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Ruth asks…

Liver cancer–other liver diagnosis ? Diagnosis web sites? Free doctor consult on-line ?

Please do not answer this if you have no medical education whatsoever. My husband returned from his routine physical with alarming news. His AST was high at 57, his ALT was high at 78, his WBC was low at 3.7, and he was anemic with a hemoglobin of 13.4 and hematocrit of 39.3. He was excreting protein in his urine and his BUN was high at 23. About 2 years ago, he also began to notice that he has begun to suffer from high cholesterol despite eating a healthy diet. His current cholesterol has been as high as 220 with a low HDL of only 39. He is asymptomatic otherwise and says that he feels fine. He is 44 years old and was born and raised in Paris, France but is of North African ancestry as is father is from Morocco and his mother is from Algeria, so his normal skin tone is quite tan/yellow–but he has no signs of jaundice in his eyes. His only significant medical history in this regard is that his parents recently told me that he did suffer a bout of jaundice when he was 8 years old and was treated with “some injections”–I assume injections of immunoglobulin.
He drinks alcohol quite rarely and only in small amounts and takes NO medications or herbs and NEVER has. He tested NEGATIVE for any hepatitis/HIV and has no other significant medical history. He has no history of any drug abuse. About a year ago he also began to suffer from itchy dry skin on his forehead until between his eyes as well as the corners around his nose. We thought until recently that this was cold weather related as it comes and goes, but it is JUNE here in Miami and he just had another outbreak ! Then, we read that itchy dry skin is also indicative of liver problems. Anyway, what I am looking for is WHAT COULD THIS BE OTHER THAN LIVER CANCER ??? The MD scheduled him for an ultrasound on the 5th of July and I assume it is to look for malignant tumors. In the meantime, I am very upset, worried, and nervous, and would just like to know if there are ANY other possible diagnosis for this list of symptoms ? Any free websites that I can go to to enter these symptoms to get other possible diagnosis ? Etc. If you need more info, don’t hesitate to ask and thank-you so much.
Thanks so much Godazo…but I neglected to mention that his thyroid is fine….no problems there. I also already stated that they did a hepatitis screening and he was negative for that.

Potter answers:

His AST/ALT are elevated but not by much, I’d call them borderline elevated. Medications or ischemia could cause that kind of elevation, various forms of hepatitis, and the liver, pancreas, and gallbladder are all in that region. I’m not sure about how significant the WBC count is, it’s also borderline low being very close to the normal range. I don’t personally consider a hemoglobin of 13.4 that is asymptomatic anemia. BUN is borderline as well, having mild dehydration could explain that too.

The bout of jaundice he had when he was younger, without knowing anything about him may have just been gilbert’s syndrome. Pretty common and benign condition.

Dry itchy skin on the forehead is a vague symptom as well, certainly could be liver. Could be thyroid, could just be dry skin :). Generally, when bile salts accumulate in someone that has liver problems they could have itchy skin, like the feeling of ants crawling on your skin, doesn’t sound like he has that.

All I see so far are some unexplained mildly elevated liver enzymes, proteinuria, and some borderline values. I agree with the approach of the ultrasound, it would show any nodules and alternatively gets you a glimpse of the pancreas and gallbladder. Other than liver cancer, it could be a liver cyst, a blocked duct/gallstone, a genetic disorder, immunological, infection/hepatitis, wilson’s, hemochromatosis, or ischemia of various causes. Hepatocellular carcinoma without a history of alcohol abuse, hepatitis B or C is pretty rare.

Sorry I can’t be more helpful, but I’m not really sure what it could be. They could do a liver biopsy if the ultrasound comes back clean, or they could just watch him and do more blood work in the future and see if it changes. Some additional blood tests can be useful to check for hyperbilirubinemia and what type, throw a thyroid study in there, and if you have Dr. House maybe check alpha-1 antitrypsin.

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