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Lump on neck and diabetic. Biopsy showed no malignant cells found. Done with liver serum check. Anything serious?

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Hi, A biopsy was conducted after we saw the lump on his neck (paratracheal lymphadenopathy). The biopsy say no malignant cells found. No acid fast bacili found. My father has been prescribed with TB medicines P E and R of the PIERS and he has been taking the same since 2 weeks now.
Today, after three weeks of culture test again says no acid fast bacili seen in the culture MGIT TB identification and we have been told to wait for another 3 weeks.

We conducted a liver serum check and here are the results
SGOT 570
SGPT 401
Total Biluribin 1.1
Direct Biluribin 0.70
Globulinn 4.4
A:G ration 0.86
Alkaline phostphatase 136

My father is diabetic. He is not eating well. He is facing severe constipation problem and tries to go several times because of the urge to pass motion but unable to relieve himself.

Kindly advise, whether the liver is ok? ( He is taking LIV52 thrice a day right from day one of the treatment) Change in medication required? Is it normal to have such high values in liver test. Also about constipation.
My dad is very very physically weak.
Posted Thu, 22 Aug 2013 in Medicines and Side Effects
Answered by Dr. Lohit K 4 hours later

Thanks for your query.

1. Liver function tests showed raised enzymes level. This is not OK.
Of the drugs he is taking, Rifampicin can cause hepatitis, dose dependent and is reversible and Pyrazinamide can cause hepatotoxicity in around 15% people but less evident with the currently using dose. Since your father is 65, the chance of hepatitis is higher.
You need to stop these drugs and consult your doctor for changing it. Continue Liv 52 syrup.

2. Constipation: Since not eating well, raised liver enzyme and diabetic, give him
plenty of fluids and food XXXXXXX in fiber, syrup cremaffin can be given which act as lubricant laxative. If not relieved or impacted then need to give enema.

3. Diabetes: Since in infection the sugar levels will be varying much, need to adjust your dose based on his current sugar levels.

4. The diagnosis may be wrong as the microscopy and culture both are negative for acid fast bacilli, get done one chest X-ray and sputum examination and HRCT may be required for diagnosis if not diagnosed with X-ray.

Ask him to have adequate regular sleep,avoid oily food, have nutritious diet with required calorie and regular exercises.

Hope I answered your question. Consult your doctor for further management.

Feel free to ask me if you have any further queries or doubts and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wish you and your father good health. Take care.

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