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Have IBS And Pain In Back. Blood Test Normal. Found Fatty Liver. Is The Pain Related To Fatty Liver?

Posted on Wed, 3 Apr 2013

Question: Hello Doctor,

I have a cramp type pain in my right side and lately it has led to bad back aches especially by the evening. I have had blood tests which were normal and a non contrast CT scan which showed all normal except a fatty liver.
COuld a fatty liver be causing this pain??
Bowel movements seem OK although I have IBS and when nervous go more. No blood in stools.

XXXXXXX

Answered by Dr. Ketan Vagholkar (10 hours later)

Hi,
Thanks for writing in.
Since CT scan has been done, you need not worry. However a double contrast CT of the abdomen would have been preferable.
Yes fatty liver can give rise to such symptoms.It is a XXXXXXX condition if left untreated as it can proceed to cirrhosis. But the best thing in your case is that if liver enzymes are normal then treatment can help reverse the changes in the liver.
I would suggest the following
1. A course of medications comprising of sorbitol, tricholine citrate and ornthine compounds to regularise the liver metabolism.
2. Dietary modifications that is you should switch over to a high protein ,low carb,least fat diet.
3. Regular aerobic exercising in the form of a brisk walk for 30 to 40 minutes at least 4 times a week.
4. Avoid alcoholic beverages at all costs.
5. Plenty of dietaryfiber.
You need to follow this protocol for 6 months after which you can repeat a ultrasound of the abdomen.
I hope this answers your querry.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ketan Vagholkar (5 hours later)

So to be clear: 1/ a fatty liver can cause right side pain and backaches????

2/ I am allergic to iodine so a double contrast CT scan wasn't possible. Is there any other way of getting a contrast scan without using iodine???

3/ Is there something in the liver causing pain that could not be seen??? Is there any other way to diagnose something worse??? Any other way to see inside???

4/ Thanks for the medicines. Are these prescribed by my doctor or can I buy them??

5/ High protein diet does that mean chicken and fish BUT NOT red meat. Difficult to know what to eat if I cannot eat fatty things and carbs.....???

Thanks

Thank you.

Answered by Dr. Ketan Vagholkar (1 hour later)

Hi,
Thanks for the feedback.
1. Fatty liver can cause upper abdominal symptoms. Other cause could be pancreatitis. But since the plain Ct does not show any stone or calcification the chances are much less.
2. Contrast enhanced CT is the diagnostic test. Ultrasound or palin CT may not reveal all details.
3. Unfortunately other investigations are not so sensitive in diagnosing liver diseases.Ultrasound may help only in cases of space occupying lesions of the liver.
4. Yes you can get them over the counter.
5. High proteim means fish, chicken and even red meat. But in cases of fatty liver red meat be better avoided.You can get your diet charted out by a medical dietician.
I hope this answers all your doubts.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ketan Vagholkar (6 hours later)

Thank you Doctor.

So if I can't take iodine based contrast scan, is there nothing else. I have had the pain since XXXXXXX and would like to know.

Can you confirm it can spread to the back???

I have read about a liver biopsy. What are the risks and benefits??

XXXXXXX

Answered by Dr. Ketan Vagholkar (16 hours later)

Hi,
Thanks for the reply.
Since the non contrast Ct is grossly normal and does not show any specific lesion you need not worry.
Yes pain originating from the liver can extend across to the back especially in the upper abdomen.
In your case there is no need for a liver biopsy at all.
I hope this answers your doubt.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ketan Vagholkar (11 hours later)

Thank you for this Doctor.

Assuming that my colonscopy tomorrow is OK, that still leaves my side pain.

Am I right in assuming then there are two courses open to me:

1/ Non test route: eat well, take supplements and do as you say and hope that the pain will go away. (It has been 2 months so far).

2/ Get a test to see how allergic to iodine I am. ( I believe this can carry risk in itself).Then get a contrast scan test to see if there is anything wrong with the liver.

If I go the second route and there is something wrong, what can be done???

Lastly, even thought there soesn't seem to be any enlargement on the scan and the fatty liver is a bit better than last Nov when I had an ultrsound - I didn't have the pain then. Can the tests like blood and scan all seem Ok and I could still have a cancer??

Thanks this is my last question

Answered by Dr. Ketan Vagholkar (10 hours later)

Hi,
Thanks for writing in.
!. From the reports already available it would be advisable if you adopt the first route.
2. The chances of there being amalignancy is very less as a malignancy involving the liver would have been picked up on a plain scan as well.
3. You can take the treatment for at least 10 to 12 weeks before you can expect some resolution of symptoms.
i hope this answers your querry.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ketan Vagholkar (2 hours later)

Thank you again Doctor.

That is good news.

So I know the full facts, what would happen if after say another 2 months I am still having daily pain and backaches? Does this mean the liver would never improve???

What would I do then???

XXXXXXX

Answered by Dr. Ketan Vagholkar (1 hour later)

Hi,
If it is fatty liver and you take the advised treatment meticulously for a period of 6 months then I am sure you should not have any pain. A repeat ultrasound of the abdomen accompanied by estimation of liver enzymes should help in confirming normalcy.
I hope this alleviates your anxiety.
Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar