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Author Topic: Info About Fatty Liver  (Read 2043 times)

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Offline tednlou2

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  • Posts: 5,731
Info About Fatty Liver
« on: September 20, 2012, 09:48:05 PM »
I always think this is a good place to ask questions, because so many here know so much about so much.  And, I would have sworn I've already posted a thread in the past about fatty liver.  However, when I did a search with my name, I could only find where I made a passing mention in other threads.  Perhaps I dreamt it. 

What do you guys know about fatty liver?  I've read millions of Americans probably have this, due to being overweight.  But, I've also read and have been told by my gastro doc that HIV causes metabolic changes and can cause this.  I also know PI's have been known to cause this.  But, I'm not on HIV meds.  But, I am in what I believe is my 11th year of infection.  I've never had any of the Heps.  Alcohol is not an issue with me. 

Ok, I'll give a little background.  I've had dull pains around my right ribs for years.  Over the last two years, I've had 2 liver ultrasounds.  They showed some mild fatty liver with some sludge in my gallbladder.  My cholesterol is below 200, but triglycerides have been up around 250.  Gastro doc felt HIV could be a cause, genetics, and my weight gain.  He wanted me to lose 10% of my weight.  I thought he was going to jump my case over Tylenol use.  I've used Tylenol in different forms for several years, since my back surgery.  But, within the daily recommendations.  He said Tylenol is not an offending drug for fatty liver.  He and another doc said they actually would prefer patients to use Tylenol, instead of drugs like Ibuprophen, Aleve, etc.  That surprised me.  He was concerned with my liver labs from my HIV doc.  He said they are often at the upper end of normal.  He said back in the 90's, the high end of normal would have been 30, but now many labs use 70.  He said fatty liver could be causing the higher readings.  Interestingly, my HIV doc switched to Lab Corp.  Since then, my liver labs have been at the low end of normal and around 30. 

Since seeing the gastro doc in May, I've lost about 20 pounds.  My clothes were beginning to fall off, and I thought I was now doing something proactive.  But, I actually began to have worse pains.  For a few weeks, I had awful shooting pains that went from my right ribs through to my back and spread into my shoulder blades.  I was also feeling a little dizzy and nauseous.  I had read that losing weight quickly could flare up fatty liver.  I called the gastro doc for another appt.  He was out on paternity leave, so I had to see this intern doc.  She felt my liver and spleen, and said both felt enlarged.  I never had a doc tell me that.  She ordered more blood work and another ultrasound.  She mentioned the weight as well as HIV.  She also said Tylenol is not an offending drug for fatty liver.  However, she said since I have liver disease, I should not take more than 2,000mg per day.  That kind of shocked me.  I hadn't considered myself to have liver disease.  She said fatty liver is liver disease.  She said she would personally call me with the results.  After not hearing from her, I made a few calls.  She never got back with me. 

Today, some assistant, who seemed like she was 18, called me.  She was trying to read the doc's notes, but was having difficulty with the slopping writing.  She said, "It looks like the ultrasound showed your liver is fairly enlarged and your liver is very fatty.?."  I told her it seemed like she wasn't sure what she was reading.  She said the handwriting was bad, but that she was sure she made it out correctly.  I asked about the bloodwork, but she said she didn't have that.  I wanted to speak to the doc.  She said she wouldn't be back in until Monday.  The previous ultrasounds showed just mild fatty liver and no mention of liver enlargement.  I explained with what she was telling me, I would want to talk to the doc about this--to clarify if the assistant was reading this right, but also because this would be a big change since the last ultrasound was done about 6 months prior.  And, to just know what this means medically.  Again, I've read and been told this is something millions have and usually has no consequences.  But, I've also read this can become serious by causing cirrhosis and sometimes liver failure.  And, HIV is always there and how that plays into things. 

I was upset that she didn't call me personally, and I'm getting info that I'm not sure is even correct.  The assistant said if this was bad news, the doc would call.  She said assistants don't call with bad news.  However, she did say I would be getting a call to schedule this other scan that is different from an ultrasound. 

Well, I ended up making this a long post, despite not intending to do so.  Sorry about that.  I'm just curious whether this is probably no big deal and something that is reversible with more weight loss.  Being honest, I have gotten chunky over the last few years, especially since my HIV dx.  I withdrew from many physical activities, I quit smoking, and I did some comfort eating.  But, I have lost 20 pounds thus far, and plan to lose another 25 to be at my goal weight.  On most BMI calculators, it says at 6 ft tall, I should be about 175 pounds.  Do you think this is a weight issue, probably exacerbated with HIV?  This concerns me that I'm already having issues and not on meds yet.  Or, would ARV's probably help with this?  Until I can speak with the doc, I'm left wondering what this means, if anything.  Is fatty liver something that usually causes more problems in people with HIV?  I was reading fatty liver, especially non-alcoholic fatty liver, wasn't even diagnosed and discussed until around 2000.   

Thanks for letting me be a drama queen.  But, hearing your liver is pretty enlarged and pretty fatty is a tad worrisome, and not being able to discuss it with a doc.  On a funny note, the assistant who called me reminded me of the student nurse on Will & Grace.  She played Jan Brady in the Brady Bunch movies. 


Offline buginme2

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Re: Info About Fatty Liver
« Reply #1 on: September 24, 2012, 03:09:35 PM »
Hey Ted I have been meaning to post to this thread, sorry for the delay.

I too have dealt with this.  Infact, this is how I found out I was HIV positive.   Shortly after contractin HIV (unbenounced to me) I was having some of the same things you experienced.  Blood tests showed liver enzymes off.  Followed up with an ultrasound which showed fatty liver.  I went to a liver specialist for more blood tests and found out I was HIV positive. 

Since then I have seen liver specialist and she tells me HIV can affect the liver (in addition too Hep A/B/C and its something that should be monitered.)  My liver doc tells me the only way to tell if your fatty liver is progressing is to have a liver biopsy.

You can take 400iu of vitamin e twice a day, other than that there is not any medication currently although there are some clinical trials ongoing. 

She also recommends lots of exercise and low fat/calorie diet.

My understanding is that they are aware there is a link between hiv and liver disease I dont think they fully understand it. 
Don't be fancy, just get dancey

Offline tednlou2

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  • Posts: 5,731
Re: Info About Fatty Liver
« Reply #2 on: September 25, 2012, 12:35:06 AM »
Bug, thanks for the reply and for sharing your experience.  Have you had follow-up ultrasounds/labs to see how much progression there is?  I reviewed the current and past labs.  My CBC was great.  My AST and ALT were both around 30--although I understand many would have readings in the teens.  My cholesterol was at 150.  My triglycerides were down from a high of 266 to 205.  I had, indeed, lost 20 pounds since my last visit.  However, the ultrasound report seemed vastly different to me.  Again, without the benefit of being able to discuss all this with the doc, I'm left to interpret this myself.  I was told I would definitely get a call today from the doc, but no call came.  I guess I'll be looking for another doc. 

The ultrasound report from January stated my liver was 16.1cm at greatest dimension.  The report from this month stated my liver was 20cm at greatest dimension.  To me, a 4cm change seems like a lot in 8 months.  I know 4cm isn't much on a ruler, but not sure what this means with the liver.  I'm not even sure the doc compared the new report with the previous.  The January summary stated, "Mild hepatic steatosis with gallbladder sludge."  The Sept summary stated, "Hepatomegaly (enlarged liver) with diffuse hepatic steatosis, with gallbladder sludge."   

I've been doing some googling.  I know, not always the best choice.  Most articles say non-alcoholic fatty liver is often due to being overweight, and this is often very reversible.  It is mainly triglyceride fat.  However, most articles say when the liver becomes too fatty and replaces healthy liver cells, this can lead to cirrhosis, liver cancer, and possibly liver failure.  I've read many things about how metabolic changes with HIV can cause this.  However, many HIV-related articles discuss certain ARV's as factors, which I haven't started yet.  And, there were articles suggesting new research believes bacteria in the gut of those with HIV could cause this.  Oh, and not eating balanced meals--going too long between meals.  I am guilty of that.  I would often eat some yogurt for breakfast, and then save my calories for dinner and eating too big a dinner, which would leave me going hungry several hours a day.     

From what I gather, I need to have a HIDA scan, where they inject a tracer into a vein to see how long it takes to pass through the gallbladder and into the intestine.  Some articles suggest a bad/sluggish gallbladder could leave the liver with too much fat.  Researching shooting pains to the back and shoulder blade often discusses gallbladder problems.  Then, as you mentioned, a liver biopsy is the only way to tell whether the liver enlargement is really due to fatty liver, and just how bad it is. 

The assistant said losing 20 pounds in four months could be a factor in this.  She said the liver has to process that fat out.  20 pounds in four months doesn't seem like the rapid weight loss I've read about that can flare up fatty liver.  I have no idea how fluid this issue is--whether your liver can become more fatty (for various reasons) and then work itself out to where another scan may show mild fatty liver again. 


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