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Dr. Andrew Rynne

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Abdominal Pain. Ultrasound Shows Hepatomegaly. What Should I Do?

hello I m 44 yrs old. last 24th November, 2012 I felt huge pain in my upper abdomen and after ultrasound doctor found gallbladder stone and suggestive fatty liver . Pls find below the two different Ultra-sonogram reports and other blood test report: Ultrasonography Report Centre: Popular Diagnostic Centre Refd. By Prof. M. Mohibul Aziz Sonologist: Dr. Haider Ali Khan Dated: 03.12.2012 Ultrasonogram of Whole Abdomen: Liver Echogenicity of liver parenchyma is slightly higher than normal. Echotexture of liver parenchyma is homogeneous with no focal abnormality. Intrahepatic vascular pattern is normal. Gall Bladder Gall bladder is thick walled with multiple echogenic structures casting acoustic shadow. Displacement of structures are seen with the change of patient’s position. Biliary Channels Common bile duct measures about 0.49 cm in diameter (at level adjacent to hepatic artery) with no evidence of calculus . Biliary tree is not dilated. Pancreas Pancreas is normal in size with normal echotexture. Kidneys Both the kidneys are normal in size, shape and position with well defined cortex and sinuses. Bipolar length of right kidney is 10.70 cm. Bipolar length of left kidney is 10.93 cm. Pelvicalyceal system of both the kidneys appear normal. Cortex and medullary pyramids are well differentiated. There is no evidence of any calculus or any sign of ureteric obstruction. Urinary Bladder Urinary bladder is well filled and regular in outline. Prostate Prostrate gland is normal in size, measuring about 3.37 × 3.72 × 3.01 cm, volume is about 19.75 cc, weighing about 19.75 gm (normal range 12 to 20 gm). Echotexture of prostate is normal Comment: 1. A case of Cholescystitis and Cholelithiasis . 2. Suggestive of fatty liver (grade I) Ultrasonography Report Centre: Monowara Hospital Refd. By Dr. Gobindo Banik Sonologist: Dr. Safia Khatun Dated: 24.12.2012 Ultrasonogram of Whole Abdomen: Report: Excess bowel gas is noted in the abdomen No pleural effusion nor ascitis is seen Liver: The liver is mildly enlarged in size measuring 15.2 cm. It shows smooth contour and homogeneous parenchymal attenuation with no definite focal hepatic lesion. Portal vein appears normal. Gall Bladder: The Gall bladder is normal in size. Multiple (moveable) bright echogenic structures casting strong distal acoustic shadows are noted in the GB lumen. There is no thickening of the gallbladder wall. The biliary ducts are normal in calibre. CBD is not dilated. Spleen: The spleen is normal in size measuring 8.0 cm and homogeneous in echotexture with a smooth outline. No mass lesion is noted within it. Pancreas: The head, body and tail of the pancreas are normal in size with and homogeneous in echotexture. It has a regular outline. Kidneys: The both kidneys are normal in size and ehotexture. The right kidney measuring 10,2 cm and the left kidney measuring is 10.5 cm in their bipolar length. There outlines are smooth and regular. No pelvic dilation or calcification isseen. No cortical thinning is noted. There is no solid renal mass. Proximal parts of bilateral ureters cannot be visualized and excludes any dilation or obstruction. Urinary Bladder: Partially filled. Visualized lumen is clear. No intra-vesicle stone or mass lesion seen. Prostate: Normal in size and homogeneous in echotexture. Volume being 20.7 cm³ (Normal value is 20.0 cm³). It has a smooth and intact capsuls. Comment: 1. Hepatomegaly 2. Cholelithiasis HAEMATOLOGY REPORT Centre: IBN SINA Dated: 02.12.2012 Red Blood Cells Haemoglobin : 11.0 g/dl Total RBC : 4.10 million/Cmm ESR : 55 mm (Auto Analyzer) PCV/HCT : 0.35 I/I MCV : 85 fl MCH : 27 pg MCHC : 32 g/dl RDW : 14% White Blood Cells Total WBC : 9,160 /Cmm Circulating Esinophils : 183 /Cmm Differential Count Neutrophils : 61 % Lymphocytes : 32 % Monocytes : 05 % Esinophils : 02 % Basophils : 00 % Others : 00 % Platelet Count Total Platelet Count : 4,23,100 /Cmm MPV : 10.4 fl SEROLOGY REPORT Centre: IBN SINA Dated: 02.12.2012 C-Reactive Protein (hs-CRP) : 25.8 mg/L Alkaline Phosphatase 79.40 U/L ALT (SGPT) 30.38 U/L AST (SGOT) 22.73 U/L GGT (Gamma GT) 72.40 U/L HBsAg Negative By ELISA Anti-HCV (T) Negative By ELISA I want to know should I need gallbladder remove by lapclo because this was the very first time I felt this pain. If I don t remove my gallbladder any problem will arise in future? What about my fatty liver problem is it any serious problem.? what should I do for it?
Fri, 4 Jan 2013
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Gastroenterologist,  's  Response
Hello, jahangir,
Tha nk you for providing a very detailed report , ultrasound exams and your
complete blood work.
There is no question that you have multiple gallstones. There is no obstruction
of the bile duct , the channel that carries the bile from the gallbladder to the
intestine, which is good. Your liver enzyme levels are normal which means
you don't have signs of inflammation of the liver or the surrounding organs,
like pancreas etc. You are very mildly anemic, but not to worry.
You mention one attack of abdominal pain.
As for fatty liver, it is very mild and with normal enzymes, again, I would
not worry. Besides, during a laparoscopic procedure, they will take a good
look at your liver and if abnormal or suspicious, they can take a biopsy.
Laparoscopic approach has made gallbladder surgery very much easier.
First, it is same day surgery. Recovery is faster. It used to be 7-10 days
in the hospital years ago with tubes in the stomch and bladder etc.
Problem with large abdominal incision, infection, wound separation etc. etc .
All that is not true now. Very rarely, for technical reasons or location of the
gallbladder, they may decide to convert to the old way with open surgery.
In experienced hands , this is very unlikely to happen.
I would recommend that you start taking some oral iron supplements along
with a Super B-Coplex Vitamin daily. Along with this you can take Vit-E 800 i.u.
daily and 1000 mg. of Vit-C daily. If you are a little over weight lose a few.
I wish you well.
Elective surgery is much better than emergency surgery for complications.
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Abdominal Pain. Ultrasound Shows Hepatomegaly. What Should I Do?

Hello, jahangir, Tha nk you for providing a very detailed report , ultrasound exams and your complete blood work. There is no question that you have multiple gallstones. There is no obstruction of the bile duct , the channel that carries the bile from the gallbladder to the intestine, which is good. Your liver enzyme levels are normal which means you don t have signs of inflammation of the liver or the surrounding organs, like pancreas etc. You are very mildly anemic, but not to worry. You mention one attack of abdominal pain. As for fatty liver, it is very mild and with normal enzymes, again, I would not worry. Besides, during a laparoscopic procedure, they will take a good look at your liver and if abnormal or suspicious, they can take a biopsy. Laparoscopic approach has made gallbladder surgery very much easier. First, it is same day surgery. Recovery is faster. It used to be 7-10 days in the hospital years ago with tubes in the stomch and bladder etc. Problem with large abdominal incision, infection, wound separation etc. etc . All that is not true now. Very rarely, for technical reasons or location of the gallbladder, they may decide to convert to the old way with open surgery. In experienced hands , this is very unlikely to happen. I would recommend that you start taking some oral iron supplements along with a Super B-Coplex Vitamin daily. Along with this you can take Vit-E 800 i.u. daily and 1000 mg. of Vit-C daily. If you are a little over weight lose a few. I wish you well. Elective surgery is much better than emergency surgery for complications.