stomach or liver?

[Guest guest]

Dear All,

I am sorry that most of the time I am a reader (lurker?) and not so

much a responder. Part of that has to do with the fact that I am

fortunately not too experienced yet with PSC problems. Last week I

had some pain 'attacks' though and I was wondering if other people

can relate to this and especially if the 'attacks' could be stomack

or liver/PSC related.

My (male 37 years old) history is that in 2001 they accidentally

found some (slighty) elevated liver enzymes in my blood-work. This

did not go away by itself and after an inconclusive ultrasound,

liverbiopt, and many consults, I had an MRCP in 2004 which seemed to

show a couple of intrahepatic slight strictures. The doctor was and

is not sure it is PSC, but wouldn't know what else it could be. I

was put on Urso which brought my liver enzyme values back to normal

(except GGT which is nearly normal). A colonoscopy fortunately did

not seem to present an IBD, and p-ANCA was negative. Jan 2006 had

another MRCP and the situation still seemed to be similar to the

previous MRCP, one of the 'strictures' even seemed to have been gone

(?). This was very good news for us. In the mean time my previous

doctor retired and my new doctor seems to have the same conclusion:

most likely intrahepatic (probably not small duct) PSC (but we are

kind of still hoping it is not).

Last saturday after a very relaxed and warm evening, I got

pain/severe uncomfortness under the lowest part of the sternum. This

lasted for about an hour. The most comfortable position during

the 'attack' seemed to be bending forward (i.e. knees to chest).

Also taking deep breaths to relax, seemed to be most 'comfortable'.

The following day I again had an attack in the shower after a tennis

game in warm weather and the day after that I had 3x an attack and

now on friday I had another one (although this one disappeared

relatively quickly by taking a bath with the shower raining on my

belly/chest area and drinking some water at the same time. At first

we were thinking these attacks might be stomack related because the

first one (and two similar episodes I had last year) were after

drinking juice (apple or orange). However, in later attacks I

noticed that pressing along the ribcage on the right side (not left

side) was painful during the attack (without pressing the pain seemd

to be located below the lower part of the sternum though). So this

made us wonder if maybe something was going on in the liver.

Bloodwork one day after the attacks showed slightly elevated liver

enzym values (AST 70(50), ALT 64(50), and ALP 128(120), in between

brackets upper normal limit). Note that these values were with me

having taking my normal Urso pills and also Omeprazol Alpharma to

calm down the stomack if that had been the problem. Ultrasound 3

days after the attacks did not show much except for on spot where he

saw some 'white edges', which might or might not be something. At

the spot where he saw these maybe white edges, the liver did seem to

feel a little sensitive though. The radiologist also mentioned that

if there was a blockage, it might need more time (a couple of weeks)

to show up as a dilation on the ultrasound (?).

Anyway, this has become a quite long post by now and thank you when

you are still reading. My question would be if any of you can relate

to these 'attack' symptoms and if you think those attacks seemed to

be stomack (reflux, ulcer?) related or liver/PSC related (or

something else).

Best regards,

Gerard