autoimmune hepatitis?

[jmom21]

I got some kind of intestinal virus with diarrhea back in July.  Immediately after I started having a pain in my right side just beneath my rib cage.  Since then the pain has greatly increased and spreads around to upper right back.  I also tend to have sharp pains in my right front side of and on throughout the day.  Around the same time as this pain showed up I also started having significant joint pain in my left wrist which has not subsided.  I cannot gain weight no matter what I eat and I do not have diarrhea or vomiting even though every once in a while I feel a little nauseous.  I also am having extreme fatigue.  I have had ultrasound, HIDA scan, ct-scan and all showed my gall bladder normal.  The ct-scan showed my liver was oddly shaped with an extending left lower lobe and that my gallbladder was folded but the doctors tell me this is normal.  All my blood work is normal except a positive ana which my rheumatologist says has such low titers that she can't diagnose me with lupus or anything.  I also had a positive smooth muscle test for autoimmune hepatitis but the hepatologist says that these titers are also too low (1:20) to diagnose that and all my liver function tests were normal.  I also have a laporascopy picture from 6 years ago that shows a strange light colored membrane covering my liver.  The doc just said it was "interesting" but showed no concern about it.  Could all these doctors be wrong and I really do have a problem with my liver?  Should I ask to have my gallbladder rechecked (it's been about 8 weeks since my last tests)?  The next test recommende to me by the hepatologist was a differential nerve block.  Should I go ahead with this and is it extensive or painful?  Will it even help or just raise more unnecessary red flags?  Any suggestions or advice would be greatly appreciated.  I have been going through this for 3 months now and am at my wits end.  I just want to feel and be healthy again.  Thanks.

[Jaybay]

What was the laparoscopy done for?  It almost sounds like you had new scar tissue beginning to form on your liver, indicating some kind of inflammation (from infection of some sort?) had to be present.  You have had the "million dollar work-up", and at this point, if I were in your shoes, I'd begin to push for a diagnostic/ exploratory laparoscopy.  Of course, that's just me.  It just seems like you've had every possible test that can be run, and it may be time to take a peek inside to see what has happened in the past 6 years.  

As for the nerve block, I'm assuming that is simply being offered for pain management.  Personally, I wouldn't block any symptoms until I had a firm diagnosis of WHY the pain is there in the first place.

[jmom21]

Thanks for the reply Jabay.  My laparoscopy was done by a fertility specialist who I was seeing at the time for unexplained infertility.  I now have two kids and they never found a reason for the delay in getting them.  I did have ITP when I was very little, about 4 years old until about 9 or 10 when I finally had a spleenectomy which corrected my bleeding problem from the ITP.  I have never had an irregular platelet count since.  The hepatologist didn't say that the picture looked like scar tissue on my liver, he said it looked like some kind of membrane covering my liver.  The picture shows the light colored membrane on top of a layer of normal colored liver.  I have been thinking about a second opinion from a different hepatologist.  The doctors don't seem to think that surgery is necessary and because of this my insurance won't cover it.  I guess if I requested or insisted that something be done they can't refuse.  I was a little aprehensive about the nerve block also.  The hepatologist said that it would determine if my pain was from muscolskeletal or actually from some type of organ.  I worry that it might bring up more issues that really aren't issues and confuse the situation even more.  Do you think rechecking the gallbladder before an invasive surgery might be worthwhile?  I've heard of gallbladders going bad and people having them rechecked only to find their percentage go down and removal necessary.  Thanks again for your advice