Does This Fatty Liver Dx require more tests?

[tdig]

Heavy Drinker.Fatty Liver on ultrasound, Normal enzymes/blood work. Should I have a biopsy?

[mikesimon]

I think it's probably common for people with fatty liver disease to have some elevation in their liver enzymes but I wouldn't worry about having normal liver enzymes.
I've read that the only absolute diagnosis of fatty liver is with liver biopsy but I would assume that a knowledgeable hepatologist or gastroenterologist can be pretty certain about the diagnosis without a liver biopsy.
When cells die they release enzymes so when liver enzymes - specifically ALT (SGPT) - are elevated it means that cells are dying. It's not as bad as it sounds because cells do die naturally but the elevation suggests increased liver injury. In short I'd rather have normal liver enzymes than elevated enzymes regardless of the diagnosis.
If I were you I would continue doing what you're doing and enjoy your life. I wouldn't get a liver biopsy if I felt well, my blood-work looked good and my doctor wasn't worried. I have had a bunch of liver biopsies and I can tell you mine were practically painless and uneventful. Nevertheless, there is a slight risk with any procedure and that's true with liver biopsies. I wouldn't even think about getting one with your situation but that's just my opinion. Whatever you decide I wish you the best of luck. It looks to me as if you're going to be fine if you keep living a good lifestyle.

Be well,
Mike

[tdig]

Thanks Mike! My spleen and platelets are good along with all other blood work and physical exams. I have quit alcohol and started a healthy liver diet. My Dr. is not concerned.  I am because everything I read seems to say that if you have fatty liver your enzymes should be elevated.. and mine are not.  

[mikesimon]

A liver biopsy will reveal the architecture or histology of your liver. Often a diagnosis of cirrhosis can be made without the need for a liver biopsy. A low platelet count and an enlarged spleen are suggestive of cirrhosis, for instance. Fibrosis is harder to pin down with specificity but there are non-invasive tests which can help such as Fibroscan. However, the liver biopsy is still considered the gold standard when assessing liver injury/disease. I guess it really comes down to what you would do with the information gained from a biopsy. If you are a heavy drinker your disease may be "Alcoholic Fatty Liver Disease". The first thing a doctor would advise you to do is either quit drinking or very significantly reduce your alcohol intake. This is true even if your disease would be "Non Alcoholic Fatty Liver Disease". Basically, with any type of liver disease abstaining from alcohol or severely limiting alcohol consumption is critical. If you are overweight then weight loss is advisable and starting an exercise routine. These approaches are appropriate regardless of the degree of liver injury so the question is can you make these lifestyle modifications now or do you need additional information from a biopsy to incline you to take action. I think if you can make these kinds of changes in your lifestyle your liver will improve. But, there is a point when the liver damage reaches a level where improvement becomes less and less likely so it's much better to act now.

Whether a biopsy is necessary is up to you, in my opinion.
What does your physician advise?

I wish you good luck,
Mike