Cirrhosis with symptoms but good labs?

[sassyb]

I’m scared about the possibility of ETOH cirrhosis.  I have an 11-12 year history of drinking alcoholically with periods of months of abstinence throughout.

In March, I started developing a red face and patches of red on the neck.  If you look closely, you can see little red vessels in the red facial skin.  (Although they do not appear like “spider angioma, radiating outward from a central lesion.")

Other symptoms have been extreme tiredness and fatigue, muscle weakness, bone pain, muscle cramps, dizzy and light-headedness.  I had night sweats every night for two months that just stopped with two weeks ETOH abstinence.  

Have also had anorexia and weight loss, about 20# in 2 months.  Also chronic low-grade fevers, 99.0-99.6, that will not go away.  I’ve noticed loss of muscle mass more than fat.

I also flush in the hands and legs.  My hands turn red and may have white spots on them.  My legs get pink.  This seems to happen mainly after I eat.  Also my gut gurgles loud and constantly after eating.  

All the symptoms I am having lead me to think there is a chance of cirrhosis:  the abdominal gurgling after meals, flushing, wt loss, fatigue, anorexia, loss of muscle mass, weakness, bone pain, low-grade fevers.

As for labs, one thing concerns me, my total bili has went up from 0.6-0.7 in Feb-April 2004 to 1.2 in May 2004.  

My WBC’s started to crawl-up from 8.02 in 12/03 to 9.44 on 05/05/04.  But they did go back down to 7.8 after resuming Gleevec for only six days.  

(I was daignosed with CML in April 1991 - treated very successfully all these years with interferon and most recently Gleevec.  But I was off Gleevec for a long time and just recently restarted it.  And I never had these symptoms with Gleevec before.  Also CBC's and Diff's remain normal, so can't blame symptoms on CML or Gleevec.)

My AST has actually went down from 31 - 22 - 21 from Feb to May 2004.  My ALT has went down from 45 - 39 - 33 over the same time period.  (AST/ALT always < 1)

Alk Phos has stayed consistent - latest 25.  

Glob 2.9 - 3.2

ALB 4.2 - 4.8

My one GGT reading I got was 72 in April 2004.

Triglycerides were high 201 in August 2003, but were 79 in April 2004.

Now, my concern is, reading an old Internal Medicaine book (Stein 1991), it states that it is possible for a person to be walking around with normal labs and still have cirrhosis!  And that the only thing showing might be an increased WBC and normal to slightly increased bili.

Is it possible, then, that I could have cirhosis, with all of these symptoms?

I had an abdom CT today.

But is a CT of any value?  I thought a cirrhotic liver could be normal size and that a liver biopsy was required for diagnoses?

What kind of diagnostic testing do I need to be definitely sure that I DO NOT have it?

[Kevin Pho, MD]

Cirrhosis is a pathologic diagnosis and typically a liver biopsy is needed for a conclusive diagnosis.  The sensitivity of a liver biopsy for cirrhosis is in the range of 80 to 100 percent depending upon the method used, and the size and number of specimens obtained.

CT scan is typically not used in the diagnosis fo cirrhosis.  The ultrasound would be a better test, however if negative and cirrhosis is still suspected, biopsy should still be considered.  

Bottom line - I would consider an ultrasound.  If negative and your physician still considers cirrhosis to be a possibility you may want to consider a biopsy.  

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

[chinchuck]

Can anyone help with gallbladder symptoms, no stones showing on ultrasound, three done in ten years, all negative and clear