Fatty liver

As part of the pre-surgery tests. my bariatric doc wanted the usuals including a abdominal ultrasound.  I took a day off of work and did the tests this past Monday.  I then got a call from my PCP's office who also got the results, on Thursday night.  They said that the doc wanted me to come in to discuss the results of the ultrasound.  She would not offer anything over the phone.  I was concerned and made an appointment to see the doc for the next day.  So I go to my appointment and my regular doc is not there, but his assistant? (a woman who seems to be treated as a doc more than a nurse, but I'm not sure if she is an MD or DO.)  Anyway, she opens my file and at the same time she is reading the diagnosis, "fatty liver" she is reading that my regular doc wanted to see me.  So she wouldn't go into my situation much as she was clearly going to defer to my regular doc on this.  She also was really pissed that the front desk people would schedule me when the regular doc wasn't there.  I don't know to what degree I'm afftected.  I don't know whether it would have been detected in my bloodwork had I not had the ultrasound.  I really don't know anything.  I guess I'll find out on Monday.  I've looked the topic up on-line several times since Friday and have come up with a theory.  I've concluded that anything that affects the liver is some serious ****!!!  So here I am waiting til I see him on Monday, contemplating my future.  Does anyone have any knowledge or experience on this one?  Its called Non alcoholic fatty liver disease.  Will I now be declared ineligible for WLS?  Is WLS a treatment for NAFLD?  Can the condition be used as a co-morbidity to expidite insurance approval?  Any info you guys might possibly be able to offer is greatly appreciated.  I'm off to the gym for some hoops this morning.  That should take my mind off of it for a while. Sonny

Sonny, My surgeon told me the same thing.  He said it is pretty common to have a fatty liver and that it should cure itself after surgery.  As a precaution, he took a liver biopsy during the surgery just to make sure there weren’t any other liver diseases.  I’ve had blood work done at my post op checkups and my liver has been fine.   I wouldn’t worry too much about it, just be aware of it.  Good luck.

Sonny, Here's what I've got on Liver / Liver Disease  Fairly high rate among Obese folk... One of the reasons for the Pre-Op diets is to shrink the liver and remove fat in order to make for shorter/easier surgery... It's not a "deal breaker" by any means and most Obese and MO folk have it to some extent. Wouldn't tend to make you "ineligible for WLS" but support as a co-morbidity and reason to have WLS.  This could certainly help with INS. (not that anyone Ever wants worse health, but good to know they've 'Caught it'!) The info to findout from your doc is the level of advancement of NAFLD. This is a glommed together bunch of info some of us have gathered together at Q-WLS. Hope it helps...---------------------------------- Non Alcoholic Fatty Liver Disease (NAFLD) Non alcoholic fatty liver disease (NAFLD) covers a wide range of liver diseases from the most common, fatty liver (accumulation of fat in the liver, also known as steatosis), to non alcoholic steatohepatitis (NASH, fat in the liver causing liver inflammation), to Cirrhosis (irreversible, scarring of the liver from chronic inflammation). Causes include- - Obesity, particularly around the waist (abdominal obesity) - High blood pressure (hypertension) - One or more abnormal cholesterol levels — high levels of triglycerides, a type of blood fat, or low levels of high-density lipoprotein (HDL) cholesterol, the so-called "good" cholesterol - Resistance to insulin, a hormone that helps to regulate the amount of sugar in your blood. All of the stages of non alcoholic fatty liver disease are now believed to be due to Insulin Resistance, a condition directly associated with obesity.  Very often, the BMI correlates directly with the degree of liver damage.  The greater the BMI the greater the liver damage.  The term non alcoholic is used because liver damage due to alcohol can present the same liver diseases as Non alcoholic fatty liver disease, regardless of alcohol consumption. NAFLD is primarily an affliction of developed countries.- Societies that exhibit sedentary lifestyle and high calorie, sugar, and fat intake which often leads to a prevalence of obesity, insulin resistance, and diabetes. NAFLD is the most common liver disease in the US and worldwide, affecting estimated 10-24% of the world’s population.  In the US, the Centers for Disease Control reports that currently, “approximately one half of the U.S. adult population is overweight (BMI>25) and one quarter of the U.S. adult population is obese(BMI>30).  Thus, upwards of 29 million Americans are likely to have NAFLD, and an estimated 6.4 million of these persons have non alcoholic steatohepatitis (NASH).” In most patients non alcoholic fatty liver disease causes no symptoms and as a result, it is very often undiagnosed.  NAFLD most often is discovered when routine blood tests show slightly elevated levels of liver enzymes in the blood or when ultrasound examination of the abdomen is done for other purposes, such as for looking for gallstones, and fat is found in the liver.  In the late stages of NAFLD cirrhosis develops and can lead to liver failure, edema, accumulation of fluid in the abdomen, and esophageal bleeding.  NAFLD has also been connected to increased incidence of liver cancer. Fatty liver is itself quite harmless, disappears rapidly with loss of weight, and infrequently progresses to non alcoholic steatohepatitis, which is the next stage of non alcoholic fatty liver disease. In non alcoholic steatohepatitis there is accumulation of fat in the liver, but there also is inflammation (hepatitis), destruction (necrosis) of liver cells, and scarring (fibrosis) of the liver. The scarring can progress to cirrhosis, which is the last stage of non alcoholic fatty liver disease.  The risk factors, the time-line, and the processes (mechanisms) responsible for progression through the stages of non alcoholic fatty liver disease are still unclear. Estimates of the number of cases of non alcoholic fatty liver disease among the obese and patients with Diabetes Mellitus type 2 (DM2) suggest that 90% have fatty liver, 20% have non alcoholic steatohepatitis, and 10% have cirrhosis.  Among those with cirrhosis, liver cancer develops in approximately 2% of patients per year. The presumptive diagnosis of non alcoholic fatty liver disease or non alcoholic steatohepatitis is made in individuals who are insulin resistant, have mildly elevated liver enzymes in the blood, and have signs of fatty liver on an ultrasound.  These patients must have no other cause for the abnormal enzymes or for the fatty liver, particularly no excessive use of alcohol. If weight loss results in a decrease or normalization of the liver enzymes, the diagnosis of non alcoholic fatty liver disease is practically assured.  Only a Liver Biopsy, however, can confirm the diagnosis of non alcoholic fatty liver disease and non alcoholic steatohepatitis and determine the severity of the disease. Whether or not it is vital to perform a liver biopsy in individuals with suspected non alcoholic fatty liver disease or non alcoholic steatohepatitis is still debated among liver specialists since no well-proven treatments are available. A liver biopsy can exclude other liver diseases as the cause of the abnormal tests or fat and provide information about the stage (and therefore the expected outcome) of non alcoholic fatty liver disease. It also may provide an incentive for an individual to adopt a healthy lifestyle (diet and exercise) with the aim of losing weight.  Weight loss, if overweight, and correcting elevated cholesterol, triglycerides, and blood sugar yields the best benefit in cases of non alcoholic fatty liver disease. For more information about NAFLD- MayoClinic.com offers-http://www.mayoclinic.com/health/nonalcoholic-fatty-liver-di sease/DS00577 The biggie is to findout from your doc, how far advanced your NAFLD is.  Yes? While waiting to meet about that? NO Alcohol, and cut back on Inflammation inducing Fats.... ----------------------------------------------------------------------------------------- More Re-Post crap from Qx----(my 'other' Board) Dr. Andrew Weil, author of- Eating Well for Optimum Health, in his column in Prevention Magazine- "Avoiding Pro-Inflammatory Fats," suggests- "…eating the right types of fats can greatly reduce pulmonary inflammation." He spells out the following- 1. People eat a variety of fats and oils. 2. The body makes fatty acids from these fats. 3. Prostaglandins, a type of hormone, are by-products of the fatty acids. 4. High levels of certain kinds of prostaglandins produce inflammation. 5. Therefore, in order to reduce inflammation, one should limit fats that produce those pro-inflammatory prostaglandins and eat more of the other ones. Dr. Weil recommends eating from the first list as much as possible and limiting foods from the second list particularly to reduce overall inflammation such as would be desired immediately Post-Op.: Anti-Inflammatory Fats 1. Olive oil 2. Flax oil and flaxseed 3. Hemp oil 4. Walnut oil and walnuts 5. Fish oil—in the form of actual fish like salmon and sardines or in supplements Pro-Inflammatory Fats 1. Safflower oil 2. Corn oil 3. Sesame oil 4. Margarine 5. Partially hydrogenated oils 6. ANY Shortening Oddly, many of the "Animal/Dairy Fats" are ‘fence-sitters’ when it comes to inflammation inducing properties. They tend to balance out offering Pro and Anti-Inflammatory effects that cancel out the harm with benefits. (This is partially responsible for the notion that "Real Butter" is "better" for you than Margarine. Because, in several regards, it is. But think in terms of "Lesser of Two Evils" rather than "Pro-Butter" validation.) Completely eliminating the second list is optimum, but Weil stresses two specific lifestyle changes that are comparatively easy: 1.) Use olive oil for everything you cook and drastically reduce how often you eat packaged baked goods like cookies and crackers. You can even bake with olive oil if you use the light variety. 2.) Limiting pre-made baked goods will protect you because they are usually full of fats from the second list.  Hope all this crap helps..... At least it'll past the time while waiting to meet with the doc? Best Wishes- Dx  

Sonny, I don't think that this will affect your eligibility for WLS, but it may affect the procedure.  My docs put me on a pre-op diet and no alcohol for about 3 months before surgery to "shrink my liver."  For the LAP RNY, they must lift up the liver and work on the stomach beneath it.  If it is too large or too heavy, I was told they may have to do the RNY open.  I lost 24# pre-op and the docs were able to perform the surgery LAP for me. Not sure what procedure you are trying for, but that's my 2 cents. It would seem as if this diagnosis would be another co-morbidity and help with the insurance end, but I am not an expert on that, either. Good luck to you! Bob

Hi Sonny,     I was told I had a fatty liver as the result of my testing as well. My surgeron and Nut put me on a low fat diet pre-op.  From what I was told, by shrinking the liver it makes the surgeons job easier. I read that some surgeries have been converted from Lap to Open because the surgeon couldn't work around the liver because of size and the fear of damaging it by trying to move it out of the way. I followed the diet as far as what not to eat, I did not follow the amounts of food like I was supposed to. It said 3 oz. of meat and maybe a cup of salad. Hell it was like a snack. I would eat more salad or veggies or something like that to fill me up. I lost weight and shrunk my liver as well. I told my Doc this and he said as long as I was eating the right foods it was OK. My surgery only took 45 minutes. He said it was because I followed the diet and it made his job easier. I lost 35 pounds before surgery and 81 pounds since ( 12-14-06). pan head

Same as the folks above me, the doc said I had a fatty liver as well.  He prescribed losing 50# and eating better, which I did.  Something about when the liver has too much fat, it's hard to move, it's too stiff; regarding the surgeon being able to work up in there.

Hi Sonny, I can only share my experience with you: My family doc ordered an abdominal echo for me too prior to recommending me to a bariatric specialist for the surgery. When I had it done, the "nice" attending nurse says to me " I've never seen such an engorged liver in all my time doing this" It floored me, and hurt me like he probably still doesn't know. But it also motivated me to do something when I asked my doctor what the consequences could be and he mentioned requiring a liver transplant as one of them. That is what motivated me the most towards having the lapband installed and losing weight. As mentionned by others, shrinking the liver is pretty much a pre-requisite if you are getty a laparoscopic surgery procedure, in order for the surgeon to be able to work. Mine flatly told me that he had closed up patients and sent them back to do more liquid dieting (Optifast for another 3 weeks anyone?) before re-scheduling them for surgery. If the liver was too big, he wasn't doing it: the patient has his share of work to do in order to show his commitment to this surgery. So, don't worry too much about it, since you already took the surgery decision to loose weight, and wait to see what your Doctor has to say. Good luck to you,

I guess I shouldn't be suprised.  What would I expect to have, a thin liver! Sonny

Fatty Liver is almost a given for anyone who has even a little extra middle age spread. Was encouraged to hear (or "see", actually saw the photos) that it had disappeared when the doc went in for internal hernia surgery. Originally on the RNY video it looked at little like bacon. In the internal hernia surgery photos, it had turned to a solid bloody red. No white stripes.