Cirrhosis and spider angiomas

Dear Doc,

I have a 6 year history of heavy drinking (half to one bottle of wine) a day. In August of 2007 I got pregnant and quit drinking over night. During my pregnancy I developed gestational diabetes which was controlled by diet, no further complication during the pregnancy. Both my parens have type 2 diabetes. After giving birth to my daughter in May of 2008 I developed post partum hyperthyroidism and to control the symptoms I was given beta blockers. I also had one episode of diverticulitis a few month after the delivery. A few weeks ago I started to get red dots on my hands and palms which was diagnosed as spider angiomas by my dermatologist. I haven't had alcohol since Aug 07. My doctor ordered several blood tests including liver function tests, cbc, pt/inr, amylase, mg, phosphorus, cholesterol, glucose (back to normal), lipase and all came back normal. Since I kept developing these red spots he also ordered an ultrasound of the gallbladder and liver which didn't show anything abnormal. My thyroid levels are still not in the normal range but are improving a little every month. My doctor doesn't think that I have a serious disease like cirrhosis but he is not an expert (family practice). I do have some right upper quadrant discomfort every once in a while that feels like a pulling. Now my questions.

Is it possible to still have cirrhosis even though all my blood work came back normal and I haven't had alcohol for over a year?

Could these spider angiomas come from my hyperthyroidism?

Could the right upper quadrant pain be related to the diverticulitis?

Would you recommend a liver biopsy?

I am terrified all day long and feel helpless.

Thank you.

[Kevin Pho, MD]

To answer your questions:

1) Spider angiomas are not commonly associated with the thyroid, although I can't definitively say that the thyroid can't be involved.

2) Diverticulitis typically presents in the left lower quadrant.  It would be atypical for RUQ pain to be caused by diverticulitis.

3) If the liver enzymes are normal, along with a normal ultrasound, not many doctors would perform a biopsy.  That being said, if there was strong suspicion of cirrhosis, a biopsy is the only way to obtain a definitive diagnosis.

These options should be discussed with a GI physician.

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 Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd