Why is my liver in trouble when I am a moderate drinker?

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Why is my liver in trouble when I am a moderate drinker?Dr Stuttaford

Your health questions answered

A reader, who spends much of his time overseas as an aid worker in Africa, India and Pakistan, has written to say that a recent blood test revealed abnormal liver function. He assures us that he is only a moderate drinker and hasn’t had any blood transfusions at any time of his life. He did, however, have major orthopaedic surgery in Africa 15 years ago.When he goes to a malarial zone he takes Malarone. He has never used illegal drugs. Patients who are found to have raised liver enzymes during a routine examination present their doctors with a difficult problem. The easy, idle, thoughtless way of dealing with an unexplained small increase in one or more of the liver enzymes in a patient is to suggest that he or she is being dishonest about their alcohol intake and accept that this is the explanation. Recent research has shown that modest drinkers are, like problem drinkers, likely to under-report their intake.

Our reader is obviously well informed. He has already considered many of the points in his medical history that could be relevant. We have to accept that he is accurate about his alcohol intake. He has obviously understood the importance of blood-borne hepatitis B and C and has told us that he has never had a transfusion or used injectable drugs. There are many other ways that hepatitis C might be transmitted other than by contact with contaminated blood or through transfusions or by drug abuse. It is noteworthy that he had major surgery before this danger was recognised. He hasn’t mentioned tattooing or body piercing that are occasional causes of transmission of hepatitis C, nor acupuncture, although reputable acupuncturists are as conscientious about sterility as doctors. Medical staff, care workers, boxers, rugby footballers, other contact sports athletes and even kindly people who bind up the minor injuries of children are all at some slight risk of being contaminated with infected blood. In an appreciable proportion of cases of hepatitis C the source of the infection is never traced. Very rarely, Malarone, an excellent anti-malarial, may cause an increase in liver enzymes. This is one possible cause, even perhaps the probable cause of the minor liver function changes. Another consideration in his case is that several tropical diseases may cause liver damage. Should he be worried? Not worried, but certainly he needs careful monitoring, and should have immediate blood tests to see if he has ever had hepatitis B or C. If the liver function tests don’t return to normal he should ask his GP if it would be wise to consult a hepatologist, who may seek a second opinion from a specialist in tropical diseases. Anyone and everyone who has abnormal liver function of unknown origin wherever they live, and whatever their lifestyle, needs to have their blood tested to make certain that they haven’t picked up hepatitis C. There are somewhere between 400,000 and 900,000 people in Britain with hepatitis C who are unaware that they carry this potentially lethal virus, but are initially free of symptoms. There are also 200,000 who have the diagnosis. It is important to detect hepatitis C at an early stage before there is appreciable liver damage and at a time when it is more easily treated. Overall, when taking into account the varying response to treatment of the many different types of hepatitis C, combined anti-viral therapy will now clear the body of any detectable hepatitis C virus in 40 per cent of cases. In patients carrying some types of hepatitis C the percentage is appreciably greater. timesonline.co.uk/talkingpointE-mail Dr Stuttaford your questions on ovarian cancer Ask Dr Stuttaford: Send your questions on other topics to drstuttaford@... or to times2, The Times, 1 Pennington Street, London E98 1TT. Please include the following: the symptoms (and how long they have been present), the person’s age, sex and marital status. Dr Stuttaford’s replies cannot apply to individual cases but should be taken in a general context. http://www.timesonline.co.uk/article/0,,8124-2195237,00.html