instruction: hello doctor I am fat my weight was 130 keg and I reduced 15 keg in five months I was having alcohol and smoking for almost 10 years I had an ultrasound where liver is enlarged more than 20 am and I had a fibroscan as well 353 and 18 median kpa kindly suggest
output: hello I can imagine how upset you must be about your overweight and liver issues well I assume you now have a thorough idea of how this weight bears an impact on your liver and with such amount of weight it is not uncommon to have a fatty liver disease with enlargement of liver size the normal liver size should be no more than 13 am despite the fact you have severe morbid obesity thankfully you deserve a vote of appreciation for struggling so high to reduce your weight by 15 keg this is a good sign by the way I would urge you to continue this in future whatever you were doing for the weight reduction since you did not mention whether you still having alcohol and smoking it is important to know that fatty liver plus alcohol can both damage the liver and the impact is much higher if both risk factors are combined I should strongly recommend you to reduce the alcohol intake if still taking or completely stop it your liver may not be able to tolerate more insult because of alcohol now coming to the numbers which you have shared the spa value more than 12 is suggestive of the development of fibrosis which is not a good sign however this value is often erratic or falsely high if someone has obesity or fat within the liver as may be in your case to confirm whether you have that degree of fibrosis you have to get a liver biopsy which can tell the exact grade of fibrosis and can differentiate whether the insult to your liver is because of alcohol you had in past or because of fat due to obesity the cap value of 353 is suggestive of the amount of fat you have in the liver this can however indirectly confirm the damage to your liver is rather secondary to fat and not due to alcohol but again this has to be confirmed on liver biopsy if you are not inclined to liver biopsy I suggest you to continue with the weight reduction strategy completely avoid alcohol intake and keep monitoring your liver function tests and fibroscan every six months alcohol related liver disease plus obesity and fat induced liver disease complete blood count liver function test hbsag anti hav antibody serum ferritin serum iron total iron binding capacity transferring saturation ash ft3 ft4 serum carbohydrate deficient transferin cdt levels serum albumin total protein and ag ratio serum creatinine bun electrolytes alpha fetoprotein app weight reduction alcohol abstinance follow up after investigation to propose plan of action follow up to provide more information and after investigations or earlier if required