Possible Cirrhosis?

[p_blues]

Hi,

I am 29 (M) and have a 10 year history of alchohol abuse, especially during my university years. During the last couple of years I have cut down to weekends only although consuming around or just above weekly limit on weekends. I stopped drinking completely 2 months ago.

Approx 10 months ago I drank heavily for 2 nights and I think I gave myself mild alcohol poisoning and felt ill all week so stopped drinking for 2 weeks. After this, I cut down my drinking but found it took less alcohol to make me feel terrible in the morning.

In the weeks leading up to quitting alcohol, I drank only occasionally as my hangovers were exagerrated until the last time I drank, 2 drinks made me feel light headed, sick and anxious later on that night, and I could feel the effects for the next day or 2.

A few days after quitting alcohol, I started to feel a little light headed. Over the next 2 weeks this accellerated until I felt weak, constantly nausious (worse in morning), and began loosing weight. I also developed a permanent red face (that looks brown sometimes) and my eyes have more visible veins. My hands are often red and my upper body develops a mild rash in the evenings. I began sleeping more and my legs especially were weak. I also had a mild temperature but this has since almost dissapearred. At times bowel movements were very light coloured or very dark and loose.

This stabalised and now I have my apetite back, no longer feel nausious, have a daily healthy looking bowel movement but still feel rather light headed, dizzy and have a permanent red face and more bloodshot eyes and am weaker and more tired than normal.

I have low platelets (113) which increased (to 121) two days later, otherwise all other labs including Liver function are normal. I now have to wait some time for an ultrasound.

During this period I have been getting a nagging pain in right upper quadrant just under the ribs or generally around that area. At the time of writing it seems to of migrated to my right kidney area though no doubt will be back in the normal place later. Physical examination revelead no sign of enlarged liver.

I would love to know what you think a likely diagnosis is, I am suspecting cirrhosis but wondering if it could be a milder form of ALD?

Also, if it is cirrhosis, should I continue to see improvement as my liver improves slightly from abstinence before it gets worse?

I have accepted that I could be seriously ill so please be honest!

Many thanks.

[aMom21]

Normal LFT are encouraging, however it does not rule at cirrhosis as cirrhosis patients can have normal bloodwork.  Did you doc run any other blood work on you?  The ultrasound could help to provide a clue, a CT or MRI are more sensitive to liver disease.  Also, I recently came across an article that brought up findings that heavy drinkers can go through a period of a few months after they quit alcohol where they actually feel worse than when they did drink.  I have a similar history to yourself so I understand your fear.  You best bet is to write down every question and concern you have a discuss them with your doctor.  I hope you have a good gastro doc or hepatologist.  Please abstain from alcohol if you haven't been already.  I would be happy to answer any other questions you may have.

Stay Strong!

  

[aMom21]

I just realized you wrote that you are abstaining.  Awesome, keep it up!  You are not alone!

[mikesimon]

A low platelet count is often a sign of advanced fibrosis or cirrhosis. I have seen a lot of this in the Hepatitis C setting. Your normal liver test results - if they are, in fact, within normal range - is probably a good sign. With cirrhosis the spleen becomes enlarged and traps and sequesters the platelets so, while your platelet production may be normal or close to normal, your count can be low due to sequestration. I believe that with cirrhosis there can also be some degree of bone marrow suppression as well but I am not certain of that aspect.
Drinking alcohol can cause a low platelet count by damaging the bone marrow. If that is the case the production of platelets may be decreased which would result in a low count.
Complete abstention from alcohol is the right move regardless.
I wish you good luck.
Mike

[p_blues]

Thanks both for your educated comments! I guess the ultrasound should help me diagnose.. Mike, im not sure what my labs were but all LFT was in normal range.

Thanks again

[mikesimon]

Let us know when you get your results. I wish you luck.
Mike

[p_blues]

Hi again. Had ultrasound today (got a lucky cancellation!).

Liver normal size and surface looks fine. Only thing is slightly enlarged spleen which I dont think the doc was even going to mention to me unless I asked her!

I guess my regular doctor will not send me for a biopsy now given normal ultrasound and LFT's, so am considering spending money on a fibroscan, apparantly its the most accurate scan for Cirrhosis diagnosis.

Clearly I am happy by this news, however im still not 100% convinced as ive read in many places that a biopsy is the only definitive diagnosis. On reading a couple of journal papers however, it came out that Ultrasound was accurate in diagnosis of cirrhosis in 89 - 92% of cases. (still not 100 though!).  I guess all I can do is continue my adopted healthy lifestyle and save up some cash for a fibroscan!

Thanks again for reading my comments, i m being rather me me me about all this!

[mikesimon]

You have to be happy when the news is good. It is a whole lot better than bad news.
I can relate to your desire for more testing. I was reluctant to mention that ultrasound is not the best test to assess liver condition but it appears that you knew that already.
I know of some people who've undergone Fibrotest and Fibroscan and according to them the results compared nicely to their biopsy results.
My experience is mainly in the Hepatitis C arena but I would think that determining liver histology in a Hep C liver wouldn't be a lot different than it would be in a liver with another disease.


The following is from:
http://www.nature.com/ajg/journal/v102/n11/abs/ajg2007500a.html

RESULTS:
Twelve studies were identified, 9 for FibroTest (N = 1,679) and 4 for FibroScan (N = 546). In heterogeneous analyses for significant fibrosis, the AUCs for FibroTest and FibroScan were 0.81 (95% CI 0.78–84) and 0.83 (0.03–1.00), respectively. At a threshold of approx0.60, the sensitivity and specificity of the FibroTest were 47% (35–59%) and 90% (87–92%). For FibroScan (threshold approx8 kPa), corresponding values were 64% (50–76%) and 87% (80–91%), respectively. Methodological quality, the length of liver biopsy specimens, and inclusion of special populations did not explain the observed heterogeneity. However, the diagnostic accuracy of both measures was associated with the prevalence of significant fibrosis and cirrhosis in the study populations. For cirrhosis, the summary AUCs for FibroTest and FibroScan were 0.90 (95% CI not calculable) and 0.95 (0.87–0.99), respectively.
CONCLUSIONS:


FibroTest and FibroScan have excellent utility for the identification of HCV-related cirrhosis, but lesser accuracy for earlier stages. Refinements are necessary before these tests can replace liver biopsy.


I am not aware of the studies showing ultrasound as that reliable. I believe you when you say they exist but I have seen other articles and opinions that are not as positive about it. Regardless it's good new and I congratulate you on you results

Good luck,
Mike

[p_blues]

Mike,

Thanks again for your input. I have the studies i referenced bookmarked at work, will find them out. In fairness, I later looked at the accuracy of low resolution ultrasound and it was very poor (around 30 - 40% accuracy of diagnosing known cirrhosis patients). Not sure whether I would of had low or high res but I too have read alot of stuff on the web about US in general not being a great diagnostic tool for cirrhosis.

Thanks for the info on fibroscan, still looks like biopsy currently being the only thing that will allow me to find out once and for all!

Still got the symptoms notably permanent red face, light headed / dizziness, tiredness and weakness (especially in legs) pains in RUQ + LUQ, I guess I will just have to take comfort in the fact that the LFT's + US are negative, hopefully if it is cirrhosis, it will be a relatively early stage.

Thanks Loads Mike

[mikesimon]

Just be sure to keep in mind that cirrhosis isn't an automatic death sentence. With compensated cirrhosis people live long and productive lives. And, if worse comes to worse, there are options available. Did I mention that I was transplanted in June 2000 with Hepatitis C as my underlying disease.
My lab results from last week are ALT 10/ AST 17/ GGT 12/ Alkaline Phosphatase 52 and Bilirubin 1.1 and though within normal a little higher than I'd like but the elevation is due to an increased indirect bilirubin and not a liver issue. So there is always hope that life will go on - even in the darkest of times.
By the way, I treated and cleared the HCV in June 2004 and that's why my numbers look like they do.
You say that your legs are tired but are they swollen with fluid - edema?
Do you bruise easily?
Are you confused - no not like we all are, more so than usual?
Do you have fluid buildup in your abdomen - ascites?
Have the whites of you eyes ever appeared yellow - jaundiced?
My understanding is that in a liver disease setting a dark - real dark - stool could be a sign of abdominal of esophageal bleeding. If you were bleeding and had no treatment I don't think it would have stopped.
I was told to be watchful of a clay colored or pale stool. I asked them what color clay they were talking about because understandably at that point I was rather obsessive. The response was "you'll know it when you see it" and they were right. I saw a stool that I absolutely knew was not right. As it turned out I was having an acute organ rejection. Monitor yourself but try not to become too obsessive about looking for signs or symptoms. Just be cautious and don't be shy to push for an appointment if you feel something is wrong. We absolutely must be our own advocate. I could tell you some stories about when I was a little too laid back and they aren't nice at all. Nowadays I push really hard when I am concerned.
Good luck to you once again.
Mike

[p_blues]

Hi Mike - wow, you have certainly been through it all hats off to you for your achievements! Gald to know your doing well!

I agree with what your saying about not being obsessive about symptoms etc, but also not being too passive about it all!

In terms of symptoms I have never had any Jaundice, Ascites, or Edema.

Legs are weak although not swollen and I am still able to work involving me standing for alot of the day.

I understand what you say about the stool, the funny thing was it was very light coloured then normal for a couple of days then pretty much black and very loose for 4 or 5 days. As it stopped on it own though , I hear what you are saying about it beig unlikely it was bleeding. This has since calmed down though and its looking much healthier now. From what you say about the clay colour, I doubt whether it was like that.

In terms of confusion, I feel rather spaced out all the time, and certainly my mental sharpness has decreased. I also keep forgetting what I am doing but I have been putting some of this down to the fact that I am distracted about my symptoms all the time. In fairness this has improved slightly but is still persisting and is showing no signs of letting up!

As i think you said earlier, and enlarged spleen / low platelets would likely be a symptom of established cirrhosis and due to the lack of edema, ascites, jaundice, I wonder if splenomgaly would manifest normally at this stage. The red face is also puzzling me, I have seen it mentioned as a symptom in some articles but not often a 'classic symtpom'. Everyone thinks I have a suntan (including work from which I have just had 2 weeks off sick!) and simply wont listen to my claims that I havent been out in the sun!!

Take care.

[mikesimon]

I am not convinced that your red face is symptomatic of cirrhosis but I can't rule it out either. I would have expected that you would have seen some evidence of spider angioma before your face would turn florid - if that is an apt description.
I agree with you that intense preoccupation with health issues/symptoms can cause distraction and/or forgetfulness and the anxiety that is inherent in the subject matter makes it worse. Shortly after I was diagnosed I traveled to study Transcendental Meditation for that very reason. I had to learn to put it out of my mind and I also naively believed that through meditation I might be able to cure myself. I didn't succeed with the cure but I did learn to get away from the stress through daily meditation.
You need more information and hopefully it will be good news and stress relieving. If it isn't then you will deal with that then. As my Mother always told me - "Son, don't borrow trouble." She was a wise woman and I hear that voice of hers almost daily. She also said "Son, look on the bright side" and I learned that if you look hard enough there is almost always a bright side.
Good luck and I hope you get some good news and are able to relax a little.
Mike

[nanasluv]

I am 28 yrs old and have had chornic edema and a bad body odor for 2 years. I have seen 2 doctors and they both ran blood work on me and everything turned out normal. MY ? is I read one of your comments and it said that a low platelet usually indicates a sign of advanced fibrosis or cirrhosis now is that true becaseu my platelets number was 272 so I take that as a good sign if what you are saying is accurate. MY issue is mainly the body odor and edema. My edema fluctuates when I lay down it goes down it is only when I stnad up or walk that it acts up. then I have this intolerable body odor and I have very good hygiene so I know that is not the problem; soI'm just wondering if these 2 symptoms are enough to raise a red flag and cause me to see another doctor when I am able to afford health insurance or am I simply just being too paranoid. I have heard that bad body odor and edema can be signs of a liver issue but the why would my labs turn our normal. My doctors even told me I just need to move on with my life but it is hard to when your body is not like it use to be. One doctor thinks my edema is realted to my weight gain becuase I am about 50 pounds overweight and I have a tendency to sweat more then the average peron so maybe that could be causing these weird symptoms. I just noticed that you seem to have alot of useful knowledge when it comes to liver issues and have been there beofre so maybe you could give me some helpful advice I would really appreciate it. I  am even scared to drink alcohol becuase I'm not sure of my own body even though I have been given a clean bill of health twice. Thanks for any advice take care now. by theway I'm glad to hear that you had a liver transplant succesfully and that your health has improved that is really good news. You seem like a nice guy who trys and help others that have been in your situation before and you deseve a great life. God bless you and I hope to hear fro you thanks very much.