How come my doctor(s) keep saying my symptoms are not liver related?

[FlyII]

First off I have history of drinking in my family, including myself.  My father passed away of Cirrhosis at 52.  I have had severe symptoms for the past three years.  It started with what feels like burning, prickly skin on my abdomen and a pressure behind my sternum that felt as if it was pushing out.  This started in December of 2001.  It has consistently gotten worse over the years and now the burning, slightly itchy chaffed feeling is on my back and abdomen only but when it is acting up it hurts for my shirt just to touch it.  I have had light colored loose stools all this time that is now consistently yellow or green, never normal. The pain behind my sternum usually is okay the first thing in the morning but gets worse after about mid-day, especially if seated at the computer.  It also gets worse with meals and spreads to my back, I get bloated and full and have to force belching for what amounts to only seconds of relief before returning to pain.  I often can still belch and taste my food many hours after eating.  I had an endoscopy in 2000 that revealed chronic esophagitus and gastritis.  I often am short of breath and I experience strictures when swallowing food.  This is not constant though.  Since fall of 2001 I have had the following tests:
1. Ultrasound - negative
2. CT scan with contrast - negative
3. Another ultrasound - negative
4. An ultrasound with CCK stimulation (Sept,2005) - negative

I have seen my doctor, a gastro and a gastro surgeon.  I asked the surgeon about my liver because of elevated bilirubin.  He stated that the liver was normal size and texture and all fluids were flowing normally.  I have spider angiomas and my doctor has looked at them but is not concerned based on all my other tests.

My question is what is causing the burning, chaffed feeling on my skin (back and abdomen, chest)?  Why does nobody know what I am talking about?  Is it pruritus?  Would not the stool color, angiomas and abdominal pain indicate liver disease even with the negative tests?  I even saw an oncologist for elevatd platelet count and he does not think there is anything wrong.  That is four different docs and a gastro surgeon.  What else can I do short of a liver biopsy? I have normal colored urine and my skin and eyes show no signs of jaundice.    
  

[Woodyspond]

Dear Comon,
I have liver disease (from alcohol) and I'm no physician but it seems that the major question that should be asked of you is..."are you still drinking?"  You said that there is a history but you don't say if you're still drinking.  If you are, I would try to quit and see if your symptoms go away.  I've read in many places that you don't have to have elevated blood levels to have liver disease.  I had a biopsy and that really is the only way to definitely diagnose the liver from what I've been told.  My liver enzymes were only slightly elevated (ALT & AST) and no other blood levels were off but the biopsy showed steotic (spelling?) hepatitis due to alcohol.
I don't know if this helps but you might want to ask your doctor for a biopsy if it will put your mind at ease.  They are not that bad. Just felt like a hard pressure in your side til they're finished, about a minute or so.

[Kevin Pho, MD]

You have had a pretty comprehensive evaluation already, including evaluation by 5 physicians.  Without examining you, it would be tough to say what is causing the skin complaints.  Liver diseases like primary biliary cirrhosis can cause itching and other skin manifestations, but this is a relatively rare disease.  Diagnosis would be done via a liver biopsy.

Most of the more common liver diseases would have been ruled out with the imaging tests that you have already had (including CT scan and ultrasound).  More specialized testing to evaluate the biliary ducts can be considered with an MRCP if indicated by your personal physician.  

You can also consider a referral to a dermatologist to evaluate the skin lesions if the current testing is non-revealing.  

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

[FlyII]

By the way, I had liver work ups many times and the bilirubin is always elevated, but the last two times it was lower, the other enzyme tests appear to be normal.  The gastro surgeon mentioned Gilberts.  He is the same doc that ordered and reviewed the ultrasound with CCK.  I am also gagging alot lately and have a salty taste in my mouth, this seems to stimulate the gagging.  I often have sour taste but attribute that to my GERD.  I had the most thorough blood work done by the oncologist regarding enlarged platelets and no cause was found.