nail abnormality and abnormal LFT

Hi,
I posted about a year ago on the dermatology forum about having abnormal nail issues.  I have, on one thumb a bubble/dent in the middle of my nail.  It never goes away...I also have it on two of my other fingernails.  The dermatologist said that it is only a concern if it is "all" your fingernails.  The issue I have is I also have unexplained elevated lft's both slightly elevated about 50/45 alt/ast.  They have been repeated many times over the past few years and stays the same.  I have had many consults with GI/neurologist/rheumatologist and any test that have been performed have come back either fine or "false positives".  It all started with me having muscle aches and spasms/fasiculations all over my body for a long periord of time.  My GP said it was anxiety related and not to worry about my liver as well.  I have gerd that is being treated with omeprazole.  All hepatitis test including C have come back negative and they have been repeated over the last year.  I have had a CT scan and ultrasound in the past.  The ultrasound was negative, the CT scan had some "hook" on the liver.  The specialist wanted it to be repeated but neither him nor my GP is concern about it and said it was normal.  Both my brothers have slightly elevated lft's but never pursued further testing.  My question is should I go to a dermatologist for my fingernail or should I just forget about pursing this.  Do you think it is related to any liver disease or GI bleeding?   What do you think?  Thanks

[Kevin Pho, MD]

I cannot comment on the fingernail in this GI forum.  I would suggest having it seen by a dermatologist.

The workup for the liver is complete.  Negative tests for hepatitis as well as imaging studies would rule out major liver disease.  An MRI can be considered for further clarity if the diagnosis is inconclusive.

I would continue to monitor the liver enzymes to ensure they are not rising.  Normally, a liver biopsy is indicated if they rise greater than 3 times the upper limit of normal.

These options can be discussed with your personal physician.

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.
www.kevinmd.com