HISTORY: 56-year-old female with history of breast cancer, NED x 4 years, with mild constant sense of fullness under right ribs. Nonsmoker. Alcohol use has always been about 1 drink a month. No palmar erythema, no spider nevi, no jaundice. Stools always hemoccult-negative, soft, normal color, but minimal volume. No GU problems. Weight correct for age until chemo/steroids. Diet primarily fish/chicken/vegetarian/no sugars/no processed foods since bc dx. No other chronic health problems of any kind.
1999 - tested for hepatitis because of mildly increased LFTs (negative)
2001 - feeling of choking at night (acid reflux)
2002 - bc dx, chemo, rads, hormonal therapy. LFTs continue up & fluctuating. Upper endo showed sliding hiatal hernia, reflux, no H. pylori, no polyps, no ulcers. Colonoscopy showed no problems. Abd U/S and repeats showed biliary sludge, 2 stable hemangiomas in liver. Acid reflux treated with PPI briefly periodically.
2003 - extensive lab tests -- even tested for Wilson's disease by ophthalmologist. GGT elevated, ALT/AST continue mildly elevated, alk-phos sometimes elevated moderately
2004 - feeling of fullness under right ribs started. ALT/AST continue mildly elevated, alk-phos sometimes elevated moderately. Chest/abd/pelvic CT showed possible renal cyst on the OTHER side, everything else normal. 5 prime nucleotidase normal. Saw gastrodoc; recommended high vegetable/fruit diet I already have been doing all along, and nothing else.
2005 - feeling of fullness under right ribs more constant. ALT/AST continue mildly elevated, alk-phos sometimes elevated moderately.
2006 - mild feeling of fullness under right ribs continues. Hurts to lie on ribs on right side from front to back, with lower ribs more tender. ALT/AST continue mildly elevated, alk-phos rising but still moderate and continuously elevated. Bone scan clear, CA 27.29 low, CA-125 good. Liver edge and spleen not palpable by doc.
QUESTION: Considering cancer history and all else, what test would be considered next? I wonder if there is blockage of biliary system, possibly by cancer, but don't know what test would cover the most problems? Also, I live in Alaska so am seen in Seattle and have to schedule tests as much as possible in advance of seeing the gastrodoc because I can't afford to stay there very long. Thank you. - AlaskaAngel