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When to consider a Fatty Liver Biopsy

A fatty liver biopsy is an invasive operation used to remove a sample of a liver tissue.

The most common reason for doing a fatty liver biopsy is when the level of your liver enzyme, ALT, is at normal range, but on the other hand, a liver ultrasound scan suggests a non-alcoholic fatty liver.

Who is it for?

Liver biopsy isn’t required in most cases, but it’s sometimes necessary. There is in-fact a scenario where the ALT enzyme level is at normal range, but an ultrasound test suggests a fatty liver.

This is where the data from the blood test and the ultrasound doesn’t add-up, and a liver biopsy can confirm or disregard an existence of a fatty liver, and see not only the amount of fat, but also if there is an inflammation, scar tissue, and necrosis (deal liver cells).

Patients with Insulin Resistance (a pre-diabetic state), or other problems related to Glucose Metabolism, are at higher risk for a complication to an advanced liver diseases.

Learn more about Fatty Liver Diagnosis

You can learn everything about fatty liver diagnosis by clicking here.

Liver and Abdominal Ultrasound Preparation

A abdominal or liver ultrasound plays a crucial role on diagnosing many liver diseases, including a fatty liver. To get an accurate results, it’s very important to understand and know how you should prepare for a liver ultrasound.

Liver Ultrasound Preparation guidelines

  • Do not drink or eat at least 6 hours before the test.
  • On the day before the test, do not eat – fresh fruits and vegetables, fried and oily food, milk, eggs, bread.
  • What you should eat – cooked vegetables, puree, marmalade, honey, roasted bread, soup, and rice.
  • No medications are needed to be taken before the ultrasound.
  • The liver ultrasound scan is completely painless.

Here is its estimated procedure

  • Lying onto an ultrasound table.
  • A special gel will be spread upon your abdomen.
  • The tester will move a tool called “transducer” (looks like a small wand) over the gel, that will create and capture the most relevant images.
  • The tester will process and look at the images, and will enter his conclusions.

Total estimated time of the test: 20-30 minutes.

A typical scene from a Liver Ultrasound room

Learn more about liver ultrasound, and take a look at fatty liver pictures.

Fatty Liver on Ultrasound & Fatty Liver Images

One of the common ways to diagnose liver disorders and diseases (including fatty liver) is an abdominal ultrasound test.

Using fatty liver ultrasound, it is possible to analyze and confirm the existence or non-existence of fatty liver.

The abdominal ultrasound is a painless test that uses sound waves to produce images of your liver, and the entire process usually takes less than 15 minutes, and it is required to fast for at least 6.

For accurate results, you should avoid eating fresh fruits, fried food, milk, eggs, and bread the day before the liver ultrasound test.

How an Abdominal Ultrasound room typically looks like

fatty liver on ultrasound

You will be asked to lie on your back for this test. A special Ultrasound Gel will be rubbed on your abdomen to help send the sound waves better and produce correct liver ultrasound images. Your health-care provider will then move the ultrasound sensor around different area of your abdominal, including your liver. He may ask you to hold your breath at times and/or change positions.

The liver ultrasound pictures helps your doctor to confirm or rule out fatty liver disease, how your liver functions, and whether it’s enlarged or not. In other words, it’s a very useful tool for diagnosing a fatty liver.

Healthy Liver Ultrasound picture

Fatty Liver Images

In the liver ultrasound picture sample above, it shows a typical healthy liver, at normal size, with no signs of a liver disorder. A liver specialist would come to the conclusion that the liver is perfectly normal.

Now lets take a look of a Fatty Liver on Ultrasound

Fatty Liver Images

You can actually see fatty liver images in the ultrasound above (the black area is fat that covers the liver). Fatty Liver is a very common reason for performing an abdominal ultrasound. In fact, it’s the most common liver disease in the world so performing a fatty liver ultrasound is one of the things many people go through to diagnose the disease.

I also recommend you to read full details on liver ultrasound preparation.

Fatty Liver Blood Test

The liver creates various chemicals that are carried out to the bloodstream. Therefor, a blood test is playing a key part in diagnosing many liver disorders and diseases, including a Fatty Liver.

Elevated levels of these chemicals may show a damage to the liver or a specific liver disease. A blood test can measure their levels, and we can try to find the problem even before its symptoms start to show up.

This liver functions blood tests requires to fast for at least 6 hours before the test. Some drugs can affect the results, so please consult with your physician about any drug you use regularly.

Fatty Liver blood test usually includes the following checks

ALT (also called SGPT / Alanine Transaminase)

This is an enzyme that assists proteins to process. High level of ALT may suggest a liver injury. The normal levels of ALT is around 5-40 units per liter (range can vary in different labs).
Fatty Liver blood test

AST (also called SGOT)

An enzyme that is located mainly in liver cells. Its levels are usually raised when there is a liver damage or injury (just like ALT). The normal levels of AST are between 5-45, which is very similar to the ALT enzyme.

ALP (Alkaline Phosphatase)

Related to the biliary tract. If ALP is raised, and high levels of alkaline phosphatase has been found in the bloodstream, the cause might be a liver disorder (including a fatty liver). Normal rates of ALP are between 44-147 units per liter.

GGT (Gamma-Glutamyl Transpeptidase)

An enzyme that is mostly found in the liver, kidneys, heart, and other important organs. The normal rates of GGT are between 40 to 78 units per liter. It’s very similar to ALP (Alkaline Phosphatase), so in that respect, raised GGT can be a symptom of a liver disorder. The difference is that elevated ALP can be also be because of a bone disease, but GGT can’t.

Albumin

This is the core protein created by the liver, that passes into the bloodstream. The ability to make albumin (and many other proteins) is influenced in various liver disorders, including a fatty liver. Normal levels of albumin are between 3.4 to 5.4 deciliter.

Bilirubin

This chemical is a direct result of hemoglobin when it’s released – the molecule that ties oxygen into the red blood cells. The causes of higher bilirubin could be a liver disorder. High level of bilirubin also makes you jaundiced (yellow colored), and could affect your skin and eye color. In the bilirubin blood test, there are 3 types of bilirubin:

  • Direct Bilirubin (unconjugated bilirubin) – passes through the liver. Normal levels of direct bilirubin are between 0 to 0.3 deciliter.
  • Indirect Bilirubin (conjugated bilirubin) – doesn’t pass through the liver. Normal levels of Indirect bilirubin are between 0 to 0.3 deciliter.
  • Total Bilirubin – this is the total amount of direct + indirect bilirubin. Normal levels of total bilirubin are between 0.3 to 1.9 deciliter.

A/G Ratio

The ratio of albumin to globulin. Some liver disorders could lead to a low total protein levels. Normal levels of A/G are below 1 deciliter.

High ALT levels in fatty liver and Elevated ALT levels

An elevated ALT levels in your blood test results could be a sign of a related disorders and diseases, such as Fatty Liver disease, Hepatitis B, Hepatitis C, Cirrhosis, and others.

ALT is a commonly required blood test requested by many physicians from their patients. It’s used to confirm or rule out liver disorders, simply because the enzyme is mostly concentrated in the liver, which is why a higher levels of the enzyme may suggest a problem in the liver.

What are the normal ALT enzyme levels?

Elevated ALT LevelsThe normal level of ALT in the bloodstream is 5 to 45 U/L (units per liter). This range can slightly vary depending where you take the blood test.

When a blood test shows elevated ALT levels outside the normal range, even a small amount, fatty liver and other liver disorders might be the cause.

If the cause of the ALT enzyme level increase is due to a severe liver disease (like Cirrhosis), the levels would be higher than what’s found in fatty livers patients.

Please note that some labs name ALT as “Alanine Transaminase”, “Alanine Aminotransferase” or “SGPT”.

What should I do if I have an Elevated ALT levels?

After you got your results, the first thing you need to do it to consult your physician, the one who requested from you to take the test. He can check the results and choose the next course of action.

In most cases, a follow-up blood test is required to confirm that the first results are not a one-time mishap.

If it is confirmed in the second blood test, you are most likely be required to do an abdominal ultrasound scan. The ultrasound is a necessary tool to look at the liver tissue and to confirm the existence of fatty liver and its severity.

How can I lower my ALT levels?

The most important thing to remember is that most liver diseases such as fatty liver, are very treatable. Fatty liver is also the most common cause of an elevated ALT level.

The main course of treatment is through a determined and decisive actions to heal your liver. It will include weight loss if you’re overweight, change in your food habits, exercise, and more.

Stop eating fat-concentrated foods, and start eating healthy. Use foods for fatty liver recommendations to learn more about what you should and shouldn’t eat. For full details please read thoroughly about fatty liver treatment.

Persistence and a real change in your life-style are the keys to lower your ALT levels.

High alt levels fatty liver

You might need some guidance

This a thought and a big change that isn’t so easy to carry out. It will need your full attention. Your health should be the #1 priority. If you need any guidance, I high recommend the fatty liver diet guide written by Dorothy Spencer BSN, RN, that has been a proven liver diet program that works. It helped a lot of my own patients. Click here to learn more about it.