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Elevated liver enzymes, no cirrhosis. Fatty omfiltration, normal sonogram of liver. Opinion?

my sons liver enzymes have been elevated since 2010- otherwise he is healthy -has a few beers once in awhile- ast 95 range 0-40 alt 195 range 0-55 no symptoms mri with dye impression steatosis no evidence of cirrhosis or hcc done 1-8-12 in 2010 sonogram liver is normal in size with hyperechoic texture, favoring moderate degree of fatty omfiltaration--no fecal hepatic lesions doctor wanted to do a liver biopsy- what is your opinion
Asked On : Fri, 29 Jun 2012
Answers:  2 Views:  139
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Internal Medicine Specialist 's  Response
I don't think a liver biopsy is necessary yet. The first step is have the patient abstain from alcohol, lose weight (to achieve a BMI <30). The cholesterol and triglycerides need to be controlled as well. If this doesn't help then he will need further blood work up to check for other causes of liver disease (hepatitis b & c, iron overload, autoimmune diseases, etc). After all this is done, then do the liver biopsy if there is still question.
Answered: Sun, 22 Jul 2012
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Endocrinologist Dr. Om Lakhani's  Response
Well he is developing something which is known as NASH.. non alcoholic steatohepatitis. Is he overweight ? As long as he is asymptomatic there is nothing to worry about now.. there are a couple of precautions to take though :

1. Stop alcohol- complete abstinence would help
2. Take hepatitis B vaccine if he is not vaccinated already
3. antioxidants and vitamin E have been shown in some studies to curtain inflammation - you can start on that
4. Weight loss (if he is overweight) would help

Is the liver biopsy required- no. There are non invasive alternatives like fibroscan and MR elastography which can determine liver stiffness with good accuracy.. You should go for that... only if they are inconclusive a biopsy may be done...
Answered: Sun, 22 Jul 2012
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