I have heard of fatty liver disease a million times in my medical transcription and editing work. The first time I ever really thought much about it was when the nurse called me after having routine blood work done at the free clinic. “Your liver tests seem to be a little elevated so we need you to come in and have more blood work.” I am sure the first thing most people do when they hear that something is not right is panic. I am no exception. Especially when they say, “Oh, don’t worry.” Any time you hear, “Don’t worry,” what is the first thing you do?! Panic button!! I had to literally force myself to calm down. Then I remembered a little about fatty liver from reports I had transcribed and did a little research. It did not seem so bad at first. The further down I dug, the more I realized how little I knew about how complicated fatty liver disease can be.
In my own case, I was feeling extremely fatigued when I first went in for my exam, exhausted in fact, and I had been having problems with my kidneys and thyroid. After doing my usual CBC, urine and thyroid tests and adjusting my thyroid and taking care of the urinary tract infections, the doc referred me to a urologist and nephrologist. Nothing “serious” was found. I even had a cystoscopy and ultrasound of just my kidneys. The only thing they found was a urinary stricture, which he opened up during the procedure. I was placed on a low-dose preventative antibiotic for a year, and the nephrologist told me I needed to control my blood pressure.
At some point, a complete comprehensive panel found my liver function tests were elevated. By that time I was having pain under my ribs, urinary retention, and sick as all get out. My first thought was, “What does that mean?”
So today I am going to talk about routine liver function tests that you should be having, at every annual exam, as they are related to the liver. If more people had a comprehensive metabolic panel, liver disease would be caught much earlier. Many people have no symptoms of fatty liver, so it isn’t caught until it is found by accident, either by lab work, ultrasound, or MRI. Early diagnosis is key to reversal.
So you go to the doctor for a check up and a few things stand out. Maybe you weigh too much and your blood pressure is elevated. These are risk factors for liver disease. The doctor will take your history and see what other problems you may have or in your family history. Make sure you talk to the doctor about the lab work and insist on the comprehensive metabolic panel (CMP). These are the liver function tests that will initially alert your doctor if something may possibly be going on with your liver.
The ALT or alanine transaminase is all about metabolising protein. This test is specific to the liver, so when your liver is damaged these levels increase. It doesn’t tell you why your liver isn’t working. It may not be fatty liver. It may be medication you are taking. It is the first step in the process of a diagnosis and reversal.
AST or aspartate transaminase is all about metabolising alanine. When your liver is damaged or diseased it also increases.
ALP or alkaline phosphatase is an enzyme in the liver, bile ducts and bone. Elevation in this could mean liver damage or disease, such as a blockage in your bile duct or a bone disease.
Your liver has several proteins that protect your liver. One of these is albumin. If your albumin or total protein is too low, you may have a problem with damage or disease in your liver.
When your red blood cells break down, as normally happens, bilirubin is born. If your liver can not clean the bilirubin out, you become jaundiced and this may indicate liver damage or disease.
I am not going to give normals here because every lab is different and ranges may be different. I encourage you to get a copy of your blood test. In fact, get a copy of every test that you have ever had or will have, every procedure, and every note in your clinic chart. They will usually have the normal ranges for the labs right on them. If you have abnormalities in any of these tests, please talk to your doctor (if they have not already talked to you). Try not to panic but be diligent to get to the bottom of it. The doctor should try to rule out anything else that could be causing abnormalities. In my case I already knew I had high cholesterol, and I was on a statin. We had already reduced it to a low dose because I was getting muscle aches and cramps. When he saw my ALT was elevated he took me off the statin altogether and started me on something else that was safer for the liver. He also gave me some diet tips and exercise advice and set me up for some more tests. Until next time…. work on making your liver smile!
Tip: Your liver smiles when you avoid foods containing high fructose corn syrup.