Is Alcohol Consumption Attributed To Liver Damage And Can This Be Reversed?

Brief Answer:
Information

Detailed Answer:

Hello,

It's unlikely that your elevated liver enzymes are due to alcohol damage because:
1. As per your history, it does not sound as though you have been drinking excessively.
2. Your AST liver enzyme level (74) is lower than your ALT (114).
3. Your liver enzymes were normal in the past.
4. Your current elevation followed illness and medications that you don't normally take.

In most cases of alcohol related liver damage, the AST level is higher than the ALT.

In most other cases of liver enzyme elevation, the ALT is higher.

So, it does not look like a classic picture for alcohol related liver damage.

Regarding what you might have heard in the internet forum, some people may not think that what they used to drink was much. Also, there are rare cases of cirrhosis from people with genetic risk factors and then all it takes is a little alcohol to cause the damage, but that is not typical. Usually you will see patterns of cirrhosis affected other family members of these people who have this risk.

It does not look like you have extensive damage by any means, and in that your albumin level is normal.

When you are rechecked, it would be good to have a full liver panel - your tests should include albumin, AST, ALT, Alkaline Phosphatase, GGT, and possibly INR.

I thought you might find the following helpful. It's from a site for physicians called UpToDate that summarizes most recent research and protocols.

"When to consider alcoholic liver disease —
Alcoholic liver disease should be suspected in patients with a history of significant alcohol consumption who present with:

●Abnormal transaminases (particularly if the aspartate aminotransferase [AST] is greater than the alanine aminotransferase [ALT])

●Hepatomegaly (enlarged liver)

●Radiographic imaging suggesting hepatic steatosis or fibrosis/cirrhosis

●A liver biopsy showing steatosis or cirrhosis

Several definitions have been proposed for what constitutes significant alcohol consumption. We define significant alcohol consumption as an average consumption of >210 grams of alcohol per week in men or >140 grams of alcohol per week in women over at least a two-year period. This is generally consistent with guidelines from the National Institute on Alcohol Abuse and Alcoholism.

A standard drink in the United States (12 oz [360 mL] of beer, 5 oz [150 mL] of wine, 1.5 oz [45 mL] of 80-proof spirits) contains approximately 14 grams of alcohol (figure 1), so the limits above roughly translate to >15 drinks per week for men and >10 drinks per week for women."

Regarding the pain on the left side, that is not the location of the liver (which is under and just below the right rib cage). It would be difficult to say specifically what the pain to the left of your navel is without an exam, but that is the general location of the stomach and 1st part of the small intestine (duodenum) and may also be part of the large intestine. Regarding the stomach and duodenum, if the pain correlates with eating or not eating, it may be irritation from acid; if it is more of a crampy pain, it may be gas in the large intestine, especially if it happens immediately in response to stress.

To answer your questions as specifically as possible:

"My questions now is do you think my drinking can be attributed to liver damage and is this something that is irreversible?"
- From your history and lab results, it is unlikely that you have severe liver damage or anything that is irreversible.

"If I had any other major related problems would it show up on routine blood work."
- Blood work gives a general picture of what can be going on, but in itself is limited. It needs to be combined with history and physical exam. But in general, we can see patterns of problems with abnormal blood work. What I gather from the history you provided and your blood work is that it is highly likely that your liver was temporarily unhappy from your illness and the meds you took for that illness, and will return to normal given a bit of time. And if there is no downward trend to the elevated liver enzymes in your next test, then an abdominal ultrasound is the next step but it may not be needed.

I hope this helps. I'm sure waiting for the next set of tests and then waiting for the results is not easy, but know that your test results are common and the elevations are not extremely high, so this all bodes well.

Let me know if I can assist you further.

Thank you.

Regards,
Dr. Bonnie Berger-Durnbaugh
General & Family Physician

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Brief Answer:
You are welcome!

Detailed Answer:

Hello,

Regarding leaving the question chain open, that's no problem. I think the company automatically closes questions where there has been no activity on it after 2 weeks.

What I mentioned last time is that anytime a patient writes back in an email chain, even if just to say goodbye, the doctor is required to respond.

Feel welcome to keep the chain open but to save yourself money, only write when you are wanting me to respond (if that makes sense).

By the way, your questions do not seem neurotic to me - people often have concerns with abnormal labs.

Hope I have answered your query. All the best.

Thank you.

Regards,
Dr. Bonnie Berger-Durnbaugh
General & Family Physician

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