How to diagnose liver disorders?

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I have seen your reports (attachment removed to protect the patient’s identity), and here are my suggestions:

1. This is a non-specific ultrasound finding and has less clinical significance, especially in the presence of normal LFTs (liver function tests), good serum albumin levels, negative hepatitis B/C, and an autoimmune profile.

2. Ultrasound is an operator-dependent modality; radiologist experience and expertise matter a lot, and reports can vary a bit.

3. You had three ultrasounds within the last four months, which we usually do not recommend, especially in the absence of some very specific reason for re-imaging.

4. This report can be a variation due to the experience and expertise of radiologists.

5. As previously discussed, I would suggest going for a fibroscan at some good, renowned hospital, and all your concerns will be cleared. The mild coarse texture of the liver can be related to the normal aging process.

I hope this helps.

Thank you, and take care.

Regards.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Metabolic is not specific for cholesterol, but fatty liver can come under metabolic syndrome. In that case, LFTs (liver function tests) are already normal. Your concerns are valid, and it has created significant confusion at your end; I can understand it. Liver change echo texture is a slow process; it cannot be affected within weeks. There are two possibilities: one is that this report is over-reported, and the other is that previous reports are under-reported. To clear this confusion, fibroscan is the best investigation to consider.

I think your general physician should consider this because, for you, it is causing significant health anxiety.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.

Hello,

Welcome back to icliniq.com.

Thanks for asking again. So, LFTs are already normal, which means if I assume a fatty liver, there is still no damage to the liver in the presence of normal liver function tests. I think this is an over-reported ultrasound and I think it is not serious.

My professional experience says, we usually ignore such non-specific findings and counsel patients accordingly, and in case of health anxiety, we suggest a solution, like in this case, fibroscan. In such a short time, I am not expecting any changes in liver parenchyma.

I hope this clarifies your doubts.

Kindly follow up if you have more concerns.

Thank you.

Hello,

Welcome to icliniq.com.

I can understand your concern.

Yes, please move on, as this is triggering your health anxiety by overthinking about this non-specific finding. A fibroscan is the best test to find out your liver status, which would be within normal limits as per my clinical assessment and your blood reports.

Counseling means talking to the patients regarding their concerns, and we are discussing them right now. Cholesterol will not cause a direct coarse echo texture of the liver in the absence of fatty liver. Your liver function tests are already back to normal; this liver texture confusion is going on, which can be sorted out by fibroscan.

I hope this clarifies your doubts.

Kindly follow up if you have more concerns.

Thank you.

Hello,

Welcome back to icliniq.com.

Yes, nothing to worry about at the moment with normal liver function tests. A fibroscan is necessary both for your confusion and to document the exact liver status at the moment (specific, not like non-specific as your ultrasound mentioned). No fatty liver on ultrasound, so cholesterol is more risk for cardiac issues rather than liver, especially in the absence of fatty liver. No further action is needed, in fact, three ultrasounds within three months are too much too, without any direct indication. A fibroscan is necessary, because of current confusion and your concerns.

I hope this clarifies your doubts.

Kindly follow up if you have more concerns.

Thank you.

Hello,

Welcome back to icliniq.com.

Yes, you are right.

Take care.

Hello,

Welcome back to icliniq.com.

Yes, nothing is wrong.

Take care.

Hello,

Welcome back to icliniq.com.

You are most welcome.

Wishing you excellent health.

Kind regards.

Hello,

Welcome back to icliniq.com.

I can understand your concern.

1) No, I do not expect any liver parenchymal changes within three to four months, even with ALT 109 in between. This ALT was not that high and the liver has a huge potential to self heal, so it is not expected that it would change echo texture within a few months like this.

2) Ultrasound is a dependent modality so I will go with consultant assessment rather than sonographer assessment.

3) One very clear thing is your health anxiety, and you are worried just because of one comment that there is a non-specific liver finding.

Do not overthink, this will induce further health anxiety, just relax, your ALT is normal now and you have an option of fibroscan to confirm your liver status.

I hope this clarifies your doubts.

Kindly follow up if you have more concerns.

Thank you.

Hello,

Welcome to icliniq.com.

So,

1) Yes, your liver is normal and I will consider consultant radiologist opinion above then a sonographer.

2) I would suggest to move on, take normal diet, avoid unnecessary medicine, regular walk and stop overthinking about this.

3) You can do two things. Get a fibroscan if possible, or, repeat ultrasound by consultant radiologist after around two to three months.

This is a simple plan. This is what we do during our routine clinical practices.

I hope this clarifies your doubts.

Kindly follow up if you have more concerns.

Thank you.

Hello,

Welcome back to icliniq.com.

I can understand your concern.

So,

1) In your case, fibroscan will be normal or it will show F0 to F1 level of stiffness which is pretty normal at age above 30 years (nothing specific for you). No major issues are expected as your liver function tests were ok with good serum Albumin levels and no old, or chronic history of liver disease.

2) That is totally fine, if you will try for baby, best wishes for that too. During pregnancy, we always check LFTs (liver function test) as a normal protocol so it will be checked by default, nothing specific for your to worry.

3) Options are not just for your peace of mind. these are the most logical options being a Hepatologist. Meanwhile, telling you to relax and nothing to worry is important too, to avoid unnecessary health anxiety.

4) Yes you should move on and enjoy your life.

I hope this clarifies your doubts.

Kindly follow up if you have more concerns.

Thank you.

Thank you for asking again... 1) liver parenchyma doesn't change in months.It takes longer period of time like years 2) Let me put an example, in damaged liver like cirrhotic liver or patient having active hepatitis B infection, we go for surveillance ultrasound after about 6 months to see is there any abnormalities. Now, if in cirrhotic liver or active viral infection, we see parenchymal changes in 6 months. Do you feel in normal liver, I will expect to get another within few months ? ( Normal liver is way more healthy and have a great potential to self heal) wishing you excellent health bear regards

Thanks for your consultation with icliniq again. So, 1) who did this scan? sonographer or consultant radiologist? 2) This ultrasound has the same findings which was done recently having non-specific liver findings or heterogeneous echo texture. 3) In order to put a stop in this situation, you need to go for fibroscan to see the exact situation of your liver and ask your GP to refer to the Hepatologist for that, if he can't write fibroscan for you. 4) Recheck fresh LFTs at the time of fibroscan, this will clear your doubts more and give us a clear picture of what is happening. 5) You can try for your baby. Wishing you excellent health kind regards

Hello, thanks for your consultation with icliniq. 1) That's great, Fibroscan is a better assessment tool for liver stiffness or damage as compared to ultrasound. 2) If you are saying 141 CAP ( this parameter is suggestive of fats in liver) and as per this reading there is no clinically significant fats and this is within normal limits 3) 4.4 kpa is a unit of liver stiffness and this is normal too. 4) You can share a report of fibroscan as an attachment to this chat , I can review it myself. 5) To sum up, both values are within normal range so nothing to worry regarding your liver. Wishing you best health. kind regards

Thanks for asking again. So, 1) I have reviewed your fibroscan report, both values are within normal range. No fatty liver and no liver fibrosis. 2) Fibroscan is an alternative to liver biopsy, reliability is way more than the ultrasound. 3) Your liver may appear mild heterogeneous on ultrasound, but in preference of normal liver function tests and normal fibroscan. I will not consider it clinically important or significant. I think you should move on rather than keep searching for an explanation of every thing which is actually not possible in the medical field. In your case, you are way too anxious and sensitive and I think now ,this is the point to put a stop on over thinking and move on ..... 4) With previous normal LFTs and now fibroscan, I don't think so repeat LFTs are needed at the moment. 5) Even ,I was not in favour of 4 ultrasounds in 4 months just to evaluate DILI. 6) Well, to sum up, I think now you have one better investigation with you regarding your liver and this is normal and you should move on.. 7) Best wishes for your future plans , including your baby.. Please don't hesitate to ask, whenever you need any medical help or recommend your friends and family. kind regards

You are most welcome. Wishing you excellent health Kind regards