Expert: Ask Suz - 9/8/2007

Question
Hi
For some time I have had a dull ache below my right rib cage.
I am overweight and a binge beer drinker so I am concerned about fatty liver.
I recently had a full medical and no liver issues came up,but my boctor said unless he did a biopsy he couldnt tell.He advised me to reduce the alcohol and fat in my diet.
A friend says I should try a 'liver flush' which worked for her.A mixture of olive oil and lemon juice caused her to pass several small green gall stones.
In my research on the net,some sites claim its valid,and others say the 'stones' are just the congealed olive oil.
What do you think?

Answer
Hi, Barry
There is so much to say about your question it's hard to know when to stop. Let me just dive in:
Are you really concerned about a fatty liver or are you really worried about chirrois of the liver but don't wish to admit it. Are you calling yourself a binge drinker or do you really suspect alcoholism? Not knowing the answers may limit the relevancy of my answer.
Liver problems are varied. They can be mild and benign or irreversible and lead to liver damage and cancer. Since i'm not a doctor I can't tell you the condition of your liver but you may want to find a doctor who will do a sonogram which is less invasive of course than a biopsy!
The liver flush you mentioned works well for stones. They are not congealed olive oil which would be very soft and unformed; not rounded or oval and hard like stones.
I am not going to counsel you to stop drinking because that's not my business and it's up to you.
In alcoholic liver disease, damage to the liver results from excessive alcohol use. In general, the amount of alcohol consumed (how much and how often) determines the risk and the degree of liver damage. Women are more vulnerable to liver damage than men. Among people who drink over a period of years, the equivalent of as little as 2/3 ounce of pure alcohol a day in women (6-1/2 ounces of wine, 13 ounces of beer, or 2 ounces of whiskey) or 2 ounces a day in men (20 ounces of wine, 40 ounces of beer, or 6 ounces of whiskey) can cause liver damage. However, the amount of alcohol that causes liver damage varies from person to person. Heavy drinkers usually first develop symptoms during their 30s and tend to develop severe problems by their 40s.

Alcohol may cause three types of liver damage: fat accumulation (fatty liver), inflammation (alcoholic hepatitis), and severe scarring (cirrhosis). So, Barry, you can see that liver problems are complex.  People with fatty liver usually have no symptoms. In one third of these people, the liver is enlarged and occasionally tender which is what you had mentioned.  People with alcoholic hepatitis may have a fever, jaundice, an increased white blood cell count, and a tender, painful, enlarged liver. The skin may develop spiderlike veins. People with cirrhosis may have few symptoms or the same symptoms as those of a person with alcoholic hepatitis. Such people may also have complications such as high blood pressure in the portal vein (the vein that carries blood from the intestines to the liver), spleen enlargement, fluid accumulation in the abdominal cavity (ascites), kidney failure from liver failure, confusion, and liver cancer.

If the person with alcoholic liver disease continues to drink alcohol, liver damage progresses and usually is fatal. If the person stops drinking, some* of the liver damage may* repair itself, although the scarring remains. The chances are good that the person will live longer.

The only effective treatment is to stop drinking alcohol. Doing so can be extremely difficult, and most people need to participate in a formal program, such as Alcoholics Anonymous (AA), to help them stop drinking.



Diagnosis

The diagnosis of cirrhosis is generally made on the basis of the symptoms and physical examination, together with a history of risk factors such as alcohol abuse. On physical examination, a doctor may feel a small, firm liver; occasionally, small lumps (nodules) on the surface of the liver are felt as well.

Liver function tests often are normal because of the tremendous reserve of the liver and the relative insensitivity of these biochemical tests. The liver can carry out essential functions even when its total activity is 85% below normal. An ultrasound or computed tomography scan (CT) may show that the liver is shrunken or abnormally patterned, suggesting cirrhosis. A liver scan using a radioactive isotope creates an image showing which areas of the liver are functioning and which are scarred. The diagnosis can be confirmed by a liver biopsy (removal of a tissue sample for examination under a microscope).

Prognosis and Treatment

Cirrhosis is usually progressive. If someone with early-stage cirrhosis stops drinking alcohol, the process of further liver scarring may stop, but scar tissue, once formed, remains indefinitely. In general, the prognosis is poorer if serious complications—such as vomiting of blood, accumulation of fluid in the abdominal cavity, or deterioration in brain function—have occurred.

No* cure exists for cirrhosis. Thus, it is a disorder that should be prevented or arrested at its earliest stages. Treatment includes withdrawing toxic agents such as alcohol and treating complications as they arise.
If you have any questions please don't hesitate to ask.
Good luck, Suz