is it possible for an 'alcoholic' to have a normal liver blood test?

[imaginaryfriend]

My aunt has been a heavy drinker for as long as I can remember but because she continually has liver blood tests that come back normal she believes she's kind of 'immune' to getting liver disease. The last few times we've seen her though I've found her looking very unwell, kind of sweaty and breathless and her feet have swollen considerably. Are there other ways a GP should be looking for signs of alcohol-related illness in her? I'm very worried.

[Flossam]

That sounds more heart related.

I would say it was possible as everyone's body reacts differently - plenty of cases of people living to excess outliving the healthy lifestyle types all the time.

Does her GP know about these symptoms?

[zippitippitoes]

I think you can get a normal liver tyest result even with half a liver..I shall see if I can find the reference if it exists..I remember being very surprised it was by a liver specialist

[imaginaryfriend]

Flossam, I think her GP knows about her symptoms. Or at least she says so.

Zippi, I'd be interested to read that. Does that mean that she MIGHT have liver disease but the tests are just not picking it up?

[imaginaryfriend]

She's 56 by the way and drinks at least, from what I've seen, a bottle of wine a day. But I frequently smell alcohol on her breath early in the day, once at 9.30am!

[zippitippitoes]

I can't find it now..but if you google you will see references to the unreliability of liver function tests..the confirmation can come from a liver biopsy

but she may have some other health problems such as heart too

[clumsymum]

Our livers are actually pretty robust, and I wouldn't be at all surprised that your aunt's is responding normally to tests.

My father was a lifelong heavy drinker of spirits (the worst) but never had any liver damage at all, partly because he also ate well (my mothers care, along with a good natural appitite which wasn't blunted by drink).

BTW in the scheme of alcoholics, a bottle of wine a day is pretty small scale you know. A bottle of gin or scotch is more dangerous, but wine is a much safer option if she must.

[foxinsocks]

yes I would say in the grand scheme of alcoholics, a bottle of wine a day (although obviously not great) is by no means on the upper end of the drinking scale.

[imaginaryfriend]

I'll google that now, zippi, thanks.

clumsy, I know it doesn't seem a lot but it's at least 50 odd units a week when a woman should only be drinking 14 at most. Plus, as I said, I'm not sure that's all she drinks. AND she's been drinking that much, every day, for at least 20 years...

[clumsymum]

Imaginaryfriend,

If she's been drinking a bottle of wine a day every day for years, then her body is probably pretty used to processing that much by now, and she may not be in huge imminent danger (not that I'm suggesting it's good for her, of course).

Be VERY wary of trying to get involved with stopping her drinking. It is very likely to ruin any relationship you have with her.
You may think that if you care for her you must tery to stop her. She will regard you as a meddling madam, and will become VERY resentful of your comments and any effort you make to help. After many years, she may be physically unable to stop, and will need medical assistance, but you have to wait until SHE is ready to do it, otherwise she will just blow you out.
Alcoholism is very distructive to family relationships.

[foxinsocks]

also I wonder if she is telling you her liver is normal or have you heard it from the GP himself? Alcoholics can be very secretive.

[imaginaryfriend]

I know, foxinsocks, but I've been doing a lot of reading about it and it's her 'habit' of drinking as much as anything else that worries me.

[imaginaryfriend]

Well, the funny thing is, she's NOT really secretive about it. She describes herself as an 'old lush' and giggles if I mention alcohol on her breath in the morning. I haven't ever nagged her about it in all these years but it was just seeing her looking so unwell lately that's made me wonder.

[imaginaryfriend]

I couldn't find anything about liver function tests being inaccurate. But I did find lots about alcohol units and my aunt is WAY over the limit...

[imaginaryfriend]

any other advice on this?

[imaginaryfriend]

bump

[imaginaryfriend]

bump

[2plus2plus1]

I am no expert, but have done various googles over the last couple of weeks B'cos my father passed away 2 weeks ago & was a chronic alcoholic.

Oedema (e.g. swollen ankles) can be a result of poor liver function, as a result of alcohol. It can, however, be a consequence of many other things. Many alcoholics I know go through phases of oedema, like my father. It comes and goes though.

With the oedema & breathlessness I might be a little worried about DVT/clotting. Don't know where the sweating fits in though & alcohol can protect against DVT to a certain extent. Irrespective of the alcohol I would encourage her to go to GP with these symptoms.

HTH

[zippitippitoes]

this is a very comprehensive source of information the British Liver Trust

[imaginaryfriend]

Thanks 2plus2, I'm sorry to hear about your father. My father-in-law died of cirrhosis of the liver so I know how awful it can be. Did you father die because of his drinking?

Zippi, I'll check that link now, thanks.

[2plus2plus1]

Don't actually know. COD was listed as I. Pulmonary Embolism & II. Cirrhosis. Have been trying to work out whether I. was a consequence of II. As far as I can see alcohol should be partially protective against PE (and as I say DVT), however, I have found a couple of references to the fact late stage cirrhosis can in some cases cause clotting to swing the other way and increase risk of PE, DVT etc.

At the end of the day I am concluding that if it wasn't the alcohol that killed him, it wouldn't have been long with the cirrhosis on death certificate.

[imaginaryfriend]

How awful, 2plus2. Did he drink heavily all his life? My father-in-law was always a drinker but when he retired about 10 years ago he became totally aimless and spent all day every day in his local pub. I've no idea how much he drank each day. My MIL is convinced that he only ever had 3-4 pints a day but I think she can't face the truth.

zippi, I downloaded a PDF from the link you posted and it was helpful but I still can't deduce from anywhere about the liver function blood test - how accurate it is in detecting liver disease due to alcohol. I would imagine my aunt has what would be called 'fatty liver' but whether it's advanced from that to early stages of cirrhosis or hepatitis I can't work out.

[2plus2plus1]

IF don't worry about me. I didn't get on with him. He has been drinking for as long as I can remember but got worse with redundancy about 12yrs ago. 3-4pints a day every day is quite a lot. I shouldn't imagine my father drank much more than this (that would be a 2litre bottle right?), with perhaps a weekly bottle of scotch on top until he couldn't afford that. But as I said I didn't get on with him & rarely saw him so may be wrong.

I guess everybody is different. I have just recalled that my father had LFTs done about 10yrs ago, and was told that the results indicate that he was borderline jaundice, and that he would have a max of 5yrs to live. He has only developed jaundice in teh last month & obviously outlasted GPs prognosis, indicating a degree of variation in our bodies be able to deal with the 'values given' IYSWIM

[2plus2plus1]

Just found this web-site (sorry don't have time to work out how to insert links) which basically says no test is accurate. Don't know if this is what you are looking for...
www.liverdoctor.com/Section2/09_livertest.asp?print=true

[LaidbackinAsia]

Imaginary friend. I have just finished working as a therapist with people with drug and alcohol problems.

The liver function test is one of a raft of test that is often completed with substance misuse patients and it is only part of the diagnostic criteria.Basically it gives you a snap shot of how the liver is functioning at the time of testing. I know lots of severely alcohol dependant people who had relatively normal LFT's and conversly some less heavy drinkers with hugely deranged results. Lots of other symptoms need to be taken into consideration.The sweatiness you describe is possibly alcohol withdrawal (yes- you can be dependant on a bottle of wine a day)

Unfortunately, and I know its a cliche, but people don't change until they are ready to change. Your aunt sounds like she has a long standing relationship with alcohol, which she is not that interested in changing. Things may get worse from a physical health point of view but there are some things a GP can do to support her (depending on how good the GP is) Eg. Some basic education about alcohol, prescribing Vitamin B and Thiamin (to help prevent Korsakoffs and other memory problems)and encourage her to eat and drink properly.

There should be some support groups in your area to offer you advice and support. Lots of people attend Al-anon and you local Drug and Alcohol Action team (DAAT) will have a list of other friends and family groups.

Hope this helps.

[imaginaryfriend]

Thanks 2plus2. It's sstrange but I never thought 3-4 pints a day would constitute a massive amount given that a lot of alcoholics seem to drink a bottle of spirits a day. I guess in that respect my aunt is way over the edge. A bottle of strong wine must be more than 3-4 pints of lager.

That's helpful, Laidback, thanks. BUT what I still wonder is if the liver tests are relatively normal in strong drinkers because their liver is less affected by the booze than it is in other smaller drinkers. What I mean is, can a liver test be WRONG in showing how the liver is affected? Rather than unhelpful in showing how much someone is drinking. Does that make sense? I know my aunt drinks too much but I want to know if the ok liver test means her liver is, as yet, unaffected. Or could it misrepresent what's actually happening with her liver?