Recently a relative presented with itching skin and yellow jaundiced eyes at his local GP. The relative had been itching for a couple of weeks before going to see his GP.
The GP took bloods and some readings were elevated. GP sent the patient to hospital where he was admitted for a few days for diagnostics- CT and MRI are clear.
The specialist suspected gallstones before the diagnostics and surprised when nothing was found from the scans.
Having talked to the patient today, we think he means bilary sludge when trying to convey to us the conversation- English isn't his first language.
He's now back in the care of the GP who will discuss the results with him next week.
The family have organised an overseas trip - they were told there's no need to cancel it. The trip is next week and would like to be able to help; relative to feel less discomfort.
My question here is, any advice? What other tests should he ask for? I believe he'll be having regular bloods drawn and nothing else as his diagnostic were clear.
I advised that that a copy of full blood work should be requested to know what the specialists are looking at and further questions to ask.
He has lost his appetite and sense of taste. He still feels hungry yet does not eat as much as normally does. The antihistamines/Piriton appear to help the itching but not completely. I told him to try fexofenadine to see if that one is better.
Non drinker. Not overweight. No liver issues prior to this.
Patient will be overseas for two weeks.
Many thanks.
- Advised creams will not help the itching as it's from inside/out.
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Anon888
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Hi Anon888! If it’s PBC your relative would have a high ALP and bilirubin and would test positive for anti mitochondrial antibodies. Lately they do ultrasound , MRI, or CT scans for diagnosis. Sometimes they will do a biopsy. There are a few things people try that helps with the itching. Some things will work for some people and others don’t. Most people try a few before they find one that helps.
Thanks Pam for your answer. I read that too for PCB and as we don't have his results, can't even begin to guess. We did ask if any of these markers were mentioned during the hospital stay. He's had the MRI and CT - both clear. Bloods still show concern for certain markers. I'm taking a wild guess that it's not PCB but "bilary sludge".
Patient is allowed to travel, and will interpret that they are not overly concerned as he's not in pain but general malaise.
Next week a call is expected to discuss his results; care is now back to his GP versus the hospital.
He hated the hospital stay...a bit farcical - couldn't find vein for cannula/prodded a dozen times/ water went under the skin versus vein/ CT halted halfway.../couldn't find MRI slot...
The trip has been planned best part of a year and wanting to ensure it is enjoyed as best as possible.
It sounds like Gallstones, some stones are missed on MRI /CT , calcified stones are mostly seen on these type of scans. pigmented stones usually doesn't show up on these scans, ask for a Hida scan, this will show the obstruction of the bile duct.
Thanks @sophiaS1980! It's what we think it could be too. Reading about PCB as he's male this would make it unlikely. His eyes are still jaundiced and itching. As he's been cleared to travel, what's your opinion if asking/waiting for the Hida scan when he returns? It's funny as we would ask many questions such is our caution with the stretched system but relative is brought up in a different era!
Men can have PBC, but more women have it. I don't want to have an opinion if he should or shouldn't travel, however, i can say if the doctor doesn't know what is really causing his problem or didn't offer a hida scan, i wouldn't trust him or her to say he is clear to travel, If you decide to travel make sure he is on a strict diet, low carb diet, no sugar or eating late night because that's when he will have an attack.
It's difficult regarding traveling. I will suggest the HIDA to his family/him. He isn't in pain - itching, malaise and lack of appetite/ taste compromised. Not my decision to make. Thank you
Ursodiol is a powder and taste really bad, you can put in coffee, ask doc for it and start it now, it can control the itching, it is used for itching and also for people with PBC,
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Hi, I think the main thing is to go along with what he wants and supporting him with what he wants. Re fatigue, on holidays I plan on doing things in the morning then back to accommodation to read and sleep in the afternoon, then I might be up to going out in the evening… or not. He’ll find what works for him but family members shouldn’t expect too much from him, don’t make fixed plans, and shouldn’t push him to do things or to push him to rest when he doesn’t want to rest. Fatigue isn’t like normal tiredness, you just have to go with it, do things when you have the energy and don’t do things when you can’t. Smaller more frequent meals can help.
Thanks. @Readlots. I created another post with more information. It's exactly what I said to his fellow travelers and hopefully they'll pay heed. His bilirubin was 156 when discharged. Still not feeling himself. Diet will play an important role.
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