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Abdominal uncomfort with HEPATOMEGALY in MRCP. Treatment.

Resolved Question:

Dear Doctor,

I'm a 50 years old house wife and I've MILD HEPATOMEGALY as per MRCP Report, including Prominent CBD and CHD without Intraluminal Pathology and small pancreatic Cyst (15X10 mm). My Biochemistry results are 1. Alkaline Phosphatase (ALP)-140 U/L, 2. Serum Lipase- 57.1 U/L, 3. Alkaline Aminotransferase (ALT)- 32 U/L, 4. C-Reactive Protein (CRP)- 5.9mg/L, 5. ESR 32 mmat 1 hr, 6. Hemoglobin- 11.3 gm/dl, 7. Hematocrit (HCT)- 35.5%, 8. CA 19-9, serum- 5.9 U/mL, 9. CEA 2.8 ng/mL.

I've been prescribed a) NEXPRO 40- one tablet before breakfast & b) LIBRATEX- one tablet before luch and dinner.

I'm feeling week and abdominal uncomfort. I'm also a Type2 diabetic since last 20 years and under oral medication..

Kindly suggest.

Thanks & regards,

Mrs. S. Das,
Guwahati, Assam (India).


Category: Gastroenterologist, Medical

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Category: Hepatologist
Dr. Ratnakar Kini is online now

Expert:  Dr. Ratnakar Kini replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
Your reports look fine except for the hemoglobin which is slightly below the normal range.
No you need not worry about the mild hepatomegaly. Hepatomegaly means liver enlargement. With the history of Type 2 diabetes, the most likely cause of your mild hepatomegaly is fatty liver. Proper control of blood glucose will reverse it. You need to worry about fatty liver only if it damages liver. If the liver is damaged the liver function test would be abnormal. But your liver function looks fine. So there is no need to worry.
There are man causes of feeling weak and one of them is low hemoglobin. You can take iron supplements, green leafy vegetables, apples, dates etc to improve the hemoglobin level.
The abdominal discomfort again could be due to diabetes which slows down digestion. Control of blood glucose and medications that promote proper functioning of stomach would provide relief.
You can continue with the medications prescribed.
You can discuss with your doctor about taking prokinetic medications.
I hope that answers your question.
Let me know if I can assist you further.
Regards,
Dr.R.K.


Patient replied :

Thanks Doctor R.K. But, the other report, viz. Prominent CBD and CHD without Intraluminal Pathology and small Pancreatic Cyst (15X10 mm), does it have any relation to the problem? What about the later one, i.e. Pancreatic Cyst (15X10 mm)? Moreover, as suggested by you taking apples, dates etc., is it advisable to take these being a diabetic? Could you please suggest some medicine to improve hemoglobin level and some prokinetic medicine, looking into my condition? Kindly suggest. Thanks & regards, mrs. S. Das.


Expert:  Dr. Ratnakar Kini replied 3 Days.

Hi,

I will not worry about the prominent CBD as your liver function is normal and the scan shows no abnormality inside it (no intraluminal pathology).
I will not worry about the cyst also as cancer has been ruled out by the tests CEA and CA 19-9 which are within normal limits. It is a small cyst and does not require any treatment.
You can take capsule Heme-up once daily to improve your hemoglobin. Eating apples and dates in moderate quantities will not affect your blood glucose. If it raises above normal you can stop them.
As far as the Prokinetics is concerned you can take tablet Lesuride 75 mg once daily half an hour before breakfast.
I hope that answers your question.
Let me know if I can assist you further.

Regards,
Dr.R.K.


Patient replied :

Thank you doctor, that helps put my mind to ease. However, I continue to feel extremely weak and a strange sensation (painless) slightly south of the meeting point of the ribs on my chest. There is no telling when I might feel dizzy or frail. Everyday tasks have become a struggle for me and I'm usually a very active person. I would be much grateful if you are able to suggest some way to or restore my lifestyle. Much thanks in advance. With regards, Mrs. S. Das


Expert:  Dr. Ratnakar Kini replied 2 Days.

Hello,
The part you have mentioned is where the stomach is located. I would advice you to get an upper GI endoscopy done if not done already to look for acidity related issues or diabetes related issues like slow functioning of your stomach that is causing your symptoms.
You can continue taking Nexpro and Lesuride.
Regards.


Patient replied :

Hello Doctor!
Thank you so much for your help. I was able to find that this is a post-menopausal condition and I am currently feeling much better since taking a pill as advised by my gynaecologist.
However, a general physician noticed a lump in my neck (to my best knowledge this lump has been there since I was a child, which is almost 40 years when I look back. This is something my family and close friends agree with too.) I was sent for an FNAC etc. and such are my findings:
USG of thyroid: a well defined heterogenous cold nodule in the left thyroid lobe. The nodule measures 33 mm x 21 mm (follicular neoplasm) with internal coarse calcification. Normal isthmus gland, parathyroid gland, normal vascularity. Likely to be benign adenomatous nodule.
FNAC: Features are suggestive of follicular neoplasm. The smears are moderately cellular. Shows thyroid follicular cells arranged in loose aggregrates and microfollicular patterns. Colloid is not seen.
The endocrinologist I was consulting with further referred me to an ENT surgeon to have the left lobe taken out, and I am really reluctant. If you could please be so kind to confirm if this surgery is absolutely necessary or even what your opinion on it is, I'd be beyond grateful.
Thank you once again and looking forward to your reply.
With kind regards, Mrs. S. Das
(Also I just noticed that my medical history says I smoke and consume alcohol regularly. This is incorrect as I have never smoked nor consumed alcohol in my life.)


Expert:  Dr. Ratnakar Kini replied 1 Day.

Hello,
I will advise you to get a second opinion Mrs. Das.
Kindly see a general surgeon and discuss your findings.
Findings are suggestive of follicular neoplasm. This means it could further keep enlarging and encroach on the organs nearby. This also needs to be physically examined. Based on your physical findings and report a decision can be taken.
I will advise you to see a general surgeon to discuss surgery option. He will be able to guide you better,
All the best!!
Regards.


Dr. Ratnakar Kini
Category: Hepatologist
Experience: 
Fellowship - DM - TN Dr.MGR Medical UniversityResidency - TN Dr.MGR Medical University Medical School - Stanely Medical College, TN Dr.MGR Medical University
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