My son, 48, is a recovering alcoholic who hasn’t had a drink in six months. He was recently diagnosed with fatty liver; he has read that he can cause cancer and is extremely anxious, although his GP didn’t think there was anything to worry about. Otherwise, my son is active and now he takes care of himself.
Name and address provided.
Dr Martin Scurr responds: Fatty liver is a very common condition; Basically, as the name suggests, fat accumulates in the liver, which affects its function and can cause damage over time.
Broadly speaking, there are two types of fatty liver disease: nonalcoholic fatty liver disease, which is associated with obesity and is now officially known as metabolic dysfunction-associated steatotic liver disease (MASLD). In fact, many people who suffer from it drink little alcohol.
Fatty liver is a very common condition; Basically, as the name suggests, fat accumulates in the liver, which affects its function and can cause damage over time.
Your child has the other type, metabolic dysfunction and alcohol-associated liver disease (MetALD), where there is not only fat accumulation, but also inflammation and damage caused by alcohol consumption.
Both types of fatty liver disease can cause scarring (cirrhosis), which is a risk factor for cancer, but the risk is higher with MetALD.
Excessive drinking can quickly cause fat to build up in the liver, in as little as two weeks, research shows.
About a third of patients with alcohol-related fatty liver will progress to the inflammatory stage if they continue drinking and 16 percent will develop cirrhosis. Ultimately, a small proportion develop cancer.
Fatty liver, whatever the cause, usually produces no symptoms until the liver has suffered serious damage; These include general feeling of weakness, swelling (in the ankles and stomach), loss of appetite, vomiting blood, passing blood in the stool. and yellowing of the eyes or skin.
But this is not inevitable, and the damage can stop (and even reverse) once the person stops drinking alcohol (or, in the case of MASLD, loses weight).
The liver is the only large organ in the body that can completely regenerate, and it can begin to do so quickly, within months.
It seems as if your child has avoided this last stage: his anxiety about the fatty liver diagnosis may help him maintain abstinence. Since he has been abstinent for six months, I imagine his liver function is close to fully recovering.
I am 74 years old and have recently had frequent attacks of cystitis. I wonder if a vaginal prolapse involving a rectocele could be a contributing factor. I have been prescribed a penicillin-based antibiotic for cystitis that has caused acute diarrhea. Should I stop taking it early? I am a retired nurse.
P. Wells, Aylesbury, Bucks.
Dr Martin Scurr responds: As a nurse, you will understand the anatomy of your problem, but first I will explain it to other readers.
A rectocele is the term for a prolapse in which weakness of the pelvic floor causes the rectum to sag against the vaginal wall.
However, recurrent cystitis (a urinary tract infection or UTI) is not a recognized consequence of a rectocele; This is something that can occur with a prolapsed bladder (known as a cystocele).
That said, many women your age have recurrent cystitis and this is not necessarily related to organ prolapse, but rather as a result of changes due to the drop in estrogen after menopause.
For recurrent UTIs, it is important that the correct antibiotic be prescribed, which involves sending a urine sample to a laboratory to be tested to identify the bacteria causing it (a step that is too often skipped).
So one option is to give a daily low dose of antibiotics preventatively for a few months. This can be effective, but must be carefully weighed against the potential risk of antibiotic resistance, developing a drug allergy, or altering the gut microbiome (the community of microbes that live in the gut and play an important role in maintaining health). health).
Some antibiotics are prone to causing diarrhea, for example coamoxiclav.
Rather than stopping the antibiotic treatment early, I would ask your GP for an alternative option after explaining what happened.
Another option is a new vaccine, administered as a spray under the tongue, aimed at preventing recurrent urinary tract infections in women.
It contains four types of inactivated bacteria, commonly involved in cystitis, and is taken daily for three months. Studies have shown this strategy to be effective in more than half of women suffering from chronic cystitis – it might be worth discussing this with your doctor too.
