Liver Pain and Yellowing Eyes After Alcohol Abuse - Gastroenterology and Hepatology

Dull pain in the liver area and yellowing of the sclera?

Hello! I have been a long-term alcoholic for about 7 to 8 years, starting with red wine, then whiskey, and later consuming approximately 250 to 300 cc of 58% sorghum liquor each night (I have a habit of drinking until I fall asleep, and possibly due to long-term alcohol consumption, my tolerance has increased, and I may have some alcohol dependence, experiencing several uncomfortable withdrawal symptoms during initial attempts to quit).
The situation was most severe in 2019 and 2020, where I would drink every night, and on days off, I would also drink 250 to 300 cc in the morning, sleep in the afternoon, and continue drinking at night...
I quit drinking at the end of March this year and had another health check-up in May.
In recent years (from 2016 to 2019), my health check reports showed elevated BMI, liver enzymes, and blood pressure.
In the 2019 check-up, my GPT was 94, GOT was 61, R-GT was 146, total cholesterol was 221, and blood pressure was 173/96 (I have never taken medication for high blood pressure, which has consistently been high during check-ups).
My monocyte count was 10.4, uric acid was 8.6, and waist circumference was 99.
An ultrasound at that time indicated moderate fatty liver.
In May 2021, during another check-up, my GPT was 27, waist circumference was 84, total cholesterol was 189, and blood pressure was 142/86 (I have measured my blood pressure at home using three different devices, and it consistently reads around 100-110/70-90).
A chest X-ray showed no abnormalities (though I understand this does not assess the liver, which I find confusing), and I did not have an ultrasound.
Approximately since 2018, I have occasionally experienced dull pain under the right rib cage that lasts about one to two minutes before subsiding (it is not severe pain, just uncomfortable), occurring irregularly—sometimes several times a day, and other times not at all, but I usually feel it a few days a week.
In May 2021, after quitting alcohol, my liver enzyme levels had significantly decreased, and the frequency of dull pain under the right rib cage has also reduced considerably, with only experiencing it once or twice in the last three to four months.
My sclera appears slightly yellow; I consulted an ophthalmologist who said it varies from person to person and did not find my sclera to be very yellow.
However, he mentioned that the liver could be a concern and suggested a blood test (but in previous photos, my sclera appeared clear...
some older adults in their 50s and 60s still have very white sclera).
During the health check, the doctor also examined my lower eyelids and did not mention anything unusual.
Is this a consequence of my drinking...
will my sclera not return to normal? I would like to ask the doctor, since the dull pain is approximately in the area of the liver (combined with my previous alcohol use), even though I have quit drinking and the dull pain is now infrequent, and my liver enzyme levels have decreased, I am concerned about the liver since it has no pain receptors.
Given the current pandemic and that I do not have any severe discomfort, I feel that going directly to the hospital might waste healthcare resources.
However, I am still quite worried, so I would like to seek the doctor's opinion.
Should I go to the hospital for further evaluation, or should I continue to observe my condition? (I have heard that if there is any sensation in the liver, it is quite serious...) I apologize for my poor writing, and I appreciate your time in responding.
Thank you.

Niming, 30~39 year old female. Ask Date: 2021/06/11

Dr. Chen Shidian reply Gastroenterology and Hepatology

It would still be reassuring to go to the hospital for an ultrasound examination.

Reply Date: 2021/06/11

More Info

Understanding liver pain and yellowing of the eyes, especially after a history of alcohol abuse, is crucial for assessing potential liver damage and overall health. Your history of heavy drinking for several years, followed by a significant reduction in alcohol consumption, raises important questions about liver function and the symptoms you are experiencing.

Firstly, the liver is a vital organ responsible for numerous functions, including detoxification, protein synthesis, and the production of biochemicals necessary for digestion. Chronic alcohol consumption can lead to various liver conditions, including fatty liver disease, alcoholic hepatitis, and eventually cirrhosis. The symptoms you describe, such as right upper quadrant pain and yellowing of the eyes (jaundice), can be indicative of liver dysfunction.

The right upper quadrant pain you experience could be related to liver inflammation or enlargement, often seen in conditions like fatty liver disease or alcoholic hepatitis. The fact that this pain has decreased since you stopped drinking is a positive sign, suggesting that your liver may be recovering. However, the intermittent nature of this pain and its location near the liver warrants further investigation, especially since the liver itself does not have pain receptors. Pain in this area could also stem from other structures, such as the gallbladder or even musculoskeletal issues.

Regarding the yellowing of your eyes, this is typically a sign of jaundice, which occurs when there is an excess of bilirubin in the bloodstream. Bilirubin is a byproduct of the breakdown of red blood cells, and the liver plays a crucial role in processing it. Elevated bilirubin levels can result from liver dysfunction, bile duct obstruction, or hemolysis (increased breakdown of red blood cells). Since your liver function tests (GOT and GPT) have improved after you stopped drinking, it suggests that your liver is beginning to heal. However, persistent yellowing of the eyes, even with normal liver function tests, should not be ignored. It may be worthwhile to check bilirubin levels and other liver function tests to rule out any underlying issues.

Given your history of alcohol abuse and the symptoms you are experiencing, it is advisable to consult a healthcare professional for a thorough evaluation. While your liver enzymes have improved, the presence of jaundice and any ongoing discomfort should be assessed further. A liver ultrasound or additional imaging studies may be warranted to evaluate the liver's structure and rule out any complications such as fatty liver disease or other liver pathologies.

In summary, while your symptoms may be improving, the combination of right upper quadrant pain and yellowing of the eyes necessitates a careful evaluation. It is essential to monitor your liver health, especially after a history of alcohol abuse. Regular follow-ups with your healthcare provider, including blood tests and imaging studies, can help ensure that any potential issues are identified and managed promptly. Taking proactive steps in your healthcare will not only provide peace of mind but also support your overall recovery and well-being.

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