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Have Baratt's esophagus detected. Had RIF pain, nausea. Ultrasound showed echogenic foci attached to the gallbladder. Help?

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Gastroenterologist, Surgical
Practicing since : 1989
Answered : 883 Questions
I am 48, a nurse, i have Baratt's oesophagus detected on screening 8 yrs ago following my brothers early death 41 yrs - oesophageal cancer - i consider myself to normally be in good health, weigh 70kgs and 167cm height, i don't drink and follow a low fat diet. I have just had an abdominal ultrsound for RIF pain much worse mid cycle, at ovulation for approx 3 mths. The pain moves around to my back and my lower abdomen. My bowels and urine are normal, i have occasional nausea with no vomiting and decreased appetite. I am waking up occasionally with LUQ pain which resolves fairly quickly. (I have a pelvic ultrasound booked for tomorrow). The abdominal ultrasound today states "Normal sized liver with increased echotexture in keeping with fatty infiltration of the liver. Focal fat sparing is noted adjacent to the porta hepatis and gallbladder fossa. No suspicious focal lesion is detected. The gall bladder is distended and shows 2 echogenic foci attached to the gallbladder wall in keeping with tiny gallbladder polyps. No pericholecystic fluid is seen. the biliary ducts are not dilated and the common duct measures 0.3mm." All other organs ie spleen, pancreas and kidneys are normal. I am surprised as i have never had pain that would suggest a gallbladder or liver problem, all my biochemistry results have been normal. What would you suggest my next course of action with regards to these results.
Posted Sat, 23 Jun 2012 in Digestion and Bowels
Answered by Dr. Ketan Vagholkar 1 hour later
Thanks for writing in XXXXXXX
From the details provided by you it appears that you have 3 issues to be addressed.
1. For the Barett's esophagus you just need to undergo surveillance endoscopy. In the event of any suspicious appearance in that region , a biopsy may be required. Otherwise the food habits which you are following are absolutely fine.
2. The liver problem which you have been diagnosed with is fatty liver. This requires attention as untreated there is a possibility of it progressing to fibrosis or cirrhosis.
You will require a combination of medications (containing ornithine,silymarin,tricholine citrate and sorbitol) along with increased intake of proteins. It will take at least 6 months of care and treatment for the fatty liver problem to clear. Your symptoms of pain and discomfort in the right abdomen can be attributed to the heaviness of the liver caused by fatty infiltration.
3. The polyps in the gall bladder are very small. Many a times these could also be incidental or artifactual. Therefore a repeat USG of the upper abdomen after 3 months is required to confirm their presence. If persistently present or enlarging in size with the onset of XXXXXXX symptoms then it could require cholecystectomy. But in majority of cases that is never required unless there is stone development in the gall bladder.
A pelvic USG will help in studying the uterus and the adnexa for any pathology causing pain.
I hope my explanation provides you with a road map for further treatment.
With regards
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