Do I have liver disease

[Tintin]

I am a 45 year old female, I have been really ill since Feb. My symptoms are, severe pain in my upper right abdomen, liver palms, spider veins on cheeks and chest,yellow coating on tongue, low blood pressure ( 76/52- 96/73) pulse rate between 86-128, yellow in the corner of my eyes, yellow urine that has a musty smell, feeling of swollen veins at the side of my throat and on the left side of my nose. I have had three nose bleeds from the left nostril.I also have headache and have painful fingers and feet are cold to the touch and then very hot. I have no visible nail beds except on my thumbs.
I also feel confused and can't think very clearly. This is helped if I take Lactulose. My breasts are painful and leak fluid. I have had a total hysterectomy, ovaries also removed, I am not on HRT. Liver function tests appear to be within normal parameters, nothing remarkable seen on ultrasound. Blood tests showed higher copper and inorganic phosphate levels, but low selenium and zinc. Have had clear results for colonoscopy, barium drink and follow through.
Had a perianal abcess removed by surgery and a large abcess at end of breast bone which appeared to burst, but very little fluid expunged in Feb.
Alcohol intake was two glasses of wine a day for the last five years. No alcohol intake at all since January. Have been unable to work and now am housebound due tiredness and pain. I am not on any medication at all and frightened to take pain relief as I am worried that there is something wrong with my liver.
Can you suggest any other tests that can be done to eliminate liver disease and advise what the problem may be.

[Tintin]

To let you undertand, I live in a small parochial town in Scotland. We don't get given copies of test results. When I asked Doc(known as a General Practitioner or GP)  I was just told results were within normal parameters. To see the actual results I would need to apply under the Data Protection Act( lengthy process) also a G P is a jack of all trades master of none.GP has refused to send me to a specialist on the basis of these results, so I am now looking for a private one and I'll have to fund it myself. My last blood tests were done at end of May and I have since bought Uristik to test urine which is showing Urobilinogen colour between 33+ and 66+, also bilirubin colour at 17+ have not seen GP about this yet as he is on holiday.Also I forgot to say in original post I lost 21lbs during feb/mar although weight has stabilised now, though I seem to be suffering from fluid retention mostly in my stomach and by the time I go to bed I look like I am 6mths pregnant and have gained 4-5lbs.I have also been taking zinc/selenium supplements since early June but they have made no difference. I also was taking VitB complex + Milk Thistle could these have masked blood test results?
Dont't know about fingers or if it is caused because of low blood pressure and lack of blood/ pooling of blood/lack of oxygen getting to them?

[Kevin Pho, MD]

Certainly the symptoms may be consistent with liver disease - such as spider veins, confusion, yellow eyes etc.  But with normal liver enzymes and ultrasound, it is unlikely that liver disease is present.  The definitive test would be a liver biopsy, but it is unlikely that a physician would do this with your normal tests.  

With the nose bleeds, I would suggest checking your blood count, platelet count as well as coagulation studies.  A thyroid test should be considered as well.

To monitor for liver disease, you can periodically measure the liver enzymes to ensure they don't rise.

I would discuss these options 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.
Medical Weblog:
kevinmd_b

[dartmouth03]

hey,

sorry about your health issues.  couple questions...

1) what do you mean your hands hurt?  is their pooling of blood in your fingers or something....like excess blood flow?

2)  also, if your liver panel is normal and your bilirubin is normal, then there is no way you could have yellow eyes.  did you check to see what your total bili was?

take care,
alex