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Should I be worried that I will die soon from liver failure?

I’ve been a heavy drinker for about 10-12 years. I am female and only 33. I have had RUQ pain, smell of ammonia in my stool for about 3 years. An ultrasound said I had a minimally heterogeneous texture to my liver. Normal blood tests and panels though. One doctor told me to completely stop drinking. The other said if I cut back and eat healthy I will be fine. I am trying to quit drinking and have cut back dramatically but wanted to know if anyone can please tell me if I’m going to die from this if I don’t stop right now.
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683231 tn?1467323017
No one here is a doctor or medical professional and even a doctor without seeing your records would not be able to  authoritatively answer your question.

That being said your ultrasound result “minimally heterogeneous texture” is not a normal result as the liver should be smooth and your result indicates some coarsening of the livers surface.

Yes you should quit drinking vs cutting back especially if you are an alcoholic as most people who are alcoholics have little success in simple reducing alcohol consumption. Eating healthy and getting exercise as tolerated are good healthy choices.

Alcohol and other causes of liver damage take a long time to rise to the level of major liver damage ie cirrhosis.

I was diagnosed with liver cirrhosis in Jan 2008 due to having had hepatitis c for probably 30 years by that time. I was curedof hep c 3 years ago which has stopped the progression of liver damage.

It is said that liver damage can improve with time for many patients even those like me with cirrhosis have about a 50/50 chance of reduction in liver scarring.

Signifigantly reduce drinking if you can or if you can’t you must stop drinking completely. Eat healthy get some exercise.

You will be fine if you take these measures to protect and heal your liver.
Thank you for the advice and the peace of mind. I am trying my best and attending intensive outpatient rehab as well as self educating myself about alcoholism, trying to quit completely.
683231 tn?1467323017
Just to add even with cirrhosis I don’t have any URQ pain that is normally not a symptom. Nor is an ammonia smell.

High ammonia blood levels are a cause of hepatic encephalopathy one symptom would be breath that has a sweet, fecal smell to it.

Other symptoms of HE:
Early symptoms include forgetfulness, confusion, and breath with a sweet or musty odor. Advanced symptoms include shaking of the hands or arms, disorientation, and slurred speech.

HE is a symptom of liver failure you are no where near that level of damage

Oh god. Now I’m worried. When I was at my worse I had a lot of those symptoms including bad breath which I never had before. I’m actually disoriented A LOT. Goes away when I stop drinking for awhile. I was also on lactulose for two months for the ammonia. Is t possible I was experiencing HE and my doctor didn’t tell me?
“Why is this medication prescribed?

Lactulose is a synthetic sugar used to treat constipation. It is broken down in the colon into products that pull water out from the body and into the colon. This water softens stools. Lactulose is also used to reduce the amount of ammonia in the blood of patients with liver disease. It works by drawing ammonia from the blood into the colon where it is removed from the body.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

That would be entirely irresponsible of your doctor to not tell you if you have HE.

Did you not ask why your were taking lactulose?

Most often if treating HE, once you start taking lactulose you would be taking it daily and never discontuining this medicine

Have they told you you have liver cirrhosis? Have you ever had a liver biopsy or a Fibroscan (a machine similar to an ultrasound but uses thumps to determine liver stiffness) or fibrosure blood test? Those tests can determine if you have cirrhosis. An ultrasound is not really used to diagnose cirrhosis more to confirm an existing diagnosis of cirrhosis.

Are you seeing a hepatologist or at least a gastroenterologist?

If you have cirrhosis and if you had HE in the past that resolved you absolutely must stop all alcohol consumption.

If you have cirrhosis and stop drinking your liver will be able to heal.

As I said I have had cirrhosis for 10 years and am fine never have had HE.

Cirrhosis is not a death sentence as long as you take steps to protect your liver.

Ask the doctor who prescribed the lactulose why you were taking it. Ask how bad your liver is and do you have liver cirrhosis.  

If you don't understand something about your treatment ask questions
When my blood work came back my liver panel was normal, only one (don’t know which one) was slightly elevated. I was told at this time, by this doctor (gastroenterologist) that my liver was “pre-cirrhotic) and that I must completely quit. My ammonia levels were elevated which is why the lactulose was prescribed for a month. I was not told that I had HE or cirrhosis. I had the ultrasound and liver panels done AGAIN a year later (last year, a year after the first and precirrhotic diagnosis). My liver showed to be the same as the test before and my liver panel was normal. I was told by this doctor that I should be fine to drink if I just cut back, but I know in my heart I need to stop using alcohol, and have for the most part. At my worst I was very disoriented, extremely tired, itchy, pins and needles in my feet, smelly breath, very strong ammonia smell in the bathroom, low appetite, weight loss, and the RUQ pain. Do you think it’s possible to have HE without liver failure?
Also, I have asked over and over to another gastro doc and two different general family docs and NONE of them seemed to think it was caused by alcohol abuse I guess bc of my age but just suggested if I cut back I’d be fine!  I’m so confused and I have asked many questions but I really needed to hear another doctor tell me I need to quit. I guess thank you for telling me that! I don’t trust doctors!!!
HE is symptom of decompensated cirrhosis to the best of my knowledge as a lay person who has had cirrhosis for 10 years who reads a lot. There are 2 levels of cirrhosis. Compensated cirrhosis is where the liver although scared is able to perform its functions. Decompensated cirrhosis is where the liver is damaged enough that it can no longer do its jobs effectively. On of the livers jobs is to remove ammonia. So like I said as far as I know having high levels of ammonia causing is by definition a symptom of decompensated cirrhosis.

However, the liver can improve with time by eliminating the cause of damage. So you could maybe have slipped into decompensated cirrhosis then stopped drinking and returned to being compensated when the HE improved. This is assuming this is what occurred. I am only guessing as I haven’t seen your records and am not a medical professional.

Elevated liver enzymes only mean your liver is currently being injured by something. Enzymes are released when the liver is trying to repair itself from injury. Normal liver enzymes only mean nothing currently is harming your liver there is no relationship to liver enzymes and how much liver damage has occurred.

After I was cured of hepatitis c my liver enzymes went into normal range and have stayed in normal but I have liver cirrhosis.

So a couple of things. Youhave a right to your blood test results. They are your results. Mine are available online from my doctors office through a web portal I can look at then any time I want. If nothing else you can request hard copies from your doctors office.

What kind of doctors have you seen for this? General practitioners or have you been seen by a liver specialist (hepatologist) or an abdominal specialist (gastroenterologist). I find it hard to imagine a doctor who he feels a patient with early cirrhosis telling that patient it is ok to drink in moderation knowing they have a history of heavy drinking which has led to early cirrhosis.

You do need to find a good doctor you can trust. You need good medical advice from an expert not someone like me a random person on the internet. I do the best I can but I am not a doctor.

Liver damage can be caused by many things. This is from a Mayo Clinic web page


Parasites and viruses can infect the liver, causing inflammation that reduces liver function. The viruses that cause liver damage can be spread through blood or semen, contaminated food or water, or close contact with a person who is infected. The most common types of liver infection are hepatitis viruses, including:

Hepatitis A
Hepatitis B
Hepatitis C
Immune system abnormality

Diseases in which your immune system attacks certain parts of your body (autoimmune) can affect your liver. Examples of autoimmune liver diseases include:

Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis

An abnormal gene inherited from one or both of your parents can cause various substances to build up in your liver, resulting in liver damage. Genetic liver diseases include:

Hyperoxaluria and oxalosis
Wilson's disease
Alpha-1 antitrypsin deficiency
Cancer and other growths

Examples include:

Liver cancer
Bile duct cancer
Liver adenoma

Additional, common causes of liver disease include:

Chronic alcohol abuse
Fat accumulating in the liver (nonalcoholic fatty liver disease)
Risk factors
Factors that may increase your risk of liver disease include:

Heavy alcohol use
Injecting drugs using shared needles
Tattoos or body piercings
Blood transfusion before 1992
Exposure to other people's blood and body fluids
Unprotected sex
Exposure to certain chemicals or toxins

Ok I just re-read your previous answer I see you have seen a gastroenterologist and hepatologist.

If they don't think drinking was the cause of your liver damage what do they think is the cause? But yeah if you have borderline cirrhosis what ever the cause continuing to drink is just throwing fuel on the fire.

It normally takes decades of heavy alcohol abuse to develop cirrhosis so I see why your doctors doubt alcohol as a cause because you simply haven’t been alive long enough to have caused liver damage to the point of cirrhosis unless something else is causing your situation.

I was infected with hep c for 30 years before my liver got to cirrhosis.

Ultrasounds really can’t diagnosis cirrhosis. To diagnose cirrhosis previously the gold standard was a liver biopsy where they insert a needle into your side and take a sample of your liver which they examine under a microscope.

Now they have less invasive tests. One is called a Fibroscan it is like an ultrasound but the devise produces a thump which can estimate liver stiffness. Another test is called a fibrosure it is a blood test which can also estimate liver damage.

Have you had any of these tests to determine how much liver damage you have.

The more you read the more you understand so you can ask your doctors good questions and are able to understand the answers. Avoid a lot of web sites they just have junk information. The Mayo Clinic and even web md can be good sources of information. The national institute of health (NIH) is also good but kind of advanced and technical for you right now. Also try the American Liver Foundation
Thanks for the great reply. It was helpful. Still have so many questions but I know hat I need to quit drinking alcohol and if I still continue to have these symptoms I will know that it is being caused by something else. Although I don’t doubt alcohol is the major contributing factor. From my research I have found that women are more likely to develop liver disease especially when drinking on an empty stomach for some reason. “Drunkorexia” is a real thing, and I slowly became an alcohol abuser during my recovery from an eating disorder in my late teens and early twenties. I was also on a anti anxiety med called Effexor which I believe increased my desire and ability to consume very large amounts of alcohol and not feel the effects until I was beyond “gone”.  After stopping Effexor I drank and felt a tremendous difference in the way I felt during and after drinking- much worse. I have done lots of research on Effexor he alcohol abuse and have found a bunch of people who have also developed a strong tolerance and urge to drink. I wonder if that was a contributing factor?  Anyway thank you for your insight. More helpful than all of the doctors I have seen. I do have access to my blood work online I just don’t understand any of it!
If you can post some of your results I can probably help. Just post ones out of normal range as normal results are normal so not an issue.

You can likely google your results. Search for lab tests online they are pretty good.
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