Question: Hello Doctor,
I started to experience mild strenuous pain near my naval area from 19th July, 2015 onwards. The strenuous pain was typical like when we do lot of abs exercise. Although the pain was mild, but certainly I was able to distinguish it from typical indigestion related pain. Here I should mention that in the previous week (i.e. between 12th to 18th), I had taken oily and spicy food as part of few family celebrations.

As I felt the pain in the naval area (and sometimes in lower right abdomen area below the waist line) was different than typical gas related pain, as an immediate precautionary measure, I switched to bland diet from 20th Night. I also proactively ordered for blood test under a wellness program (Attached image file Thyrocare_Wellness_At_a_glance provides the description of the blood work). Attached PDF files named Thyrocare_wellness_report_XXXX (part1 and part2) contain the report from that blood work. The report indicated –
•     High SGPT 197 and High SGOT 104 (Refer Page10 of part1)
•     High Uric Acid 7.3 (Refer Page7 of part1)
•     High Ferritin 439.7 (Refer Page6 of part1)
•     Vitamin-D deficiency (Refer Page14 of part1)
•     High bad cholesterol (Refer lipid profile test in Page9 of part1) and additionally high APO B/A1 ratio and C-Reactive Protein (refer page3-4 of part1) as cardiac risk marker

After seeing the high SGPT and SGOT value, I visited internal medicine department of a nearby hospital on 25th. To corroborate, doctor ordered Liver Function Test once again from hospital’s internal lab, report came as SGPT 184 (reference Upto 41) and SGOT 75 (reference Upto 40). Doctor also ordered USG – nothing specific came out in that report except for “hepatomegaly with fatty changes” (Attached image USG_Abdomen_Pelvic_XXXX).

Previously also, in year of 2011 (the last time when USG was done as part of health checkup program), I was detected with fatty lever – although that time SGPT and SGOT value was normal with borderline high bad cholesterol. I am non-drinker and non-smoker. I had jaundice at age of 14.

I am still on bland diet. Consulting doctor hasn’t yet prescribed any medicine – neither for fatty lever nor for uric acid. However, I am yet to undergo hepatitis panel test (A, B, C and E) as suggested by her.
Doctor, can you please evaluate my condition and let me know what should be my future action? Is there any serious condition underneath?

Hello Doctor,

Thanks for your reply and evaluating my condition. As followup, following are my questions -

[1] The hepatitis panel test report is now available – refer Thyrocare_hepatitis_panel_part1 and part2. If you can spare some time, can you please have a look and let me know whether there is any concern.

[2] By comparing between previously undergone wellness test and recently undertaken hepatitis panel test, following differences are observed –
Wellness-panel Hepatitis-panel
============== ============
Date: 22nd July,2015 1st August,2015
SGOT: 104.9 62.6
SGPT: 197.9 144.9
GGT: 35.4 25.3
Lymphocyte%: 31.4 41

(i)     As lymphocyte% increased in last 10 days, do you think there is some viral infection in my body which has caused increased SGOT/SGPT enzyme at the first place?
(ii)     Or, do you still think it is the fatty lever which is the major contributor of high SGOT/SGPT value?

[3] As SGOT/SGPT is showing decreasing trend, should I rely only on bland diet to bring the levels normal (or close to normal)? Or should I need to start on some lever medications along with diet control?

[4] It seems Udiliv 150mg is prescribed for fatty lever. Do you recommend this drug?

[5] What should be my followup test procedure considering my present condition?