Bruising as the only symptoms of Cirrhosis?

[Oil_Man_Bob]

Dear Dr.

I am a 33 year old Canadian currently working in the oil fields between the UK and Netherlands.  I am a healthy weight and generally fit although I am a smoker (15 a day).  I used to be a fairly heavy drinker in my late teens through to mid-late 20's.  I was never an alcoholic but I did like to party quite a bit.  I still drink to excess on occasion (shore breaks) but most days and even weeks I don't touch a drop.

Just lately I've noticed that the morning after drinking, I have unexplained bruises (maybe two or three) on my body, mostly arms and legs.  These bruises usually heal quickly over four or five days.  Generally I dont bruise more often or any easier than anyone else and have no other syptoms (I've checked myself for spider nevi, red palms and clubbed nails- I have none of them).  I'm not fatigued and have a healthy appetite.  My diet could be better but I take a multivitamin - it's hard to grow veggies on an oil rig!

Six weeks ago, before I really started to think about this, I had a medical for company insurance purposes.  This included a reasonably thorough liver assesment including Aminotransferease, Gamma GT, Alkaline Phos, Bilirubin and Albumin as well as things like Platelets, HB and WBC.  All of these were completely normal.  I cant remember all of the numbers but Platelets was about 300 and Albumin 5.0.  I do know that PTT wasn't checked though.

My concerns are thus:-

1.  Is it possible that cirrhosis could have sneaked up on me during my drinking years, and now be presenting as bruises through reduced co-agulation factors, even though my LFTs, platelet count and albumin are totally normal.
2.  At what stage would cirrhosis usually cause easy bruising, and would there usually be other symptoms?
3.  When a person bruises easy because of cirrhosis, would they only bruise easier with alcohol in their system, or would the easy bruising always be there.

If you could answer these three question for me that would be a big help, we have a doctor on here but he's kind of one of the guys so no-one wants to talk to him about anything other than an acute injury.  I only stumbled on the cirrhosis thing on the internet while trying to self diagnose.  I've decided to stop getting drunk on shore breaks too.  Not worth the worry.

Thankyou very much in advance.

Bob.

[Thomas D Schiano, MD]

Bob, do not worry about having cirrhosis (you have enough working on the oil rig).  The coagulopathy of cirrhosis would be present at a later stage and would show an abnormal platelet count and abnormal prothrombin and INR. I would not make a difference if someone was actively using alcohol or not. almost always people would have other symptoms.

[Thomas D Schiano, MD]

for the bruising to be due to the liver disease definitely the albumin would be decreased as would the platelets. It in fact could be nutritional due to vit C deficiency, etc.

[Oil_Man_Bob]

Dear Dr,

Sorry, this will be my last post (promise),

With only one exception, all of the bruises I've picked up have been on the front or sides of my lower legs (I'm very lean and have virtually no fat there - my veins are quite visible through the skin in that region).  

1.  Would it be possible for coagulopathy in the context of cirrhosis to only effect this one area repeatedly, or would it be 'whole body'?

2.  Final question- you said that 'coagulopathy' would normally present at a 'later stage', generally how 'late' do you mean, and would you normally expect the albumin (5.0) and platelets (291) to have dropped prior to this if cirrhosis were present.

Thanks again for your advice / support.  Noting this is a free forum I've made a donation to the charity box in the canteen.

Yours,

Bob.

[Oil_Man_Bob]

Dear Dr,

Thanks for your swift reply.  I've never had my PTT or INR checked (at least not that I recall), but I do know my Platelet Count was 291 as at 6 weeks ago- I think this is OK right?  

Starting to think maybe the bruising is diet related, lack of Vit C or something.

Thanks very much for your help.

Bob.