Some liver/biliary disease symptoms but no clear diagnosis...help!?

[MaineMan]

I am a 55 y.o. male with a history of years of modereate to heavy drinking during nightly "happy hours" after work.  I stopped consuming alcohol three months ago when I felt awful and the following symptoms appeared:  clay colored stools, marked fatigue, occasional slight ache in the lower right abdominal area (in the area between the bottom of the rib cage and hip, sometimes extending around to my back), and the development of grayish colored skin at the inside corners of my eyes.

Family physician ordered bloodwork, ultrasound and CT scans.  Ultrasound results were normal.  CT was normal except for noting that I had a "left renal cyst." Routine blood tests were normal for liver tests, kidney tests, blood counts and Sed rate.  More comprehensive blood tests (including CBC, comprehensive metabolic and Hepatitis A,B,C) yielded results in the normal range except for three findings: WBC 4.7, %Monocytes 12.3, Total Bili 1.4

My rural family physician's best guess is "some type of viral infection that needs to run its course...or possibly Gilbert's Syndrome."  

I broke my approximately two months of alcohol abstinance by joining some vacationing friends in a few glasses of wine for three consecutive evenings.  Up until that point I was showing modest improvement in level of fatigue and slightly darker stool color.  However, I noticed regression of symptoms after the drinking of wine, and resumed abstinance. Since then I have again noticed modest improvement in fatigue and stool color.  However, I am feeling discouraged by not feeling "normal."  To make matters worse, my family practioner has just announced he is closing his practice, and I live in a rural area with very few physicians accepting new patients.  I decided to self-refer myself to a gastroenterologist, but that appointment is still more than a month away!  I've done some self-education about my symptoms on the internet and am concerned that I could have some liver disease or other scary problem, and am wondering if I should pursue a comprehensive evaluation at a facility like Mayo or the Lahey Clinic. In fact I called Lahey and they gave me an appointment two months from now!  Yikes!  I'm an educator and have to return to work soon as the new school year begins.  I'm worried that I may not have the energy to do my full time job.  I'm getting frustrated and wold appreciate any feedback concerning ideas as to where I should go from here, or what might be causing the troublesome symptoms.  Thank you very much for reading and responding.

[SUELADY]

A related discussion, nausea/vomiting was started.

[big sexy]

Hi im a 33 year old female im so confused and little scared.well about a year ago i had a retroperitoneal ultrosound done because hemateria.well it came back as a mass identified in the anterior segment right lobe of the liver.it measures 13x15x16mm and has a central vessel and extensive vessels along its periphery. well my question is i had a cat scan done it showed nothing they say the ultrosound just formed a pic than they tell me it just thick wall but when i had cat scan done i took the stuff you drink late like within hr before exam and they left pants on with zippers can that interfere with results.well i been hemateria for about year.and have severe stomach pains im now under gi doctor and he got my ultrosound report hes sending me back for another cat scan what i want to know is how can the ultrosound make a detailed pic like that with central vessel and extensive vessels running from it please help me very confused.i just cant see ultrosound making a pic like that or thickness wall whatever that is they have vessels running from it they never did any other follow up to make sure after that cat scan well like i said my gi dr sending me back for cat scan its been a year but i just wanted to know if ultrosound can make something that detailed up thank you very confused.

[MaineMan]

Dr. Pho:
Thank you very much for your response!  I'm still a little anxious about waiting almost a whole month for my gastro appointment, but the info in your response makes me feel like perhaps a few weeks doesn't mean much in the big picture.  I am on the "cancellation" list...so maybe I'll get lucky and get a call from the doc soon.  Thanks again.

[Kevin Pho, MD]

Certainly the clay-colored stools can be suggestive of biliary obstruction, as evidence by the slight increased in bilirubin.  However, with a normal ultrasound and normal LFTs, it is less likely that a serious liver or gallbladder disease is present.  

I would first see the gastroenterologist to see if further workup is warranted.  If Gilbert's disease is the diagnosis, there is usually no further workup or treatment for this.  

In the meantime, I would consider stopping alcohol until the consultation in case there is a liver issue causing the symptoms.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[MaineMan]

Dear "Surgeon":
Thanks so much for your response!  I will certainly follow through with the gastroenterologist appointment before going to high powered clinics...and I understand you saying that my symptoms are "pretty non-specific."  But I was surprised to see you mention mononucleosis as a possibility...because I didn't realize that grayish skin in the corners of the eyes, clay-colored stools and a persistent low grade ache in the right abdomen could be connected with mono, and that the symptoms could go on for three months.  Keep in mind: I'm a layman!  But some internet research (sometimes a mixed blessing) has me concerned with dire possibilities especially associated with the clay-colored stools (MedlinePlus lists common causes including cancer or benign tumors, sclerosing cholangitis, Biliary cirrhosis, etc...all pretty scary stuff!).  But your response makes me think I shouldn't burn too many calories being anxious about waiting another month for the gastro appointment.  Feel free to comment further, but regardless, thanks again for taking the time to respond.  - -MaineMan- -

[surgeon]

mononucleosis is a possibility. Your symptoms are pretty non-specific. Your liver tests are practically normal. Clay-colored stool, if related to liver/biliary disease, would be associated with markedly elevated bilirubin levels, among others. I'd see the gastroenterologist before going up the ladder to the other clinics.