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What Causes Enlarged Liver And Enlarged Spleen?
Question: I have enlarged liver and enlarged spleen. I have pain near the ribs (left & right lower side), little lower to the left & right shoulder back. I am taking Liv 52, Udiliv & Esoga-RD. Are these medicines correct for curing the above 2 ailments? What food shall I take? Do jogging increases the pain due to enlarged liver and enlarge spleen?
Brief Answer:
it depends upon the cause
Detailed Answer:
Hi,
Thanks for writing to HCM.
There are many causes for simultaneous liver and spleen enlargement, like viral hepatitis, malaria, blood disorders, infection mononucleosis, etc.
And so the treatment varies with the cause. What you are currently taking is essentially liver tonic and an antacid which is usually given in viral hepatitis (jaundice).
You must surely shown to someone and got a few tests done. So what was their diagnosis? What were the test results?
If its viral hepatitis only, then you need to take a bland diet ( almost no oil and spices) and boiled or filtered water, to give your liver rest to help it recover.
And yes jogging may cause pain if both are moderately enlarged. Do walking only till you recover fully.
Hope that i have answered to all your queries. If you haver further queries, i will be glad to answer.
Regards
Dr. Ashish Verma
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dear Dr. XXXXXXX XXXXXXX
Thanks for the advice. As advised by you, I am enclosing the test results (Whole Abdomen USG, Chest X Ray, Urine Test, Blood Sugar (Fasting + PP), Lipid Profile, LFT) for your perusal. I got these tests done in the last week. The pain in the side of the ribs (first started with right side and then also on the left side ribs) 3 years back. My job (since the last 8 years) requires too much travelling and eating fast food/high calorie oily/spicy food. After the pain started 3 years back, I had to lead a very controlled food and took all the above medicine. The pain got cured after 3/4 months of medicine and controlled food. But again due to work pressure, I had to start taking the oily, spicy fast food. Also I had the habit of drinking very little water. Long before (around 6 years back), I had the bad habit of drinking alcohol without water/soda) but the quantity was less and period was small. May be 3/4 pegs and 1 year (once in 2 weeks).
Please advise what is the reason of my pain in the back side (little lower to the left and the right shoulder) and side ribs (right & left). What is the reason of my enlarged liver & spleen? This pain comes back severely every day. I am taking painkillers (declofenac or acclofenac) minimum 1 per day. Is the reason oily/spicy fast food or early alcohol? Or is it hepatitis? Around 1 month back, my bilirubin (direct) was showing value 0.5 mg/dL. The local doctor gave medicine (most likely Ursokem) and now the value is with in limit. But the pain in the back (lower to shoulder & side ribs is not going and is there every day). Please advise the food I should take and I should not take? Should I do jogging as the local doctor asked me to reduce weight (my current weight is 92 kg for age 41 years and height 5’6”).I am already taking medicine Telvas, Ton-Act TG, Glyciphase +Euglim 2 for my blood sugar, blood pressure and trygliceride apart from Udiliv 150, EsogaRD, Liv 52.
Please advise on the basis of the total situation explained above, what is the reason of my pain in the back side (little lower to the left and the right shoulder) and side ribs (right & left). What is the reason of my enlarged liver & spleen? Is the reason oily/spicy fast food or early alcohol? Or is it hepatitis? Please advise the food I should take and I should not take? Should I do jogging or walking as advised by you yesterday?
Looking forward for your advice.
Best Regards
XXXXXXX
Brief Answer:
its more likely to be pancreatitis
Detailed Answer:
Hi,
All your blood reports are essentially normal and so is the chest xray.
There is fatty enlargement of the liver, which is mostly due to your alcohol intake that you used to take neat, and for that one year is more than enough.
In my opinion, this has also had a bad effect on your pancreas. As back pain is more commonly seen is pancreatitis, rather than liver or spleen enlargement. Also your fast food and oily diet would had only added to the damage caused already.
Your spleen is just mildly enlarged and than is not of much significance. That can be due to pancreatitis.
What i would suggest that you get your serum lipase and amylase levels done to see if its pancreatitis or not. As its not hepatitis as your Liver function test is normal.
In addition to that, you need to change your diet to a healthy one to prevent disease progression and allow it to heal.
Avoid running if its increasing the pain, walk till then.
Regards
Dr. Ashish Verma
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dear Dr. XXXXXXX XXXXXXX
The USG report that I have sent says “Pancreas in normal in size, outline & echotexture. No definite focal parenchymal lesion is evident. Pancreatic duct is not seen dilated”. Do you still suspect pancreatitis? The pain is not only in the lower back shoulder but also in the lower right and left ribs. Kindly advise what may be the reason: pancreatitis or liver or spleen enlargement.
As far as food is concerned. Nowadays I am taking corn flakes without sugar in breakfast with only warm water as I cannot digest milk. During lunch, I am taking a small quantity of steamed rice and dal. And dinner, I am doing same as lunch. I am thinking of changing to corn flakes in dinner. Kindly advice as what should be my food.
Will drinking more water (3/4 litres/day) help? Normally I don't feel thirsty? I have joined in a job in Kuwait recently and cannot get the test advised by you (serum lipase and amylase levels) done now as there are some visa complication. I will consult you once these are done. Till then, please advise whether it is pancreatitis or liver or spleen enlargement and what should be my food & water intake.
Best Regards,
XXXXXXX
Brief Answer:
a normal usg dosent rules out pancreatitis
Detailed Answer:
Hi,
I have read your usg report, but a normal usg does not rules out pancreatitis.
The pain at your lower ribs may be due to enlarged liver and spleen. They both are enclosed in a capsule and when they enlarge the capsule stretches and causes pain.
Back and shoulder pain can also be due to your posture and traveling. You can try doing dome back exercises for that and see if that helps.
Though there are many other factors involved I still suggest that you need to get tested for pancreatitis.
Regarding your diet, you can eat vegetables and fruits also. Drink at least 2-3 liters of water a day. It helps in removing toxins from the body.
Dr. Ashish Verma
Above answer was peer-reviewed by :
Dr. Prasad
Dear Dr. XXXXXXX XXXXXXX
I would like to elaborate of the part of the pain in the lower shoulder. This pain is such that when I try to inhale deep or try to yawn or feel like sneezing, I feel the pain. When I am sitting normally or lying normally, the pain does not trouble me. When I try to twist my body in standing posture or sitting posture, I don't feel any pain. I feel the pain in while turning in lying posture. Can you make out from the above symptoms, the cause for the pain. Whether it is pancreatitis or something else? Can I get rid of this pain with healthy food? How many days it may take to get rid of the pain? Also tell me whether I can take corn flakes in dinner also or should continue with steamed rice.
Best Regards,
XXXXXXX
Brief Answer:
then its not shoulder pain
Detailed Answer:
Hi,
Then movements that you described that cause pain are the one those push the diaphragm down.
Your liver and spleen are just below the diaphragm so any movement that pushes the diaphragm down also pushes those organs down and that leads to pain. Also the nerve supply of our body is such that pain below the diaphragm is referred to the shoulder also.
Now this leads us to a new possibility. This type of pain occurs in inflammation and infection. Also the reports to have attached does not has a hemogram or routine blood examination.
This is needed, as it will tell about any infection present. Forget the pancreas test, but please get this done at the earliest, if not already done.
Based on the conversation till now, i believe that you are not having fever or bowel disturbances. Also are you a non vegetarian?
Dont take cornflakes twice a day. It will greatly reduce your nutrient intake. Bring variety in your diet to cover most of the essential vitamins and minerals.
Regards
Dr. Ashish Verma
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dear Dr. XXXXXXX XXXXXXX
Though I am in Kuwait in visit visa, I will, as per your advice, try to get the routine blood test with in 2-3 days. Kindly advise what should I say to the test lab? Saying simply "routine blood test" is sufficient or I need to tell them more specifally about the blood test? Also I would like to ask you, if I take vegetables & fruits along with corn flakes in dinner (twice a day) replacing steamed rice dinner, will that be ok?
Also I would like to inform you one more symptom, which I have some times. I am having fever on 99.8 deg F, though there is no obvious cause for this fever. I have not measured the temperature earlier, I have felt feverish quite often in the last 30 days.
forgot to answer to your query. I am basically a non-veg but not taking non-veg since the last 30 days, as taking non-veg (even fish curry) increases the pain.
Kindly advise for the blood test & dinner doubt.
Best Regards,
Brief Answer:
you having infection dear.
Detailed Answer:
Hi,
Now you came out with the main thing - the fever. If you had told this at the first time only, things would had been so much simple.
See, the pain you you have described till now is typically seen in sub-diphgramatic collection, which is seen in infection. And this also explains your hepato-spleenomegaly.
Now get the blood test done, say in the lab that you need a 'complete blood count' and with that show it to a local doctor, as you need to be started on antibiotics, asap.
Also as your usg is not showing any collection, you need to get a CT scan done. I dont kown how difficult it will be with your work visa to get it done; but I feel it is needed. Ask for a contrast enhanced ct scan of the abdomen. But for this they will need to know your creatinine clearance. So along with the complete blood count, also get a 'renal profile test' done at the same time. Also if possible, and if its done there, get tested for 'malarial antigen', 'widal test' and 'HIV' in the same sitting.
Though your fever is not classical, but in India the most common infectious causes for hepatospleenomagaly with fever are malaria, typhoid and HIV. So it will really help if these can be ruled out at the first go itself.
Please do get these blood tests done asap, as you need to be started on antibiotics.
You can take fruits and vegetables along with cornflakes twice a day.
Regards
Dr. Ashish Verma
Above answer was peer-reviewed by :
Dr. Prasad
Dear Dr. XXXXXXX XXXXXXX
Will it be possible to get the medicines prescribed by you after I send you the copy of the blood test report?
Best Regards,
XXXXXXX
Brief Answer:
i doubt that
Detailed Answer:
Hi,
I really dont have any idea of the medical system there. Few drugs used here may not be used there.
Better to show to a local doctor there for the prescription as he will be better knowing what drugs are available there.
I can always guide you. You get thr tests first and send me the reports. Further course we will decide depending on the reports.
Dr. Ashish Verma
Above answer was peer-reviewed by :
Dr. Prasad
Dear Dr. XXXXXXX XXXXXXX
Thanks for the advice. I will get back once I succeed in getting the blood test done, as advised by you.
Best Regards,
XXXXXXX
Brief Answer:
sure
Detailed Answer:
Hi,
Ya sure, i will be available.
Regards
Dr. Ashish Verma
Above answer was peer-reviewed by :
Dr. Shanthi.E
Dear Dr. XXXXXXX XXXXXXX
It seems that my blood test (as advised by you) can take place after around 6/7 days. Pl advise whether shall I close the discussion and re-start later once the tests are done or continue this current discussion only? There is a timer above which says that the discussion will automatically after around 2 days. Also tell me if I want to contact you after 6/7 days with the test report, will I need to pay the consultation fees once again.
Best Regards,
Priyaranjan XXXXXXX Chowdhury
Brief Answer:
you can restart a new discussion
Detailed Answer:
Hi,
If this discussion is anyways going to end in two days, then better to close it. You can always start a new one and that will require repayment.
Best regards
Dr. Ashish Verma
Above answer was peer-reviewed by :
Dr. Yogesh D
Dear Dr. XXXXXXX XXXXXXX
Most likely I am going to have the test reports by day after tomorrow? Can I revert back to you with my reports for your advice?
Best Regards,
XXXXXXX
Brief Answer:
sure
Detailed Answer:
Hi,
Yes you can come with report any time.
Dr. Ashish Verma
Above answer was peer-reviewed by :
Dr. Yogesh D
Dear Dr. XXXXXXX XXXXXXX
As advised by you, I am enclosing the test report for complete blood count. I am giving 2 scanned copies of the same report for better legibility. Kindly advise if there is some infection, as suspected by you. Also advise, which medicine group, should the local doctor advise to me, dosage for those medicines that I should take. Also advise any Indian brand for the same medicine. I can get the same most likely from some colleague going to India.
I have another question. I tested Glucose – fasting and PP yesterday. The values are little strange to me.
Glucose Fasting – 3.7 mmol/l (against reference 3.9-6.1) whereas,
Glucose PP – 9.4 mmol/l (against reference 3.9-7.8).
I tested these above 2 parameters after around 2.5 hours with only few bread veg sandwich with cucumber and salt. Can these above test results be considered as correct, as per you? Or these results are wrong? If you think these are correct, shall I continue/increase/decrease with my Euglim 1/Glyciphage 850 medicine. Kindly advise.
Best Regards,
XXXXXXX
Brief Answer:
sugars are in control
Detailed Answer:
Hi,
Your total wbc counts are a little raised with more of neutrophills, so you are having a mild infection.
I usually start my patients will similar profile on a combination of a quinolone and an antiparasitic drugs, like in India you get Norflox-TZ (400/600mg) or Ofloxacin-ornidazole (200/500mg) combination, twice daily for 5-7 days.
You can ask your local doctor for a similar medication. Also for your fever and pain you may take an NSAID like aceclofenac and paracetamol combination like in India you get Combiflam or Zerodol-P, twice daily.
Also, intake of the above drugs will cause gastritis, its advisible that you also take an ppi like omeprazole(20mg) or pantaprazole (40mg) on empty stomach till you are taking these drugs.
Regarding your sugar levels, they are under control, so no need for any change in dosage of your sugar meds.
Take the above for a week and tell me the response.
Get well soon.
Dr. Ashish Verma
Above answer was peer-reviewed by :
Dr. Prasad
Dear Dr. XXXXXXX XXXXXXX
Thanks for the detailed advise.
I have one doubt. How are you saying that sugar levels are under control? The Fasting value is less than the lower limit and PP value is higher than the higher limit?
Glucose Fasting – 3.7 mmol/l (against reference 3.9-6.1) whereas,
Glucose PP – 9.4 mmol/l (against reference 3.9-7.8).
Kindly clarify/advise.
Best Regards,
XXXXXXX
Brief Answer:
it all depends upon what you have eaten
Detailed Answer:
Hi,
In a diabetic patients the fasting values are more important to see for the control.
The goal never is to be in the reference range, it is to be as near to it as feasible.
Also these reference limits vary from lab to lab.
And the most important of all is that the fasting levels should not be more.
Your fasting levels are just a little beloe the range, that infact shows you are having very good glycemic control. The post prandial level is actually measured 2 hours of a complete meal.
You had eaten bread which has high glycemic index, and so the sauces used inside. So your PP level is acceptable.
Also just one reading is not sufficient to reach to a conclusion. If you are really worried about your level of control, then get HbA1c levels, as they are much better indicator.
Regards
Dr. Ashish Verma
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Above answer was peer-reviewed by :
Dr. Shanthi.E
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