Dear Dr. Roach: I am a 77-year-old woman. I am 5 feet, 2 inches tall and weigh 107 pounds. I take no medication. When I went to the doctor last week, he found that my alkaline phosphatase was 176, my ALT 10, and my AST 11. He told me I had fatty liver and to get a scan, but I had no way to get to the place to have it done. He did not say anything else about it. I have no symptoms. Does this sound like fatty liver to you? I did not really like my doctor, but with my insurance it is hard to change doctors.
If I do have fatty liver, is there anything I can do for it? J.F.
Answer: Fatty liver is an increasingly common problem. Risk factors include being overweight and having diabetes, high blood pressure and abnormal blood cholesterol levels. Alcohol use is also a cause of fatty liver, and all people with fatty liver are strongly recommended to abstain from alcohol entirely. The primary treatment is diet and weight loss.
It sounds like there was some missed communication between you and your doctor. Fatty liver is a possibility; however, it does not seem likely to me, as you have not identified any of the risk factors, and you are certainly not overweight (if anything, you are a bit underweight). Further, although the alkaline phosphatase can be elevated in fatty liver (yours is just a bit high), it is more common for AST and ALT to be elevated, which yours are not.
An ultrasound scan is a good, but not definitive, way of looking for fatty liver. A liver biopsy is still the definitive test, but it’s often not done in people whose history, physical exam and ultrasound are all suggestive.
A slightly abnormal alkaline phosphatase does not necessarily mean you have a liver problem. Bone issues (fractures, Paget’s disease of bone, high thyroid and parathyroid hormone levels) can cause a high alkaline phosphatase, too. Additional liver tests — checking the GGT level or specifically what kind of alkaline phosphatase you have (by isoenzyme analysis) — can make the source of the elevated alkaline phosphatase clearer.
Getting an ultrasound scan and additional blood tests is a reasonable place to start. Unfortunately, lack of confidence in your physician is a different problem. If you really can’t get a new doctor, then you need to have a conversation about proceeding with evaluation in such a way that you can do so while being confident that you are getting good advice.
