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Dr. Andrew Rynne

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I am concerned about my liver. My alkaline phosphatase is

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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2040 Questions

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Posted on Mon, 31 Dec 2018 in Digestion and Bowels
Question: I am concerned about my liver. My alkaline phosphatase is elevated at 127. Normal is 37-113. I tested positive for autoimmune hepatitis (smooth muscle antibody SMA positive). I had an ultrasound that showed increased liver echogenicity. I had another ultrasound today to measure my liver stiffness. The results are not back yet. It hurts when the doctor presses on my liver area, and then it continues to hurt for some time after that.

I have a sudden increased fat around my middle, even though the rest of my body is slim, and I have been losing weight.

Can you tell me if these signs point to a serious liver problem? If so, what can I do about it?
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Follow up: Dr. Ramesh Kumar 0 minute later
I am concerned about my liver. My alkaline phosphatase is elevated at 127. Normal is 37-113. I tested positive for autoimmune hepatitis (smooth muscle antibody SMA positive). I had an ultrasound that showed increased liver echogenicity. I had another ultrasound today to measure my liver stiffness. The results are not back yet. It hurts when the doctor presses on my liver area, and then it continues to hurt for some time after that.

I have a sudden increased fat around my middle, even though the rest of my body is slim, and I have been losing weight.

Can you tell me if these signs point to a serious liver problem? If so, what can I do about it?
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Auto immune Hepatitis itself is serious problem.

Detailed Answer:
Hello and Welcome to 'Ask A Doctor' service.
I have reviewed your query and here is my advice
The observation of bright liver echo pattern on ultrasound is commonly considered a sign of hepatic steatosis. In easy words it could be suggestive of mild fat deposition in liver termed as fatty liver.Most likely you are having non alcoholic fatty liver(would assume that you are non alcoholic).As age of a person increases fat began's to accumulate in various parts of body like blood vessels(atherosclerosis) or liver(fatty liver),Its very natural and a part of process called aging.The amount of fatty acid in the liver depends on the balance between the processes of delivery and removal.As the age increases the number of transporter cells which carry fat from liver to peripheral parts(for utilization decreases);Causing increased deposition of these fatty acids in liver.
2)Hepatitis as the name suggest means inflammation of liver cells.As liver cells are inflamed they would be more stiffy and pressing them would cause pain.In easy language suppose your thumb is inflamed and you press it then it's natural to have pain.
Autoimmune Hepatitis itself is a serious issue and can lead to cirrhosis and liver failure if not. treated properly. Autoimmune hepatitis is a disease in which the body's own immune system attacks the liver and causes it to become inflamed.Response to steroid and immunosuppressive drugs are excellent.Once your investigations are over your doctor would start you on it.It can't be cured but can be fully controlled.Loss of weight and central obesity are due to improper liver function.
Once medications would be started you would start feeling much better.
Hope i was helpful.
Thanks!
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
Auto immune Hepatitis itself is serious problem.

Detailed Answer:
Hello and Welcome to 'Ask A Doctor' service.
I have reviewed your query and here is my advice
The observation of bright liver echo pattern on ultrasound is commonly considered a sign of hepatic steatosis. In easy words it could be suggestive of mild fat deposition in liver termed as fatty liver.Most likely you are having non alcoholic fatty liver(would assume that you are non alcoholic).As age of a person increases fat began's to accumulate in various parts of body like blood vessels(atherosclerosis) or liver(fatty liver),Its very natural and a part of process called aging.The amount of fatty acid in the liver depends on the balance between the processes of delivery and removal.As the age increases the number of transporter cells which carry fat from liver to peripheral parts(for utilization decreases);Causing increased deposition of these fatty acids in liver.
2)Hepatitis as the name suggest means inflammation of liver cells.As liver cells are inflamed they would be more stiffy and pressing them would cause pain.In easy language suppose your thumb is inflamed and you press it then it's natural to have pain.
Autoimmune Hepatitis itself is a serious issue and can lead to cirrhosis and liver failure if not. treated properly. Autoimmune hepatitis is a disease in which the body's own immune system attacks the liver and causes it to become inflamed.Response to steroid and immunosuppressive drugs are excellent.Once your investigations are over your doctor would start you on it.It can't be cured but can be fully controlled.Loss of weight and central obesity are due to improper liver function.
Once medications would be started you would start feeling much better.
Hope i was helpful.
Thanks!
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ramesh Kumar 39 minutes later
Thank you for your answer. I also have other autoimmune diseases (Lupus, Sjögren’s, CNS vasculitis) for which I have been prescribed Cytoxan IV for six months. Would this help my hepatitis? I am very scared to start it, for fear of the side effects. But I am scared not to for fear of continuing strokes/TIAs, which I have several times a month. Is there any natural way to treat all these autoimmune diseases? Another symptom that happens with strokes is acid reflux and sudden large bowel movements. I had a TIA today and had three feet of stool suddenly expell from me with strong, painful peristalsis. It seems somehow related, but I don’t know why. Do you know?
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Follow up: Dr. Ramesh Kumar 0 minute later
Thank you for your answer. I also have other autoimmune diseases (Lupus, Sjögren’s, CNS vasculitis) for which I have been prescribed Cytoxan IV for six months. Would this help my hepatitis? I am very scared to start it, for fear of the side effects. But I am scared not to for fear of continuing strokes/TIAs, which I have several times a month. Is there any natural way to treat all these autoimmune diseases? Another symptom that happens with strokes is acid reflux and sudden large bowel movements. I had a TIA today and had three feet of stool suddenly expell from me with strong, painful peristalsis. It seems somehow related, but I don’t know why. Do you know?
doctor
Answered by Dr. Ramesh Kumar 47 minutes later
Brief Answer:
Follow up.

Detailed Answer:
Hello again my dear patient,
Sorry to hear about that,
See during stroke/TIA blood supply to part of brain gets hampered.As soon as the blood supply is hampered the autonomous nerve which controls body functions like urination and defecation gets dysfunctional transiently hence stool comes out.
Same is with GERD may be the part of brain related to controlling your gut mobility gets hyperstimulated and hence acid is thrown back.
Frankly speaking no one can give 100% accurate answer however one can try to connect things to each other via theroretical knowledge.

Cytoxan as said in previous answer is an immunosuprresive drug and is treatment of choice.Though it has side effects too like any other medicine yet in your case we have to consider pros over cons.Yes it would help in auto immune Hepatitis also.

I am sorry but as I have studied modern medicine I have very less knowledge of naturalopathy.You may consult an Ayuvedic doctor for the same on this forum(But as per me I dont think natural medicines can help in auto immune problems;But why not give a try).
If we don't use this drug you may land up in liver failure in few years.However if you keep taking this drug(dose would be lowered slowly) you would be fine for years.May be you experience few side effects 10-20 years down the XXXXXXX Hope you got the answer pros are much better then cons and so you have to take it.Patient with kidney liver transplant etc take such drugs through out life with minimal side effect.So my dear patient don't over think too much start proper medications.
In case you ever feel any problem write to me am there to help you always.
May God bless you,
Thanks and get well soon.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
Follow up.

Detailed Answer:
Hello again my dear patient,
Sorry to hear about that,
See during stroke/TIA blood supply to part of brain gets hampered.As soon as the blood supply is hampered the autonomous nerve which controls body functions like urination and defecation gets dysfunctional transiently hence stool comes out.
Same is with GERD may be the part of brain related to controlling your gut mobility gets hyperstimulated and hence acid is thrown back.
Frankly speaking no one can give 100% accurate answer however one can try to connect things to each other via theroretical knowledge.

Cytoxan as said in previous answer is an immunosuprresive drug and is treatment of choice.Though it has side effects too like any other medicine yet in your case we have to consider pros over cons.Yes it would help in auto immune Hepatitis also.

I am sorry but as I have studied modern medicine I have very less knowledge of naturalopathy.You may consult an Ayuvedic doctor for the same on this forum(But as per me I dont think natural medicines can help in auto immune problems;But why not give a try).
If we don't use this drug you may land up in liver failure in few years.However if you keep taking this drug(dose would be lowered slowly) you would be fine for years.May be you experience few side effects 10-20 years down the XXXXXXX Hope you got the answer pros are much better then cons and so you have to take it.Patient with kidney liver transplant etc take such drugs through out life with minimal side effect.So my dear patient don't over think too much start proper medications.
In case you ever feel any problem write to me am there to help you always.
May God bless you,
Thanks and get well soon.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ramesh Kumar 35 minutes later
I don’t want liver failure so if my liver test comes back positive for damage I will definitely have to take the Cytoxan. If I just have fatty liver due to obesity, then wouldn’t achieving normal weight remove all my liver problems? I will keep up my healthy diet. I have lost 10 pounds in the last six weeks. I have 30 pounds to go. But I should take the Cytoxan for my other autoimmune problems, I guess. I’m just scared. I don’t know how it will make me feel. To prevent kidney damage from Cytoxan would saline irrigation of the bladder help? I am most scared of damaging my bladder.

Thank you for explaining why I always get an over-stimulated bowel and GERD when I have a stroke event. Frequently then I cannot urinate and have so much urine in my bladder it is extremely painful and I have to be catheterized. Is that related to autonomic dysfunction caused by stroke?

Thanks again. You are a wise doctor. Better than my own doctors.

Deborah
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Follow up: Dr. Ramesh Kumar 0 minute later
I don’t want liver failure so if my liver test comes back positive for damage I will definitely have to take the Cytoxan. If I just have fatty liver due to obesity, then wouldn’t achieving normal weight remove all my liver problems? I will keep up my healthy diet. I have lost 10 pounds in the last six weeks. I have 30 pounds to go. But I should take the Cytoxan for my other autoimmune problems, I guess. I’m just scared. I don’t know how it will make me feel. To prevent kidney damage from Cytoxan would saline irrigation of the bladder help? I am most scared of damaging my bladder.

Thank you for explaining why I always get an over-stimulated bowel and GERD when I have a stroke event. Frequently then I cannot urinate and have so much urine in my bladder it is extremely painful and I have to be catheterized. Is that related to autonomic dysfunction caused by stroke?

Thanks again. You are a wise doctor. Better than my own doctors.

Deborah
doctor
Answered by Dr. Ramesh Kumar 31 minutes later
Brief Answer:
Follow up.

Detailed Answer:
Hello again my dear patient,
Firstly don't panic,
Liver takes years to fail that too if not properly treated.
So firstly don't panic. My only motive is to provide you with lots of information. Cyclophosphamide has to be taken for auto immune hepatitis because this if not treated over years would lead to cirrhosis and then liver related problems.
Earlier you said that you are slim and just having centripetal obesity so I though you are not obese. Fatty liver is a different issue start taking natural supplement milk of thistle daily it would help to rejenuvate the liver along with it do cardio training 3 times a week and follow a low fat diet.
YES start taking cyclophosphamide for autoimmune hepatitis. See fatty liver and hepatitis both are different issues in which inflammatory condition like hepatitis is more severe and should be dealt properly.
Yes brain is the boss of your body and various parts of it control different functions. As explained earlier as blood supply is hampered these nerves loses their capacity to control organs transienty hence causing problem.
Take sylimarin a liver rejenuvator daily.
Take Liv 52 ayuvedic tablet along with it(order online).
They act as hepatoprotective.
Feel free to query any time.
Do rate the answer.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
Follow up.

Detailed Answer:
Hello again my dear patient,
Firstly don't panic,
Liver takes years to fail that too if not properly treated.
So firstly don't panic. My only motive is to provide you with lots of information. Cyclophosphamide has to be taken for auto immune hepatitis because this if not treated over years would lead to cirrhosis and then liver related problems.
Earlier you said that you are slim and just having centripetal obesity so I though you are not obese. Fatty liver is a different issue start taking natural supplement milk of thistle daily it would help to rejenuvate the liver along with it do cardio training 3 times a week and follow a low fat diet.
YES start taking cyclophosphamide for autoimmune hepatitis. See fatty liver and hepatitis both are different issues in which inflammatory condition like hepatitis is more severe and should be dealt properly.
Yes brain is the boss of your body and various parts of it control different functions. As explained earlier as blood supply is hampered these nerves loses their capacity to control organs transienty hence causing problem.
Take sylimarin a liver rejenuvator daily.
Take Liv 52 ayuvedic tablet along with it(order online).
They act as hepatoprotective.
Feel free to query any time.
Do rate the answer.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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