Fatty Liver and Low-Echo Nodules: What You Need to Know

Fatty liver with hypoechoic liver nodules?

Hello Doctor, I have been experiencing elevated serum glutamate-pyruvate transaminase (SGPT) levels for a long time.
My last test showed a level of 57 (normal is 35), so I have been regularly monitoring my liver condition every six months.
All other values are normal.
I just had a health check-up in November 2023, and this time my SGPT level is still normal: CER 1.0 and AFP 1.4.
I do not have hepatitis B or C.
My height is 175 cm, weight is 97 kg, and I have fatty liver, which feels moderate to severe; the imaging looks quite white.

I saw the ultrasound records in the National Health Insurance APP from November 2021, which did not note anything specific.
In May 2022, it mentioned a 1.4 cm low-density nodule in segment 5, and in November 2022, it noted a 1.5 cm low-density nodule in the same segment.
The doctor who examined me did not mention anything specific and did not refer me to a regional hospital for further diagnosis (I went to a small branch hospital).

I am unsure about these low-density nodules, which have not changed much in size over six months.
Could they just be hemangiomas, or possibly low-fat areas due to the fatty liver? Should I be concerned about liver cancer? Thank you, Doctor.

Niu, 30~39 year old female. Ask Date: 2024/01/24

Dr. Chen Shidian reply Gastroenterology and Hepatology

Further imaging studies are required for confirmation.

Reply Date: 2024/01/24

More Info

Understanding fatty liver disease and low-echo nodules in the liver can be quite complex, especially when it comes to interpreting ultrasound findings and laboratory results. Based on your description, it seems you have been diagnosed with moderate to severe fatty liver disease (also known as non-alcoholic fatty liver disease, or NAFLD) and have been monitored for liver function through regular blood tests and imaging studies.

Fatty Liver Disease
Fatty liver disease occurs when excess fat accumulates in liver cells. This condition can be caused by various factors, including obesity, poor diet, sedentary lifestyle, diabetes, and certain medications. In your case, your elevated serum transaminases (AST and ALT) indicate liver inflammation or damage, which is common in fatty liver disease. The fact that your liver function tests have shown some fluctuations but are currently normal is a positive sign, suggesting that while there may be some liver stress, it has not yet progressed to severe damage.

Low-Echo Nodules
The low-echo nodules you mentioned (1.4 cm and 1.5 cm in size) are areas on the ultrasound that appear darker than the surrounding liver tissue. These nodules can represent various conditions, including benign lesions like hemangiomas or focal nodular hyperplasia, or they could be indicative of more serious conditions, including liver cancer. However, the stability of these nodules over a six-month period is reassuring. Generally, benign lesions do not change in size significantly over time, while malignant lesions tend to grow.

Risk Assessment
Given your history of fatty liver disease and the presence of low-echo nodules, it is essential to consider the following:
1. Monitoring: Regular follow-ups with your healthcare provider are crucial. Since your nodules have not changed significantly in size, this is a good sign, but continued monitoring through ultrasound or other imaging modalities may be warranted.

2. Liver Cancer Risk: While fatty liver disease can increase the risk of liver cancer, the presence of stable low-echo nodules does not automatically indicate malignancy. Your healthcare provider may recommend further evaluation, such as a CT scan or MRI, if there are any concerns about the nature of these nodules.

3. Lifestyle Modifications: Addressing the underlying causes of fatty liver disease is vital. This includes weight management, dietary changes (reducing saturated fats and sugars), and increasing physical activity. These lifestyle modifications can help reduce liver fat and improve overall liver health.

4. Follow-Up Testing: Since you have been experiencing elevated liver enzymes in the past, it is essential to continue regular blood tests to monitor liver function. Additionally, tests for viral hepatitis (like Hepatitis B and C) should be performed to rule out other causes of liver disease.

Conclusion
In summary, while the presence of low-echo nodules in the context of fatty liver disease warrants careful monitoring, the stability of these nodules is reassuring. It is essential to maintain regular follow-ups with your healthcare provider, adhere to lifestyle changes, and stay informed about your liver health. If you have any concerns or notice any new symptoms, do not hesitate to reach out to your healthcare provider for further evaluation and guidance.

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