I will pick up a copy of it tomorrow before my colonoscopy. I don't know what a lot about what this all means but I do have a copy of my first Lab Result Report. My platelets were 198 (???), my bilirubin was .9, Protein, total, serum 7.5, Alkaline Phosphatase 63....and there is much more. The only items that were a little off was WBC (white blood cells??) 3.8 (low??), Neutrophils absolute(?)1.7 (low??)and MCV (??) 100 (high??)

I don't have any symptoms for colitis either, ie no diarrhea, I can eat everything. I am pretty much a vegetarian, and only eat a little chicken, no red meat or fish. My diet consists of fruit, vegetables, and dairy. I eat no junk food at all.

I've been honest with both of my doctors about how much I drank and neither one even discouraged my drinking, even when I made it clear I'd never drink again, the one dr. said a glass of wine a day is ok. WOW!! My primary dr. is more concerned about my triglycerides and prescribed niacin, which I was going to take until I read it is bad for the liver. I told her I wasn't going to take them, I'd rather be tested again in eight weeks after not drinking beer to see if that caused the triglycerides to improve. I don't think the gastro dr. thinks I have cirrhosis either...neither are concerned about my blood work. I seem to be the only one who is worried....petrified.

Tbonz, how were you diagnosed??

Would the full liver panel tell if I had a fatty liver??

Thank you everyone, for your responses.

I just received a call from my Gastro Dr. He received a faxed report of the ultrasound results. There is a small cyst on my liver, and I have a gallstone. After I got off of the phone I searched on the internet for information about gallstones and read that cirrhosis is one of the causes of pigment gallstones...the exact quote "The stones tend to develop in people who have liver cirrhosis, biliary tract infections or hereditary blood disorder---such as sickle cell anemia---in which the iover makes too much bilirubin." The other type of gallstone is cholesterol, caused by high triglycerides if I understood correctly. I will have to find out which kind I have...and can a gallstone cause the liver to be inflamed??

Also, from what I've been reading, it doesn't sound like an ultrasound can conclusively confirm one way or the other cirrhosis. Any thoughts on what I should do next? I am so confused.

I hesitate to comment on the bloodwork. Mine was all over the place but enough to suggest further testing. Ultrasound, CT scan, Endoscopy(which showed the varicies in the esophogous. That confirmed the cirrhosis but a biopsy was performed because in my case the risks were relatively low. The biopsy is the ultimate test (someone here refered to it as the gold standard) but a correct diagnosis can be made w/o it.
Sounds like your Dr's have not really brought it up and a cyst on the liver and gallstones are not necessarilly indicative of cirrhosis.
Sounds like you need to sit down with the doc and directly voice your thoughts and fears. especially if they are not concerned about the bloodwork. If that does not help,try and see another doc.
Did you actually speak to the Dr when called with the ultrasound results or was it a nurse?

I spoke to the Gastro DR. today...not a nurse regarding my ultrasound results, but I was not prepared for what he told me. I did not expect to hear I had a cyst on my liver or a Gallstone, so at the time I didn't know what else to ask.

I've also been very clear with both Drs. concerning my fear of cirrhosis (after reading what I have on the internet)and that's why an ultrasound was scheduled and why the full liver panel blood work was done.

I think what I'm going to have to request a liver biopsy...I think that is the only way to know for sure, the status of my liver. Does insurance have to honor this sort of request?

As for insurance, it depends on the type of insurance you have. Some insurance does not cover diagnostic tests unless accompanied by surgery.
However, since a biopsy must be performed in a hospital, it should be covered. I would check with your insurance in advance since it is a costly procedure.

The procedure is relatively painless and you will remain awake during the process. A CT scan is used to pinpoint the location of the needle insertion. The liver is quite vascular and there is some risk of bleeding. Since my platelets were low, I had to be given a transfusion prior to the biopsy to help prevent bleeding. Four or five tissue samples are taken and then sent to a pathologist for microscopic examination.

I would follow my doctors advice as to whether a biopsy is needed at this stage.

I second ALgernon, your blood results, other exams and symptoms should be enough to make your doctor decide if you need a biopsy or not.

I'll add my 2 cents here and say I agree with the advice you've gotten. Our GI wouldn't even consider a liver biopsy until other tests were done. Craigs right abut your liver numbers but they came down considerably. I would find a dr. you trusted, and read what you can, then listen to the advice the dr. gives you. You may not need a liver biopsy.

Annie,
What other tests would you recommend? I have a cyst on my liver and a gallstone, along with "sediment" in my gallbladder. My GI didn't see my ultrasound...he can't read them, he is just giving me the results that were faxed to him. Yes, I know my blood work is better, but wouldn't that be because I'm no longer drinking? What I really want to know is how much liver damage I have. Maybe I need to see a hepatologist.

If your GI has no extensive cirrhosis/ liver disease experience, you better see a hepatologist, who are usually GI's who specialize in the liver.

Hi, I am really not qualified to advise you what tests you should or shouldn't consider. Someone said a good dr. should be able to feel a liver problem by pressing the area of the admonen. I know our dr. did.
Have you had an MRI? Who are you seeing about the cyst? We started with our family dr. who sent us to an internest, then to a liver specialist. who told us to run, not walk to the transplant evaluation. I think it was the MRI showed the dieased liver and that is the test we carried with us to Georgetown.
Steve's bloodwork was all over the place too, but it was never close to normal. Has the dr. mentioned an endocoscopy?
Yes, it's true that not drinking will change your blood work but so many other factors are also involved. Sometimes an elevated number can be caused by tylenols or other medicenes.
Annie

I haven't had an MRI and I haven't seen anyone about the cyst...I just found out about it.

Hi Karen,

I wanted to tell you that I had several gallstones when I was in my early twenties and actually had to have surgery when I was about 25.

There are times when labs make mistakes in results and if there are results that look way off, then usually a Dr will or should run them again to be sure its acurate and not a lab error.

As far as palpating the abdomen and feeling the liver. Yes,they can do that and can sometimes tell if it feels firm when it should be fairly soft. That is why when we get a good checkup, usually they press around on your stomach.

Back to the gallstones. They can block the bile duct at the liver and cause issues and that is why they usually remove the gallbladder. If it is left alone, it can cause major pain and I mean pain! It was comparible to childbirth to me and it sneaks up on you during the night. I do not want to lead you to believe it hurts in the pelvic area such as childbirth but I was referring to the pain level it can cause!

I do agree with the others in that if your GI does not have much liver experience that I would be wanting a referral to a hepatologist so you can be completely educated and informed in order to keep yourself healthy.

Take care and stay in touch here. THere are many people that can help you a lot with your questions and to just be here for emotional support. Everyone has been so kind and helpful to me from day one.