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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes intermittent inflammation in the liver?

Answered by
Dr.
Dr. Abhijit Deshmukh

Gastroenterologist

Practicing since :2001

Answered : 492 Questions

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Posted on Wed, 7 Sep 2016 in Digestion and Bowels
Question: Here way go. Long story but hoping to get some insight/ideas and opinions.

Back in 2011 I became ill with some unknown virus. Possibly a reactivation of ebv. I developed elevated liver enzymes specifically alt which went as high 90 but came down rapidly over the course of a year. Eventually after a long period of time the number came down into the 20's and 30's. I also developed a high Bilirubin which was basically all the indirect fraction and with a negative hemolysis work up based on CNBC I found out I have Gilbert's syndrome as well. Actually looks back all off my labs have always had a near elevated total bilirubin level. I also had abdominal ultrasound which showed a totally normal liver and a slightly enlarged spleen.

In 2013 on my yearly physical we found the alt was elevated again. This time very mild at 53. Once again went for an ultrasound and the liver was normal and a slightly enlarged spleen. No change from previous ultrasound. Appear entry I have a slightly enlarged spleen that no one seems to be concerned with. Anyways 3 months later had a repeat lft done and the alt was down to 24. Everything else normal outside of the indirect bilirubin.

In September 2015 I had to get vaccinated against rabies due to possible exposure from a rabid raccoon. Within 3 weeks I had the worst reaction becoming very ill. I became highly hypertensive, developed cranial neuropathy, and extreme nausea. The hospital did blood work on me and showed liver enzymes elevated again with an Alt of 72. I was diagnosed with sensitivity reaction to the vaccine and was advised I would recover over time. 3 months later Alt level was 48 and than 3 months after that Alt 35. I had an ultrasound which showed the same results as previous, normal level and slightly enlarged spleen. Radiologist comments was a normal ultrasound.

I just want for my follow up to make sure everything is still good and Alt is back elevated again at 50. My doctor casually says you have mild fatty liver and the good news is there would be a medication out in the next few years to treat it. I realize fatty liver is common but how can he come up with this diagnosis when my ultrasounds are all normal. I would think that they would at least show some fatty infiltration. If this is fatty liver is this XXXXXXX or basic fatty liver that can be reversed? I also have crohn's and take humira and lialda. Maybe a med issue even though the GI says no? I am otherwise healthy. Normal BMI, blood pressure, and no diabetes. I do have high cholesterol but normal triglycerides.

What to do next? I have seen 2 doctors and they are handlin like this is no big deal. They kind of brush it off and it makes me feel like I am going crazy.


doctor
Answered by Dr. Abhijit Deshmukh 16 hours later
Brief Answer:
Hi I guess not much to worry

Detailed Answer:
Hello
Thank you query
I understand your concern
Possibly you have a mild intermittent swelling or inflammation in liver which could possibly be due to multiple reasons like what you mentioned XXXXXXX or due to crohns or due to the medication you are taking.
Well worthwhile getting tests like anti nuclear antibody, anti smooth muscle antibody serum ceruloplasmin hepatitis b and c tests to rule out autoimmune hepatitis XXXXXXX disease or hepatitis b and c infections. These disease are rare and unlikely in your case but worthwhile ruling them out. In addition can get an fibrosis done to look for any scarring of liver in addition to inflammation if all these tests are OK then can relax and may point to diagnosis of XXXXXXX In addition stop worrying about it. Keep a watch on liver functions but don't get worried by them.
Avoid pain killers if any reduce weight if overweight.
All this will help you in long run
Hope this answers your questions
Happy to help
Wish you a speedy recovery
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Abhijit Deshmukh 42 minutes later
thanks. can mild XXXXXXX be cured through lifestyle changes?
doctor
Answered by Dr. Abhijit Deshmukh 22 minutes later
Brief Answer:
Hi

Detailed Answer:
Thank you for a small query
Well yes mild XXXXXXX can be cured by lifestyle modification like diet alterations weight loss if obese exercise etc
Best wishes
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Abhijit Deshmukh 7 minutes later
thanks would supplements help? I was thinking Bouton adding omega 3 to my diet to boost hdl cholestrol a bit. is it safe to consume alcohol in moderation once it's cured?
doctor
Answered by Dr. Abhijit Deshmukh 28 hours later
Brief Answer:
Hi

Detailed Answer:
Thank you for your query
Can go ahead with omega three fatty acids avoid any supplements as far as possible
Avoid alcohol as much as possible
Best wishes
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Abhijit Deshmukh 6 minutes later
thank you. last question. in regards to the spleen I have read that cirrhosis of the liver can cause an enlarged spleen. would an ultrasound show signs of there potentially being cirrhosis?
doctor
Answered by Dr. Abhijit Deshmukh 4 days later
Brief Answer:
Yes, ultrasound scan is able to pick up cirrhotic changes

Detailed Answer:
Apologies for the late reply. Yes, ultrasound scan are able to pick up changes seen if liver is cirrhotic.

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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