worry about my liver

[roshine]

Hi Doctor ,
I need your assist , please .
Every thing started 2 years ago .Many symptoms including fatigue , loss of appetite ...for2 months then get healthy spontaneously . I did many tests then I found only hbcab +ve , hcvab -ve  ,  hbsag -ve , hiv - ve .I guess I infected with HBV then resolved  since I found  also hbsab +ve ,hbeab +ve ..
The only symptom that I got 1.5 year ago up today is a mild pain in the URQ in the back and infront of .( I am not a drinker ,not a smoker ) .
This made me try to find out the cause of pain and if there is a bad reason . I did  a CT scan last year and some ultrasounds during the last 18 months .all were normal and not show any thing bad . I did several HBV DNA  all were undetectable ( unless the last one I did six months ago which showed a tiny number 10  IU/ml .) .
I did lab.tests last year and this year as next :

Last year : ALT =21 , AST =28 , ALP =58 , T.BILI.=0.9  , DIRECT B. =0.5 , INR=1.24 , TOTAL PROTEIN=6.9 ALBUMIN=4.2 GLUBULIN = 2.7 CHOLESTROL=140 .

This year : ALT =17 , AST =23, ALP =68 , T.BILI.=0.3 , TOTAL PROTEIN=6.9 ALBUMIN=3.7 GLUBULIN = 3.2

Also I did CBC six months ago all show very normal. And finally I did U/S this week and the doctor said my liver is completely normal .
I am worried about continuous mild pain URQ and albumin decrements this year comparing to last year ( although bilirubin is improved ) .. Can I have chirrosis that is not shown by U/S and CTscan or even toward to have chirrosis   ( because of pain and because of  albumin decrement ) ?
My appetite is very normal .

Best Regards.

[roshine]

Hello Doctor ,

And what about this sentence : " GB is mildly distended ( fasting state ) " ?

Regards

[Thomas D Schiano, MD]

sludge is not unusual to be present.  rarely it can lead to chronic pain syndromes

[roshine]

Hello Doctor ,
I appreciate your assist .
I did MRCP as you recommended .
The specialist called me after he did the MRCP then he did U/S to me . He said every thing seems to be normal . While doing U/S , he asked me if I am fasting  ( I was for 9 hours ) . then I heard him speaking to the other specialist saying " sludge " . The report came as next :

GB is mildly distended ( fasting state ) , no filling defect , normal biliary tree , no intra or extra biliary dilatation or filling defect , normal CBD diameter .

Normal liver , spleen & pancreas . No focal lesion .
Normal both kidneys .
No obvious bowel mass seen .

I need your conclusion  , please .
Regards.

[roshine]

Thanks for help.

[Thomas D Schiano, MD]

if possible to get an MRCP may be helpful

[roshine]

Many thanks for your clarifications .
I'll be very grateful if you have any advice .And do you think that I need to do future tests or no need ?
Best regards.

[Thomas D Schiano, MD]

i dont think that this is related to your liver then.  Sometimes the gallbladder can be inflamed causing such symptoms.

[roshine]

I highly appreciate your answer .

Ihave to add two things related to your answer:
1- I did urinalysis more than one time and all came normal ( negative albumin ) also s. creatine =0.6  & s.urea=25
2- I did endoscopy ( upper and lower ) 1.5 year ago when the pain had just started  and every thing was fine unless + h.pylori in the stomach as mentioned in the report . I took a medicine in that time .But the pain still there .Also for 2 years I have too much gases .
Is there any advice ?

[Thomas D Schiano, MD]

i wouldnt worry too much about the albumin as the other liver tests are normal--check a urinalysis to make sure you are not developing any protein.  i definitely dont think that you hve cirrhosis.  as long as the CT scan had IV contrast you should feel secure.  if the pain persists you may need an endoscopy

[roshine]

Any help , please ?