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    What causes perihepatic ascites?

Posted on Fri, 30 Jun 2017 in Medicines and Side Effects
Question: I am a 52 year old woman. I have been diagnosed with osteopenia based on a Dexa Scan. I have had two blood tests for Multiple Myeloma, and both were negative.

But I am repeatedly breaking ribs. No other bones, but this past week I broke yet another rib (my 5th in two years) lifting my veryfat catin her carrier to take her to the vet. I ended up in Urgent Care, and they did an X-Ray and then an Ultrasound (they thought the pain might be gallbladder). The US technician really hurt me. I mean she pressed super hard even though I told her I thought my rib was broken.

The X-Ray showed the 7th right rib was fractured, but not displaced. I was told the Ultrasound was normal, but when I received the report it said, "Liver: Normal size and contours. Normal echogenicity and echotexture. Minimal perihepatic ascites." Aren't ascites really bad? I had not fasted as I was not expecting an ultrasound. I don't know if that explains anything. But that phrase worried me. However, I would assume that the Dr would have said something if it was bad.

Well, as the week has progressed, I have felt worse. So I went to my GP. She repeated the X-Ray, and now I have three broken ribs, and the one that was broken but not displaced, IS displaced. I truly believe the ultrasound technician broke the other two during the exam and displaced the third.

So my questions are: Are the "minimal perihepatic ascites" something I need to be concerned about?

And, do you know of any other diseases, other than osteroporosis, that would explain the repeated rib breaks? What are my ribs breaking so easily, but my other bones only showing minimal degrees of osteopenia per the Dexa Scan?

Thank you.
Answered by Dr. Ivo Ditah 2 hours later
Brief Answer:
You should not be worried at this time. Upload the report for review!

Detailed Answer:
HI and thanks for contacting us at healthcare magic.

1. Ascites means fluid in a cavity. Peri-hepatic means that there is fluid around the liver. If the liver covering is irritated by a torn rib, this can be observed. I will suggest that you upload the report that mentioned this for further review. However, there is no reason to get worried at this time about minimal perihepatic ascites.

2. Yes, osteoporosis can increase the risk of ribs getting fractured. I will suggest that you get on medications for osteoporosis. This is supported by the fact that you are having multiple fractures that could be easily explained by osteoporosis. How severe is the degree of osteoporosis at the ribs regions?

Kindly upload these reports to me for more insights and guidance. To upload an image, simply click on the link to upload a file and follow the instructions. If this proves difficult, please send the image by mail to YYYY@YYYY and request that the image should be uploaded to your query.

I do promise to get back to you with more insights and helpful recommendations as soon as the requested information gets here.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ivo Ditah 23 minutes later
Here is what the ultrasound said:

CLINICAL HISTORY: Right upper quadrant pain


TECHNIQUE: Routine high resolution right upper quadrant ultrasound.

Liver: Normal size and contours. Normal echogenicity and echotexture. Minimal peripehatic ascites.

Biliary system: No gallstones, gallbladder wall thickening or pericholecystic fluid demonstrated. No biliary dilation. The common duct measures 3 mm.

Pancreas: No mass or peripancreatic collection seen. Typical, slightly limited visualization of pancreatic tail noted.

Right Kidney: 10.2 cm in length. no evidence for suspicious masses or hydronephrosis.

No evidence for aortic aneurysm. Inferior vena cava is grossly patent.

IMPRESSION: 1. Minimal perihepatic fluid. Otherwise unremarkable right upper quadrant ultrasound examination. No significant biliary dilation, abnormal collection or mass demonstrated.

What are your thoughts?

My doctor reviewed everything today. She is kind of scaring me. She said it was not at all normal to have any fluid near my liver, that it could be a sign of liver damage, or malignancy. She is sending me for a CT scan of the chest and abdomen. She said the word ascites was alarming.

I read many things online that concur with what you said that a rib break can cause fluid in the area. But my Dr said the word ascites was a red flag. Even though, I had a totally normal CT with contrast in February of my Abdomen and Pelvic area, and all my bloodwork, as recently as February for my liver has been totally normal. Normal CMP and CBC.

I am very nervous because I can't have the CT scan until next week. And I don't really want another CT and all the radiation if my liver looks fine.

I have two daughters with autism, and I need to be healthy for them.

As I said, I had an abdominal/Pelvic CT scan in February that was totally normal. And I had complete bloodwork then that was normal. I have never had abnormal liver bloodwork.

I just don't understand how if a CT in February was fine, and my Ultrasound said the liver looked fine, and bloodwork in February and for years before was fine for my liver - CBC and CMP, I could possibly have a liver problem.

I only drink a couple of glasses of wine on Fridays and Saturdays. Nothing else.

The worrying is making me feel ill.

Can you have a normal CT scan, a liver that looks normal on an Ultrasound, normal blood work, and still have liver disease?

Does what the radiologist wrote on the report indicate a problem?

Do you think I need another CT scan?

Thank you so much and God bless.

Answered by Dr. Ivo Ditah 58 minutes later
Brief Answer:
CT more for saftey than confirmatory!

Detailed Answer:

Having reviewed all these details, a ct scan would be more to make sure all is well than looking for a flagrant liver disease. Be calm and not alarmed. Your worries are genuine but the current findings are not that alarming to keep you up all night.

Be relaxed and let's follow through with the results of this ordered ct scan. We will be definitive and most likely with good news.

Let's stay in touch!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ivo Ditah 22 hours later
Dr. You are very kind. I'm probably being redundant here, but...

The fluid found then is typical after a 7th right rib is fractured near the liver?

If the fluid is still there in the CT Scan, but my liver looks okay and my bloodwork is okay, can I be assured it's just from the rib fracture?

Also, can ascites ever be the first symptom of liver disease?

My doctor seemed so grave in her opinion that ascites was a bad thing. I'm scared. But I have had bloodwork every year for years and never had anything unusual and as recently as February, a CT and all my liver bloodwork was fine.

I would honestly rather not have another CT. So much radiation
Answered by Dr. Ivo Ditah 2 hours later
Brief Answer:
IT is necessary to get the CT-Scan!

Detailed Answer:

It is necessary to get a scan. This will clear all doubts. It is better to be safe than sorry. I understand the fears about radiation but we stand to gain more than loss here.

With many previous investigations that showed no liver damage, this is very unlikely to be suggestive of a serious liver disease. I will be more about irritation that an intrinsic liver disease.

I hope this helps and guides. I wish you well and happy to keep the exchanges going on. Please, kindly keep me updated.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ivo Ditah 17 hours later
Hello Dr.

My CT is scheduled for Monday. I had bloodwork done today, a complete metabolic panel. Everything was normal, including all the liver values, ALP, AST, Albumin, etc.

Does that mean my liver is very likely fine?

Also, I got the X-rays from both places. Last Monday, the X-ray showed my 7th right rib was fractured, but not displaced. Then I had the super painful ultrasound.

Then last Friday's X-ray shows my 7th rib is displaced, and my 6th and 8th ribs are fractured. Is it possible that the ultrasound technician in causing the rib breaks, also bruised my liver and caused the ascites?

Would an X-ray show ascites?

Thank you
Answered by Dr. Ivo Ditah 3 hours later
Brief Answer:
Liver most likely fine!

Detailed Answer:

1. Your liver is most likely fine and the fluid around it most likely related to irritation from the broken ribs. Am not sure the technician could have caused the broken/displaced ribs. Be optimistic and okay.

I wish you well and keep me updated.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Ivo Ditah

Internal Medicine Specialist

Practicing since :2002

Answered : 3922 Questions


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