Fatty liver vs. liver sarcoidosis

Hi Everyone,

Can someone tell me what is the difference between fatty liver vs. liver sarcoidosis? I have a fatty liver according to an ultrasound and a catscan and my doctor keeps saying that it's just fatty. My liver enzyme tests were slightly elevated. How can he tell the difference. Does a liver with sarcoidosis have some basic distinct characteristics that are immediately identifiable vs. just fat in the liver? I asked if it could be sarcoid in my liver and he said no, it's just fatty! Would the test results say something more specific to indicate that it could possibly be sarcoid? I have been having some really bad stomach problems... ie, bloating, nausea & vomiting. Sometimes I am awaken by having to rush to the bathroom to vomit. My GI doc has run a number of tests to see if it's my gallbladder and everything is coming back normal. I also have pain in my right side and back. Could that be from the sarcoid in my lungs? Has anyone with liver sarcoid had pain with it or is this pain most likely from my lungs? Just curious, as you know we have to practically diagnose ourselves. I am about fed up to my eyeballs with these doctors not knowing more about sarcoidosis!!!!!!! By the way, my spleen is fatty too!

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When you say both the liver and spleen are fatty I tend to say get a second or third opinion as I think they are sarc problems if you have sarc anywhere else it is probably guaranteed. A fatty liver if there is no other indication does not have to mean sarc, whereas sarc can and does leave scleara on the surface so the surface looks like train tracks or barbed wire and the yellow fat or scirossis becomes pronounced but the marks are what denotes sarc and a few other diseases like it.

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Been there, done that, got the t-shirt!

Okay maybe that is a British joke but what I mean is that has already happened to me. Dr was convinced it was just fatty liver but I pushed and pushed for a liver biopsy and low and behold it wasn't just fatty liver at all! Yes there was fatty liver but also the inevitable granulomas of sarcoidosis.

The conclusion - scan as much as you like but until you have a liver biopsy then you cant know for sure. Incidently as I said in other posts a defective liver doesn't always produce symptoms so even if you do have a biopsy it may not necessarily show it as a cause of your own particular symptoms. Sorry if this sounds vague.

Keith

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I am going through much of the same myself except my doctors acknowledge that without a liver biopsy you can't tell the difference between fatty liver and liver sarc. You need a biopsy to confirm or rule out sarc. My liver enzymes have consistently been going up first the ALT then the other one I'm sorry my mind is on vacation ! Now their both elevated. I too experience the pain and nausea and GI issues. Let me know how you make out:)

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I've had a fatty liver for 5+ yrs and it was just biopsed in May when my gallbladder was removed. My levels are always elevated. Ends up, if the surgeon is correct, that it is a fatty liver damaged from a med that was given to me unsupervised that can cause liver damage and I was on it for 1 yr.

I had constant right side belly and back pain and test aft test was done, I had so much radiation put into me I should be glowing but always came back that my gallbladder was fine. I finally found the right dr and my gallbladder was removed and it looked fine until opened and it was completely inflamed just as I told the drs it was.

I have granulomas in my spleen but NO dr wants to discuss that issue and I've had them for yrs so I guess I won't worry about it.

Good luck to you, I am so happy my pain is gone. I still have some bloating and aft surgical pain that may stay with me but I am happier.

GN

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Good Morning!

OMG! What great information!! Thank you all for getting back to me so quickly! Do either of you have pain with lung sarcoidosis?

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I have been told i have a fatty liver but have been to see a liver consultant who tells me that he thinks i have a fatty liver and sarc in the liver, as i had my gallbladder removed and it was found to be in there, an he said if its in the gallbladder then he is very sure it will be in the liver, so he is doing a biopsy within the next few weeks. I too feel sick a lot and have pain in the side that goes to my back

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Thank you Shellycav66!

I am waiting on the results from a gallbladder emptying test and if they come back normal, I am going to insist that he takes it out anyway!

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Don't know exactly what your doc has tested for or why he feels you don't have hep sarc, but only way to know for sure is the biopsy. I had slightly elevated enzymes for several years + high cholesterol (the bad kind and low levels of the good kind) and high triglycerides. Doc sent me for a CT guided biopsy of a random tissue sample (versus a specific lobe). It came back positive for granulomas, but with not a lot of them. He said I needed to get cholesterol under control first before worrying about sarc. Fatty liver is much more dangerous. Also, treatment for sarc is generally prednisone and it makes you gain weight. Last thing someone needs when they already have problem with fatty liver. Make sense? The sarc can cause pain, but so can the fatty liver. Sarc isn't the only disease that causes pain, and we aren't immune from other diseases, too. We have to be careful about maintaining our health in all that we do so that when we have problems with sarc, we are in the best shape possible to deal with it. : )

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Hi Shae44. I agree with Farrow. I have had liver sarcoid for the past 25 years. It was diagnosed during a liver biopsy. Although my liver enzymes tests were always slightly elevated, I was never diagnosed with a fatty liver nor did I have any visible symptoms of sarcoid. Then, 4 years ago I blew up (or swelled up) like a nine month pregnant woman and had terrible pains on my right side underneath the chest. The pain was so bad I couldn't sleep or stay in one position for very long. I was immediately hospitalized and had another liver biopsy done. It showed I now had cirrhosis and only 30% of my liver left. Who knows what happened or if anything could have been done about it. I've never taken prednisolone in a pill format. I have been taking prednisolone in my eyes for the last 37 years due to iritis. Get a liver biopsy if you want to be certain. Good luck!!

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Don't know about everyone else but my lungs hurt actually before I began to cough and hack up the world's yuckiest crap but we always have fun with this stuff. My liver biopsy was done when I had gall bladder surgery and showed sarc. But everyone already knew because of the scars.

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Thanks everyone,

Seems that there is a big correlation between the gall bladder & liver symptoms for us! Now, I won't take no for an answer in getting a biopsy done!!! I truly believe that I have sarcoid in my liver, gall bladder & spleen! Wow, this is so messed up.

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As for your question about pain in my lungs. I only get pain in my lungs when I do to much. For instance I just had my PFT's done and we did a 6 minute walk test as part of the Pulmonary Function Test. My lungs hurt so bad after doing that. Most of my pain is throbbing pain on my right side, pain on the left side under my ribs and in the middle of my chest. Of course I get the heart palps all the time which are driving me crazy and go hand in hand with over doing it.

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I have NASH Diease which is Non Alcoholic Fatty Liver Disease with Hepatitis and Scaroid of the Liver all DX with Liver Biopsy at the U of M in Michigan. So to see if you have Scaroid in the Liver you will need a Biopsy of the Liver. I have had Sarcoid for a very long time and Now it is every where except the brain. Doing Chemo Now and taking one Day at a Time.

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A PET scan would display liver grandulomas and grandulomas anywhere in yor body.
This would rule out a fatty liver if abnormal cells appeared on the scan. Just a thought.
My PET displayed all the areas of abnormal tissue. This was followed by biopsies to find a dx.
Often, a fine needle biopsy will not pick up the granduloma tissue leading to an incorrect reading.
After 3 fine needle biopsies (liver -spleen and lymph) where enough tissue was not retrieved for diagnosis, a laproscopic biopsy of all three organs, got the visual and also the tissue to get my organ sarc diagnosis. GOOD LUCK in your walk with sarc.

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Hi ellj,

So nice to have you back! I have been pushing to get a PET scan done and nobody will touch it! All the doctors keep saying that there is no evidence to prove that I need one. What should be required for them to have this procedure done? Is it based on the lab results only? Because with them doing all these tests for my stomach problems and every test has been normal, seems like I should be able to convince somebody to do it. I am calling my GI doctor now! Will let you know the outcome!

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If not a PET, have they done a CAT scan of the abdominal organs?

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yes, and everything is fatty... my liver & spleen, however, he said that my gall bladder was normal???

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I have had multiple CT scans done and a PET scan and they all confirmed the Sarc on my liver and spleen and lots of other places. The first radiologist read the PET stating that I 'had severe metastatic cancer'. That was 2 years ago. I have stage 3 lung sarc, and I have lots of right side pain under my rib, gallbladder ultrasound was negt. and I have LLQ and back pain, too. My pulomonologists said it was inflammation from the sarc and since I can't take NSAIDS, because they mess up my BUN and Creatinine and could lead to kidney failure, he RX'd some Flexeril and Darvocet to take.

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I was told that a liver biopsy would be hard to get to and too painful to go through just to diagnose sarc when the PET and CT already showed granulomas on my spleen and liver. So I dropped it. I wonder if it got bad enough, if they could resect the liver, and take out the spleen??? If that would help??

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Shae44...have you considered getting some second opinions...I mean I keep reading your post and I get mad. Your health and life aren't nothing to play with!! Enough is enough....I myself done reached the point of fed up!!!!!!!!!! I call the docs EVERTIME I catch a pain...and being a sarcie you already know that is on a regular basis. I make the document everything now...from blisters to a piece of hair I lost....lol...but really. I do so just in case they screw up and FINALLY find what the heck I been telling them it's going to be hell to pay!!!! And I do mean PAY!!!!! When you are in pain..everything AIN'T normal...

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