Concerned Patient

[flybynight]

Doc, I've got a few questions for you. I am a 28 yr old male with a 10-12 year moderate/heavy drinking history.  Big binge drinker 2x week until about 2 years ago, then maybe 3/4 - 1 bottle of wine per night for the last 2 years. (more still on the weekends)

I've stopped drinking for the moment and continue to feel like **** 2 weeks later.  Let me know if you can give me some guidance on a few things I've found no infomration on:

1) I have a dull ache in my URQ, I can feel it sometimes when  I cough, and its just there.  When I flex my abdominal muscles, my right flank bulges more than the left - this is due to enlarged liver I imagine.  Common occurence?

2) I am very fair skinned and my palms are reddish with white spots and I can't remeber if they always have been.  Can this this a condition of something that is going on internally?  I'm more curious about the white spots and not whether or not it might be palmar erythmea.

3) Since I have quit drinking I feel kind of out of it all day long.  My vision is a little off and my mind isn't as sharp as it once was and I just feel wierd.  Does liver disease contribute to a general feeling of fuzziness & anxiety?  Or am I experiencing withdrawl syptoms (symptoms) this much later?

4) Finally, I have two whitish/yellowish wart looking things (one on my arm and one on leg.)  I know you can get something along these lines from PBC.  Can you shed any light on this?

I know that you will finish your response by telling me that I need to consult my physician, and I intend to, but I really am not ready at the moment to tell my fianc and family that I am very ill from being a lush all the years, etc...

Thanks for the guidance -

[Kevin Pho, MD]

To answer your questions:
1) Drinking can lead to an alcoholic hepatitis or fatty liver that may lead to RUQ pain.  

2) Palmar erythema can be indicative of liver disease.  I cannot be sure about the white spots without examination - you can have this evaluated by a dermatologist.

3) Yes, liver disease can lead to anxiety and mental status changes.  Withdrawal from alcohol is also possible.  

4) Again, difficult to say without examination.  If PBC is considered, antimitochondrial antibodies or a liver biopsy can be considered.

I would start the evaluation with a liver ultrasound and blood tests for hepatitis.  More specialized testing can be considered if the diagnosis continues to be 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.
kevinmd_b

[Kalio1]

You do describe symptoms that can be attributed to liver problems however I'd do some testing and evaluation to find out for sure what is going on and don't try to guess by looking for clues on the internet. Don't avoid the doctor when you already have symptoms. You need that wakeup call and to be honest and confront this now. Avoiding the doctor is just another phase of denial. Don't let guilt from drinking get in the way, you could be wrong and have some other liver issue that is being made worse by alcohol.
I thought it would be hard to stop drinking but the doc visit and learning the truth about my health made it EASIER to not drink. It is poison to anyone with a liver problem. I love my bottle of wine too, but not if it is killing me.
You owe it to yourself and your family and friends to face up to this, the doctor visit might help you.
Stopping alcohol is the first step, congratulations to you for that but you need HEALTH CARE. You do not want end stage liver disease, keep that in mind the next time you are tempted to consume. Look at some rotten livers on the net or read about symptoms of ESLD on the net if you need to to see what happens. Google it, it's damn scary.
Your symptoms could also be caused by other contributing factors and any number of other conditions, please get evaluated!
You should be tested for hepatitis and other liver conditions to rule out as a contributing factor, you can have hep and not know it. You need you liver function tests to really know your situation and a biopsy, if warranted.
Alcohol is like pouring gasoline on any liver problem.
The good news is your liver is regenerative and with time, diet and exercise and time away from alcohol you can correct some of the damage if you stop now.

Your liver doesn't "feel" pain, what you are feeling is the enlarged liver pressing on surrounding tissue/nerves causing the URQ pain. If you have those symptoms, it is likely you feel tired and crappy all the time too. The "brain fog" you describe can be caused by liver problems. Your liver when compromised produces more ammonia and that can affect your brain. This is not something to mess around with, make that doctor's appt. today. You really don't want an alcohol induced dementia problem that is permanent.
Start drinking tons of water to help your liver flush, find a substitute drink to consume when everyone is having a drink. Sometimes thinking about it is harder than actually doing it.

An internet diagnosis gets you no where, see a doctor. Start with your primary care doc and also possibly see either a gastroentrologist or a heptologist depending on what your doctor finds, he will refer you if necessary.

good luck to you.

[jbspoon]

about two weeks ago I had a laproscopic fundoplication to correct a hiatus hernia and reflux disease, the reflux has settled considerably however I'm experienceing quite severe burning and cramping pain in my stomach (mainly in the centre and the left near the bottom of the ribs). I had a ct scan last week which revealed the fundoplication was holding and everything was fine, however the pain isn't settling.

is this pain very common after surgery??

Regards

Jiri