Liver pain - I do not know what disease is this

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Hi there,

I have a problem with the liver and I do not know what disease is that.

Let me explain how all started.

In the winter of 2017-2018 (1 year and half ago) I had a lot of problems respiratory tract infections (pneumonia, bronchitis and colds) and I took several rounds of antibiotics (2nd generation cephalosporins and levofloxacin) and several other medicines (like ibuprofen - not too much - maybe 1 pill of 200mg at 3 days) and many herbs.

Then in March 2018 I’ve had bacterial prostatitis and I had to take 1 month of levofloxacin. Also, my GP gave me indomethacin (for several days) so that I can urinate better. Needless to say, indomethacin din not improved the condition...

All have passed, and I did not had any respiratory problems nor prostatitis in the past 11 months.

In April 2018 I have discovered a good salmon in our neighbourhood store and I have started to eat a lot of it (about 2-300 grams) every day. Unfortunately, I cooked it by frying in oil. After 1 month I develop gastritis (probably my stomach was weakened from Ibuprofen and too much fried oil has raised the acid too much …).

I started to take Pantoprazole for 3 weeks and Sucralfate. The stomach pain has reduced significantly, but not entirely. I took a break from PPI … and after 2 weeks the stomach started to hurt again. I tried some herbal medicine, with no significant effect.

In August 2018 I started to take Ranitidine (150mg in the evening), because I read that PPI have too many side effects. After 5 weeks of ranitidine, I started to have a very strong pain in the right side of the abdomen where the liver is located. No other symptoms, just the pain. I stopped Ranitidine, and the pain has disappeared. After 1 week, I resume Pantoprazole (because the gastritis was still there). After 1 month of Pantoprazole, I again had strong pain in the liver area. I stopped the Pantoprazole and the pain has disappeared. Also, the stomach condition has improved significantly.

In November 2018, I was ok. I followed a simple diet: potatoes, carrot, chicken breast, banana.

I December I said that I’m cured and I can eat anything what I want. Bad mistake, after 3 days the stomach pain was again present.

During this time, I have lost weight (about 9 kg in the last year) so I started to eat white chocolate to gain weight again. After 3 days of white chocolate [200g per day] the strong liver pain was again there. The pain was more severe if I bend forward. It felt like I had a wound there.

At the end of December I went to a lab of to do some blood test for liver. The values have been:

Gamma GT = 93 (normal interval [0-55])

ALT = 70 (normal interval [0-45])

AST = 35 (normal interval [0-35]).

My GP was on vacation, so I had to research more by myself.

I took silymarin (150mg/ day - not very constant) since August 2018, but with not too much effect.

After the first blood test I started to take Quercetin. The pain has disappeared very fast. After 1 week of 3x 500 mg of Quercetin, the pain in the liver area was almost nonexistent.

I repeated the blood test after 1 week, this time with more parameters:

Gamma GT = 124 (normal interval [0-55])

ALT = 82 (normal interval [0-45])

AST = 32 (normal interval [0-35]).

Direct Bilirubin = 0.17 (normal interval [0-0.2])

Total Bilirubin = 0.48 (normal interval [0.1-1.2])

B and C hepatitis = negative.

So, the Quercetin has improved my symptoms significantly, but [some] of my blood tests became worse. I stopped Quercetin.

At that moment I was novice in that field and I have not realized that I need more blood tests.

I started to take Silymarin [300 mg/day], Essentiale Forte [6 pills per day], Liv52.

After 2 weeks (to another blood test lab):

Gamma GT = 67 (normal interval [0-50])

ALT = 39 (normal interval [10-60])

AST = 30 (normal interval [10-50])

ALP = 274 (max value 270)

Albumin = 4.9 (normal interval [3.5-5])

Eosinophils = 6% (max normal value is 5%); but I had this value 6 years ago too.

So, my blood tests have been improved, but some are still outside the normal range.

My GP ignored me telling that the values are not pathological.

I also did a stool test for H Pylori and was negative.

Also, I went for a upper gastroscopy and I was diagnosed with mild antral gastritis and no H. Pylori. They gave me Nexium, but I refused to take knowing the liver pain from Ranitidine and Pantoprazole.

In the meantime, I have started to read more and I did tried all kind of medicine.

SAMe, L-methionine, NAC = all good, reduce the liver pain and improve blood tests, but I get pain in the stomach from them and I cannot take them for too long (several days).

ALT and AST are usually inside normal range, but Gamma GT and ALP never decreased below maximum value.

I suspected that I have intrahepatic cholestasis from drugs, but I did not had other symptoms [no itching, urine has normal color].

Also I did a test for Bile acid in serum and the score was 1.4 (max value 10) … so, maybe is not cholestasis.

I went to an ultrasound and the liver is enlarged [16 cm in diameter - I understand that normal size is 14 cm], but no other problems there.

I tried TUDCA for 2 days before getting stomach pain from it … and even if the liver pain has disappeared, the blood test have jumped out of range (ALT jumped to 80, Gamma GT jumped to 90, Direct bilirubin jumped to 0.4).

I also tried Medrol (Metilprednisolon) … only 1 pill of 16 mg because I got a serious stomach pain from it.

The ALP has decrease with 30% from the previous value! Now is at 80% from upper range.

Now I’m on phospholipids (3x 600 mg /day) and silymarin (3x 150mg / day) and much better than in December 2018. But I still have some small pain in the liver area.

Also, I cannot tolerate Ranitidine (I get liver pain after 1 pill). I got liver pain even after 2 pills of Sucralfate (this drug goes to liver too?! ). I do not know from which other drugs I get liver pain because I did not tried !

Stomach is better since I started to drink water with Ph 8.8.

Also eat a lot of oatmeal.

Last blood test looks like this:

Gamma GT = 87(normal interval [0-50])

ALT = 43 (normal interval [10-60])

AST = 21 (normal interval [10-50])

ALP = 221 (max normal value 270)

Direct bilirubin = 0.18 (max normal value 0.25)

Prothrombin time = 25 seconds (normal range [13 - 17]). I recall that whenever I had an open wood it took more time to stop the bleeding.

What disease is that?

What other tests should I make to understand the problem?

Cholestasis? If so, why Bile acids in serum are so low? Why it does not respond to TUDCA?

Autoimmune hepatitis? My ALT and AST are in normal range.

Or what else can be there? My GP says that blood test values are not pathological … but why the liver hurts?

Fatty liver? In the past I have ate a lot of chocolate trying to get some weight (now I have 65 kg at 177cm, BMI = 20.7). One year ago I had BMI = 23.6. I recall that I had some very mild liver pain after eating chocolate in the past … but the pain would have disappeared after stopping chocolate.

I cannot eat sugar anymore. I cannot eat white bread or pasta because I get liver pain.

I also had Hepatitis A, like 30 years ago.

I did consume alcohol only occasionally (that is 4-5 drinks per year).

Please help!

thanks,

Mike

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16 Replies

  • Posted

    Hi there,

    I have more new details about my case.

    Gastritis has been fixed (with diet only).

    But for liver area, things went only worse with only minor improvements. In the worst case the direct bilirubin has been 2x maximum and GGT has been 3x maximum. ALP has been 1.2x maximum. ALT 2x maximum.

    I did a MRCP and a small bile duct stricture has been detected in the left hepatic duct (just before it enters in the common hepatic duct). But no dilatation.

    Below is the picture:

    image

    All tests for autoimmune diseases are negative.

    I do not have inflamatory bowel disease.

    I have a very good appetite and I do not feel tired.

    Could this be the problem of pain in that area and abnormal liver enzymes?

    Sometimes pain goes to the right side of chest and then on the right upper back.

    I have noticed that if I eat fat I get better. Is this because fat helps with bile flow?

    thank you,

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    • Posted

      Hi,

      Sorry for not being very clear. The stricture is not on small ducts, but rather on the left hepatic duct where it meets the right hepatic duct. The doctor said that the stricture is small (3mm diameter) and short. You can clearly see that on picture.

      What is unclear for me if a 3mm stricture can cause problems or not.

      The doctor said that if symptoms persists I should go for a ERCP with ballon dilatation.

      I've been tested for auto-immune diseases (ANA, pANCA, ASMA, AMA, LKM1 and several others) and all are negative.

      thank you,

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    • Posted

      thanks for explanation. do you still have pain and weightloss? what other symptoms do you have. its positive that your blood results are coming back as negative

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    • Posted

      Hi,

      I have lost about 11 kgs since May 2018 until 3 months ago when gastritis has been fixed. Since then I have gained 3 kgs.

      Note that I am skinny (65 kgs at the moment) and have always been so, until 3 years ago when I ate a lot of cookies for several months and I've been able to get more weight. Still, no fatty liver is present on (multiple) ultrasound (investigated by 3 doctors so far)!

      I can easily get weight ... 3 weeks ago I ate a lot of cookies and I got 1.5 kg in 3 days. But this was not maintained after stop eating sugary stuff.

      The pain is only getting worse. Few months ago the pain was present only when eating sugar / simple carbs, but now is almost constant. Not strong, but constant and annoying. Sometimes the pain goes to the right side of ribs cage and then to the upper right-back.

      The pain disappears for several hours if I eat fat!

      But is getting much worse if I eat carbs (including fruits - probably the fructose is the problem with fruits).

      I had this pain in the past (maybe 10 years ago I went for the first time to GP and told me that my liver is enlarged on untrasound), but the pain appeared only when eating more chocolate/cookies. Without sugar, there was no pain. At that moment the GP did not make further comments and did not investigate the problem even if I visited her several more times for the same problem. However, things are different now: the pain is more persistent and strong.

      Currently GGT = 2x maximum. ALP = 1.1 maximum, ALT = maximum, direct bilirubin = 1.1 maximum. But I take TUDCA, sylimarin and phospholipids.

      thank you,

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    • Posted

      why dont you ask your gp to refer you to dietician liver specialist. may be you are becoming tolerant to some foods not breaking down by the liver.

      did the consultant rule out PSC? im guessing you are not jaundice otherwise you would have very dark pee and high bilirubin

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    • Posted

      Hi,

      I went to a liver specialist ... that one sent me to MRCP, where the stricture has been noticed.

      However, no diagnosis for PSC has been made. For PSC I understand that bile ducts should show multiple strictures and dilatations after strictures. In my case only 1 stricture has been noticed.

      I'm negative to pANCA (I understand that more than 80% of PSC patients are positive to pANCA).

      Also, I do not have IBD (most patients with PSC have IBD). My stool is normal (no diarrhea, no constipation).

      No jaundice, no dark pee.

      Currently only direct (conjugated) bilirubin has been twice the maximum. Total bilirubin has been in range.

      I do not feel tired.

      I have good appetite.

      thank you,

      Report / Delete Reply
  • Posted

    Here's a shot in the dark, but you seem very determined to get to the bottom of your liver issue.

    You might wish to look at ferritin. Males tend to accumulate iron as they age, and the liver is the bodies primary storage site for excess iron. Iron is a powerful pro-oxidant and as iron accumulates, inflammation can rise, typically reflected in GGT & ALT elevation.

    Ferritin is a dirt cheap test, & your doc shouldn't mind ordering this. The upper limit for the normal range for ferritin is set quite high by many labs (300+), but optimal levels are considerably lower. The World Health Organization puts the upper limit for ferritin at only 200 for both males and females. There is a school of thought that the optimal level for ferritin is likely closer to 100, & inflammation can start to occur at around 150.

    Interestingly, quercetin, as well as another liver tonic, curcumin are both iron chelators, which can relieve symptoms and improve liver labs when iron is at all elevated. The chelation effect of these supplements isn't enough to actually lower liver iron though; they simply relieve symptoms.

    Blood donation will lower iron swiftly and dramatically, & it may only take 2 or 3 donations to fully resolve a mild iron elevation. Ferritin & Transferrin Saturation (aka: TSAT or iron saturation) are the key labs to look at. As mentioned above, ideally ferritin should be lower than 150. Transferrin saturation should be in the middle third of its normal range, and not over or even near the upper limit of normal.

    To lower iron through blood donation, donate only "whole blood". The iron is in the red cells, & plasma or platlet donation will not lower iron at all.

    Sub-clinical iron elevation is getting more attention lately due to iron fortification of food. It has been called "Ferrotoxic Disease", so you may wish to do some research on this.

    Best of Luck for getting this resolved, & let us know what you find out.

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    • Posted

      Hi,

      I did tested the ferritin twice in the past months.

      Last value was 115 on a [30-400] range.

      Copper was 76 on a [70-140] range.

      However, things are changed now for me.

      I have stopped eating fructose and start drinking coffee.

      Yesterday I did again some blood tests and the results are:

      GGT 82 where normal range is [0-50]

      ALP 179 [0-270] - big decrease here !

      Direct bilirubin 0.4 [0-0.25]

      ALT 15 [10-60]

      AST 29 [10-50]

      So, GGT is high, but ALP has decreased significantly.

      I currently cannot eat nothing containing fructose without getting pain there after few hours. Usually the pain reduces in 24-36 hours if I do not make mistakes. Also, I can eat nothing with chemical substances ... everything must be very natural.

      I suspected some Hereditary Fructose Intolerance, but is hard to believe since I have eaten so many sweats and fruits until now (that is 42 years). Anyway, I have sent a sample for DNA sequencing to clarify.

      I currently take 1 TUDCA of 250mg per day and 3x Phospholipids per day.

      Taking SAMe and NAC (which both increase glutathions) is also very good ...

      Anyway, the "disease" has progressed. A year ago I was able to eat fruits with no problems (I mean no pain) ... but currently I get pain even from several grapes.

      Liver size is in range now ...

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  • Posted

    Great turnaround in labs! I'm surprised your not seeing improvement in your symptoms. Perhaps tincture of time will heal your wounds. At least your liver is back to normal size.

    Your supplement stack looks fantastic. Livers do love Lecithin (and coffee!). Glad your iron & copper are benign. Doctors tend to poo-poo iron elevations, but always best to look at all angles when you've got a medical mystery going on. DNA sequencing is a great idea.

    I dearly hope you've turned a corner, and your malaise will improve.

    Yours is an interesting case... Let us know how you're doing.

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  • Edited

    do you have more info you can share?

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    • Edited

      Hi,

      Yes, I have new info.

      I'm OK now...

      But I still do not know what disease I have.

      Doctors were not very useful.

      I have read a lot and I did a lot of experimentation by myself.

      I tried TUDCA for several weeks, but I've obtained no serious benefits from it.

      Finally, I have read an article about some child disease where the bile flow is impaired. The solution was Omega 3.

      So, I tried Omega 3 too ... and in few hours the pain has disappeared!

      Every time when I have some pain in the liver area I take 1 gram of Omega 3 and everything is ok.

      I have noticed that the pain is greater when I eat a lot of carbs (which are known for not stimulating the bile release). But with Omega 3 I counterattack the negative effect of carbs. Simple fats seems to help also, but not as much as Omega 3.

      thank you

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