Understanding My Health Challenges: Prediabetes and Fatty Liver
At the age of 30, I weigh 58 kg and stand at 168 cm tall, maintaining a routine of gym workouts three times per week. Recently, I underwent routine blood tests, including liver enzyme assessments and HbA1c levels. This was necessary due to my prolonged use of fluconazole to treat recurring fungal infections; the tests were conducted three weeks after I completed my last medication dose. **Initial Findings:** - ALAT: 46 (reference range is under 35) - HbA1c: 5.8% Following these results, my physician recommended a comprehensive evaluation of my liver: - Hepatitis tests returned negative. - Alkaline phosphatase and bilirubin levels were within normal limits. - Abdominal and pelvic ultrasound results showed no abnormalities. The only notable anomaly was an elevated GGT level (108). Consequently, I was advised to cease all medications and retest in a month's time. **One Month Later (medication-free)**: - ALAT further increased to 56 - GGT rose to 118 - HbA1c improved slightly to 5.7% My doctor diagnosed me with prediabetes and suspected fatty liver (hepatic steatosis), recommending a low-carbohydrate diet along with increased physical activity. Despite my slim physique, I carry some abdominal fat, leading me to suspect that it might be visceral fat. **Questions I Have:** 1. Can individuals have low cholesterol and triglycerides while still suffering from fatty liver, despite normal HDL and LDL values? 2. Is it possible for liver enzymes to continue to rise even two months after discontinuing fluconazole? 3. What steps should I take next? The results from my second blood test startled me, revealing even higher liver enzyme levels despite my efforts to improve my health: - Nearly two months have passed since I ceased fluconazole. - I reduced my sugar intake significantly. - I maintained my regular exercise routine. This situation has left me feeling perplexed and anxious, seeking advice, particularly from others who may have faced similar health challenges.
Answers (1)
12/16/2025, 2:10:43 PM
OpenHealth AI
Your health concerns about prediabetes and fatty liver are valid, and it's understandable that you're feeling anxious given your recent test results. It's great that you're actively seeking to improve your health and maintain a fitness routine. Let’s break down your questions and provide clear next steps.
Main Points:
- Yes, individuals can have low cholesterol and triglycerides while having fatty liver.
- Liver enzymes can indeed remain elevated for some time even after stopping fluconazole.
- Prioritizing a holistic approach with a focus on diet, exercise, and regular monitoring of your health is essential.
Explanation:
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Fatty Liver and Cholesterol: Fatty liver can occur even in those with normal cholesterol and triglyceride levels. The condition involves lipid accumulation in liver cells, which doesn't always directly correlate with blood lipid levels. Often, insulin resistance plays a significant role, which ties into prediabetes.
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Liver Enzymes & Fluconazole: Liver enzymes can remain elevated post-medication due to the underlying conditions contributing to liver stress, such as fatty liver or other metabolic factors. It's also possible that the liver needs time to recover, and repeated testing helps monitor this recovery.
Next Steps:
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Adopt a Low-Carbohydrate, Balanced Diet: Focus on whole foods, lean proteins, healthy fats, and plenty of vegetables. Aim to limit refined sugars and refined carbohydrates, as these can contribute to insulin resistance and fatty liver. This dietary change can help improve liver health and manage blood sugar levels.
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Increase Physical Activity: In addition to your existing gym routine, consider incorporating more regular cardiovascular exercises that can enhance fat metabolism, such as brisk walking, cycling, or swimming. High-intensity interval training (HIIT) may also be beneficial if you haven’t tried it yet.
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Hydration and Sleep: Ensure you’re drinking plenty of water throughout the day and prioritize getting 7-9 hours of restful sleep per night. Both hydration and adequate sleep are crucial for metabolic health and liver function.
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Monitor Your Progress: Continue regular follow-ups with healthcare professionals for comprehensive metabolic panel tests. Keeping a food and activity diary can help track improvements or patterns related to your symptoms.
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Manage Stress: Consider stress-reduction activities like yoga, meditation, or mindfulness practices to enhance overall well-being, which can indirectly influence metabolic health.
Remember, while these lifestyle changes may take time to show results, consistent effort can lead to significant improvements in your health. If you have any further questions or need more specific advice, feel free to ask. It's essential to stay informed and proactive about your health journey!
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7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options
# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - **Portocaval shunt size: 9.9 mm** (blood bypassing the liver into the inferior vena cava) - **Arteriovenous shunt size: 4.4 mm** - **Portal vein size: 6.1 mm** (patent) - **Three nodular cystic lesions** located in the perivascular area, with largest measuring 11.6×20.7 mm, enhancing during the venous phase - Liver features a heterogeneous architecture, exhibiting irregular enhancement - Gallbladder appears elongated and slightly enlarged - Other abdominal organs exhibit normal findings **RADIOLOGIST’S ASSESSMENT:** "Congenital portosystemic shunt indicative of Abernethy malformation; less likely arteriovenous malformation (AVM); cannot dismiss the possibility of localized liver lesions." **ADVICE:** Seek consultations with an abdominal and vascular surgeon. ### Blood Tests (August 1, 2025): **Complete Blood Count:** - WBC: 10.44 × 10⁹/L (normal range) - **RBC: 2.1 × 10¹²/L** (LOW - indicating severe anemia) - **Hemoglobin: 69 g/L** (CRITICALLY LOW; normal is 117-166) - Platelets: 403 × 10⁹/L (elevated) **Biochemistry Analysis:** - Urea: 1.80 mmol/L (normal) - Creatinine: 33.4 μmol/L (normal) - **ALT: >1000 IU/mL** (EXTREMELY HIGH - severe liver dysfunction) --- ## FOLLOW-UP IMAGING (December 16, 2025 - 5.5 Months Old) ### Liver Ultrasound: **RESULTS:** - Right lobe: 64 mm, left lobe: 43 mm - Liver capsule appears irregular and vague - **Parenchyma: heterogeneous, showing 7 hypo-isoechoic nodules** (sizes range from 11.5×10.7 mm to 17.6×15.4 mm) - Capsule features uneven contours - Blood flow noted during Doppler examination - No dilation in intrahepatic bile ducts - **Portal vein: 3.9 mm** (decreased from 6.1 mm - indicating improvement) - Common bile duct: 1.4 mm - Gallbladder: measures 43.7×9.2 mm (pear-shaped, wall thickness 2.0 mm, homogeneous, free of stones) **ULTRASOUND ASSESSMENT:** "Presence of liver volumetric formations (specifically liver hemangiomas)." --- ## LATEST MSCT (February 6, 2026 - 7 Months Old) ### MSCT with 3-Phase Contrast: **FINDINGS:** - Liver remains normal in size, but shows heterogeneous structure with uneven contrast enhancement - **Portocaval shunt: 9.9 mm** (no change, continues to drain directly into the inferior vena cava avoiding liver acinus) - **Arteriovenous shunt: 4.4 mm** (no alteration) - **Three nodular cystic lesions** in perivascular space, maximum size 11.6×20.7 mm, enhancing in the venous phase - **Portal vein: 6.1 mm** (noted during porto-venous phase) - Arteries show no filling abnormalities - Intrahepatic bile ducts remain non-dilated - Gallbladder is elongated and slightly bigger, free from stones - Pancreas: normal - Spleen: measures 66.9×38.5 mm (not enlarged), splenic vein is 3.6 mm - Kidneys: normal placements and structure - No excess fluid detected in the abdominal cavity - No visible changes in lymph nodes **MSCT ANALYSIS:** "Congenital portosystemic shunt indicative of Abernethy malformation, unlikely to be AVM, presence of focal liver lesions cannot be ruled out." **RECOMMENDATION:** Engage with an abdominal and vascular surgeon. --- ## RECENT BLOOD WORK (December 2025 - January 2026) ### Complete Blood Count (January 19, 2026): - WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? 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