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High bilirubin levels and liver dysfunction - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Average Posted in: Liver and Gall Bladder
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1776 Questions
User :   29 year old female. 100 lbs, have lost 10 lbs. since October. Had a US in Oct. that picked up an echogenic focus, "most likely representing a cavernous hemangioma 3.4 cm". (Dec) Follow up CT with in contrast states "probable focal fatty infiltration" 4 cm. I also have high bilirubin. All other liver function tests are normal. I am concerned, but doctors do not seem to be. Apart from this I have been very ill since the end of September with digestive problems, weight loss, headaches, etc. Should I be worried about cancer?
Doctor :   Hi
User :   Hello
Doctor :   How can I help you?
User :   can you see my question above?
Doctor :   Let me read your query.
User :   Thanks.
User :   I also have access to many of my recent medical tests, if that helps, i.e. you have further questions
Doctor :   Have you recently the checked biliirubin levels?
User :   yes, the bilirubin was checked yesterday
User :   I am Canadian, if that makes a difference
User :   it fluctuates
Doctor :   May I know if those values were normal?
User :   the values are high
User :   0-21 is normal
Doctor :   Are you there?
User :   yes
User :   sorry
User :   something happened to the screen
User :   i am here now
User :   mine is moderately high
Doctor :   Ok
User :   29
User :   0-21 being normal
Doctor :   Since when are you having the symptoms of reduced appetite?
User :   it was 34 on the first test
User :   i have been having digestive problems since october that have been very bad
User :   but I have had problems (less frequently) for a few years
Doctor :   May I know if your scan indicates multiple hemangiomas or a single one?
User :   the ultrasound stated "a solitary 3.4 cm echogenic focus is noted on the left lobe with appearances most likely representing a hemangioma" and the CT scan reads "4 cm probable focal fatty infiltration located in the left left adjacent to the falciform ligament. It has a regular shape"
User :   follow up MRI reccommended --although i was unable to complete the MRI due to severe claustrophobia
User :   ALT, AST, GGT all normal
Doctor :   Ok
Doctor :   Let me brief you.
Doctor :   Your symptoms of loss of appetite and digestive problems can be attributed to raised bilirubin levels and liver function dysfunction.
Doctor :   However the cause for these disturbances can be determined by scans alone.
User :   hello
Doctor :   Are you there?
User :   yes
Doctor :   From the description of the scan, its unlikely that the cause is a cancer.
User :   really!
Doctor :   Can you confirm your phone number?
User :   I am very concerned
User :   why do I need to do that ?
Doctor :   Since we are facing some technical issues during the chat, I can discuss your concern on phone, if that is fine with you.
Doctor :   Are you there?
User :   Hmm, where are you calling from?
Doctor :   I am from India.
User :   Do I pay for the call ?
Doctor :   I shall call you.
User :   Do I pay?
Doctor :   And you need not pay.
User :   Is this normal protocol ?
User :   The chat seems to be working now
Doctor :   Ok
Doctor :   Let me proceed then.
User :   please do
Doctor :   As I was mentioning to you, the appearance of the CT scan is not conclusive of a cancer.
Doctor :   A more informative scan such as SPECT CT scan or an MRI can shed light on what the lesion is.
Doctor :   Are you there?
User :   yes
User :   We do not have SPECT scan in Ontario
User :   or Open MRI and I just cannot do the MRI
Doctor :   Ok
Doctor :   then the alternative approach will be
Doctor :   repeated CT scans over a period of time.
Doctor :   A single, non growing lesion will rule out cancerous lesion.
User :   well it wasn't seen on an US that I had last year
User :   around the same time
Doctor :   Let me put across to you in simple words.
User :   ok
Doctor :   Two form of tumours exists a benign one, is a non concerning problem that needs no treatment and a cancerous/malignant one.
Doctor :   The lesion that is seen is likely to be benign one unless proved by higher scans or
Doctor :   Biopsy.
User :   yes...
Doctor :   Biopsy is dangerous when performed on cavernous hemangioma.
Doctor :   But from previous experiences
User :   my CT was enhanced with contrast, so I think hemangioma may have been ruled out, but this is what I am unsure of
User :   as, the CT was performed as a hemangioma protocol
Doctor :   cancerous lesions are usually multiple, irregular growing lesions.
Doctor :   and not single, regular focal lesion.
User :   oh, then they do not have a regular shap
User :   usually
User :   what is strange to me is that this focus was not there last year around the same time and now it is 4 cm
User :   does it make a difference that the ultrasound in october saw 3.4 and ct saw 4 cm?
User :   4 cm seems rather large to me
Doctor :   I can understand your concern.
User :   i know it's unlikely, but my aunt was diagnosed with liver cancer when she was 23, they saw it on ultrasound, that was over 30 years ago, she's still alive, but it does happen
Doctor :   benign lesions can be of varying length.
User :   I guess I don't understand how they saw hers on US and I still don't know what this is after a CT scan
User :   ok
User :   you mean they can grow quickly or...
User :   appear suddenly
Doctor :   They can appear any time and the growth is gradual.
Doctor :   Hence, if i were your doctor,
Doctor :   I would get repeat scans after few months to see the progress of the lesion, if higher scans are not feasible.
User :   should I recharge to continue to chat with yoy?
User :   our time is running out
Doctor :   and will consider this lesion as a benign one(as they are regular)
User :   are you still there?
Doctor :   Are you there?
User :   yes
User :   what if it is cancerous, the waiting is not a good thing, no?
Doctor :   Have you followed what I have suggested?
User :   do you mean about waiting and getting follow up imaging later on?
Doctor :   A MRI or a SPECT scan will be a better option, if it is not feasible,
Doctor :   then you will need follow up scan regularly
User :   but you do not think that this lesion is cancerous
Doctor :   at a period of 3-6 months.
User :   based on the information i have provided to you
Doctor :   with regular liver function test.
User :   thank you
Doctor :   Yes.
Doctor :   Based on the scan, I don't consider it be cancerous at this time.
Doctor :   I would however suggest you to follow up regularly with your gastroenterologist or hepatologist,
Doctor :   regular liver function test and repeat scans may be necessary.
User :   I have a GI doctor at the moment, but I do not see him until February
User :   yes
Doctor :   Further treatment plan can be decided based on those follow up scans.
User :   I intend to press the point of diagnosis any chance I have with any doctor
User :   I need to know what is going
User :   on
User :   so follow up scans are usually that far apart
User :   3-6 month
User :   months
User :   I also had a complete abdominal chest x-ray x 2 and nothing
Doctor :   Diagnosis is unfortunately possible only by a higher scan or a biopsy.
User :   hmmm
User :   so, no one can be sure
Doctor :   Biopsy again can be done only after ruling out cavernous hemangioma.
User :   MRI is likely my only option
User :   what about CT without contrast?
User :   maybe sooner?
Doctor :   CT without contrast will not provide any additional information.
User :   and decide from there if a biopsy is warranted
User :   so how do they know that it's not a hemangioma based on the CT contrast test?
User :   does it mean that the contrast did not travel through the lesion as it should have?
Doctor :   I cannot predict that without looking at the scans.
User :   ok another question is, say that this was cancerous, and it spread from my colon, or somewhere not immediately identified on CT, would there not be other changes in some of my blood work CBC, etc that would indicate cancer? If the answer is yes, what would they be?
Doctor :   Metastatic cancers are mutiple, irregular and again easily picked on contrast scans.
User :   and blood work?
User :   and primary liver cancer is rare, hence the assumption that i should not be worrying about this too much
User :   time running out again
User :   2 mins left
User :   i cannot renew again
Doctor :   Liver function test are indicators for presence of metastasis.
User :   thank you
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