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Diabetic. Diagnosed Hepatitis C. Blood test showed ALT 44. Ultrasound showed enlarged spleen. Does diabetes causes this?

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My husband is 47 years old and has diabetes that is not yet under control. Has had it since about 2005 documented. He has recently found out he has hep c. ALL his blood work is normal except ALT and it is 44. The doctor is wanting to do a biopsy because the ultrasound shows an enlarged liver and spleen. Doesn't diabetes cause this to happen also? He said that he more than likely has stage 3 or 4 cirrhosis. We don't understand how that can be since his blood work is all normal with the exception of the ALT. Do you suggest getting a biopsy? Please help. Do you think it is possible to have stage 3 or 4 cirrhosis with good blood work results? Thank you.
Posted Sun, 25 Aug 2013 in General Health
Answered by Dr. Robert Galamaga 1 hour later
Hello and thank you for sending your question.

It is very difficult to adequately assess the liver just from imaging alone. This is especially true in a case where hepatitis has been found.

Even in the setting of cirrhosis testing from the blood might appear normal.
This is because sometimes if the liver cells are damaged they may not release some of the enzymes which we measure the blood. One additional test which may be helpful is the INR. This helps us determine how well the liver is doing at synthesizing coagulation proteins which is part of its vital function.

Overall I think a liver biopsy is reasonable. This would represent a standard of care in the setting of newly diagnosed hepatitis. I really think you should strongly consider going forward with the biopsy. This will allow a pathologist to look at the liver under the microscope to determine if there is any active damage.

After this is done you can get together again with your doctor to discuss the next step in managing the hepatitis.

Thanks again for sending your question. Please let me know if you have any additional specific concerns.

Dr Galamaga
Above answer was peer-reviewed by
Follow-up: Diabetic. Diagnosed Hepatitis C. Blood test showed ALT 44. Ultrasound showed enlarged spleen. Does diabetes causes this? 13 hours later
His INR is 1.0, so my question is do you think he could have stage 3 or 4 cirrhosis since all his blood work is normal? We will go ahead and get the biopsy. That should tell us more. Thank you so much for answering our question. We are really concerned about the cirrhosis diagnosis. Could you please elaborate on that?
Answered by Dr. Robert Galamaga 19 hours later
Hello again.

I would have to say that it is doubtful that he has advanced cirrhosis. However the only true way to assess for this is with the liver biopsy.

I realize your hesitation in continuing with the recommended biopsy. However I think having the biopsy done will eventually give you peace of mind related to this whole matter. If the biopsy reveals that the liver appears in good shape it Will be very reassuring.

I would hesitate to try and review the problems associated with cirrhosis in this case until we have the biopsy results.
It is a very good sign that the INR is normal.

Thank you again for sending your question. If you have specific concerns that you would like to discuss I would be happy to review those with you as well.


Dr. Galamaga
Above answer was peer-reviewed by
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