Q. I am a 36 years old man and consumed alcohol quite heavily for 4 years. Now I take around 5 pegs of 60ml once a week for the last 10 months. My liver measures 16.5 cm and was found mildly enlarged in size with diffusely hyperechoic parenchyma. Gall bladder wall thickness was normal. Luminal echoes are normal. No calculi. C.B.D-not dilated. Pancreas - normal size and parenchymal texture. Bilirubin total 0.6 mg/dl, biliribin direct 0.3 mg/dl, serum albumin 4.9 g/dl, serum globulin 3.1 g/dl, Alb/Glob ratio 1.6, ALT – 127 IU/L, AST – 140 IU/L, ALP – 116 IU/L, WBC – 6570/cu mm, RBC - 4.9 mill/cumm, Haemoglobin 15.2 g/dl, PCV - 100.6. The doctor advised Ursocol 450 mg twice a day, Silbostin 120 mg- thrice a day, Riconia LP once daily for 2 months and to repeat the tests. The results of second test are: AST and ALT were 75 IU/Land 36 IU/L respectively. After seeing the report, the doctor suggested Silbostin 120 mg thrice daily and Veloz 20 mg daily for 6 weeks and to repeat the liver function tests (LFT). The third result of LFT last month was: bilirubin total 0.51 mg/dl, biliribin direct 0.16 mg/dl, total protein 8.26 g/dl, serum globulin 1.71 g/dl, Alb/Glob ratio 1.6. Since AST and ALT were fluctuating, I was asked to undergo further tests. HBsAg Elisa - negative, HCV - negative, Ceruloplasmin - 0.31 mg/dl, ANF - positive (titre - 1:80), Staining - nucleolar. Now the doctor says that this might be a case of auto-immune hepatitis and has suggested liver biopsy to further confirm the level of injury to the liver. Also, I might have to take medications for few more years. He has given the tablet Ursodiol 300 mg (Udiliv) at present and asked to continue till I make up my mind regarding liver biopsy. Is my problem curable? Please suggest.
The liver enzymes are produced by intact liver cells and the level rises with injury, whether it is alcohol induced or due to virus infection or auto-immune disease affecting the liver. No doubt in some cases more than one pathology can co-exist. Liver biopsy however shows the specific type of damage that can occur as well as the presence and absence of different white blood cells and the general structure of the liver architecture if normal or otherwise. So it is essential for a correct diagnosis and I suggest you agree to have this test.