Normal liver panel but liver disease?

If the symptoms you describe are on-going and not getting any better (or worsening), I would have some serious doubts about any doctor who would say there is 'nothing wrong'. And the short answer to your question - yes, it is possible to have compensated liver disease with normal LFTs.

Then how is diagnosis made? Ultrasound was normal, fibro test was 0-1, 2 docs have said it's Gilberts or"something similar" and another said it's likely just ibs!!!!! We don't believe them ....

Should we insist on a biopsy? Scared about complications but more scared about not. Also worried doc is just going to send us away

Hey Davey. More testing is definitely a good idea. Is your sister being seen by a Hepatologist? If not, that would be the first thing I would suggest. The biopsy question is one that a Hep could answer. Like any other invasive procedure, there is a risk of complications with a biopsy - but the risks are low, especially in someone like your sis.

Gilbert's syndrome is a fairly common genetic 'disorder' - its symptoms are mild jaundice and fatigue. There is no treatment, as the syndrome is harmless. The symptoms usually come and go throughout the person's life, usually appearing during times of stress, infection, when exercising/exertion, or when dehydrated/not eating.

Xxer - I don't see how a person with decompensated liver disease could have normal LFTs. At that point, the liver is failing. When a person is decompensated, they will have portal hypertension, ascites, jaundice, H.E., etc. Their LFTs will reflect decompensation.

Hello bblbt! I know there will always be exceptions, but generally with decompensated cirrhosis, LFTs will be abnormal in some way. By this time, the liver is heavily scarred and not able to perform its normal functions, which will then be seen in liver function tests (LFTs) results. Yep, you are a rarity! Lol

Yes, usually the albumin will drop due to the declining synthesis abilities of the liver and the globulin levels will tend to rise. The thing to watch is the A/G ratio (albumin/globulin) since it is a very sensitive marker to track this. Normal A/G levels will be greater than 1 (closer to 2 is ideal) and less than 1 is indicative of serious problems. Also, due to the declining synthesis abilities, the INR will trend higher as the liver disease progresses but this usually doesn't become pronounced until the liver function has deteriorated to roughly 20 to 30% or so. Platelets will drop primarily due to an enlarged spleen caused by portal hypertension but the liver disease can also reduce the platelet production as well. Unfortunately, all this can get quite messy and all the other parts of the portal flow system will be further stressed as the liver stops pulling it's load and they have to try "compensate" for as long as possible. Certainly those that keep doing things to insult the liver and other organs further will accelerate the process.

Decompensation can be present without clinically significant portal hypertension but is uncommon. From what I understand, this would be caused by the blood flow being "re-routed or short-circuited" past the active liver lobular portions (via the bridging scar tissue) as it makes it's way from the portal tracts to the central hepatic veins. That's if there is still positive/forward portal flow and viable hepatic veins still present of course.

Post Edited (bblbt) : 6/3/2014 12:34:45 AM (GMT-6)

hijack! ;)

INR related thing - my sister had 1.21 with a lab range of 1.2. Is this a warning that it's tipping into danger zone or as that it's ever so slightly out of normal range it's nothing to worry about. I heard INR doesn't increase until it's 70 or 80% beaten up.

Is a 1.2 an "increase" or when we hear 80% damage, does that mean a BIG increase?

and what would big increase mean?

Thanks for your input

Post Edited (daveypoo) : 6/3/2014 5:52:34 AM (GMT-6)

Davey - I wouldn't be too concerned with 1.2 since it's just at the upper end of the normal range as I think you've already noted and reflected in MamaLama's reply. It will need to get much higher to really start taking note of.