instruction: hi doctor I am 49 years old and I have been drinking approximately 350 my of vodka every day for approximately 10 15 years I also have smoked half pack a day for 30 years but just recently quit for the past year and a half maybe even two years I have had diarrhea daily I went to a doctor who prescribed is medicine and b12 shots but nothing changed my stomach is large distended and hard when I eat half a sandwich or six bites of salad I am so bloated I cannot move I feel a dull bruise like pain very dull in my lower right quadrant from time to time maybe once every two weeks my ast and alt levels are high 12 and 13 glucose is 16 absolute eosinophils are 720h I have attached my lab reports my guess is this is liver disease pancreas disease or diabetes any ideas do I have to quit drinking or can I cut back I am currently taking stelara for psoriasis
output: hello I think there are multiple issues you need proper workup your alt alanine transaminase ast aspartate transaminase are due to alcohol related liver disease better is to do us ultrasound abdomen other issues are I had gone through your blood reports your hemoglobin and hematocrit are in range of polycythemia vera which is a blood coagulation disorder so what is feel is you need a good doctor hematologist for polycythemia and related to your gastric issues us abdomen and endoscopy with biopsy can be done if possible as this will tell us liver and pancreas status as alcohol affects both second thing stop smoking which is a culprit for your high he so to get that worked up there are series of tests need to be done my advice is to choose a good doctor to get everything thing done