What does the following abdominal ultrasound report indicate?

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Posted on Tue, 8 Nov 2016 in Abdominal Pain
Question: Hi,
I am 34 years, male. I am just done with ultrasound of my abdomen and here are the results. My doctor has also requested for blood work as well. I am having pain in my abdomen, feeling bloated most of the time when I sit and feels better when I standup and walk. I never had anything like this before and these symptoms appeared over the last 2-3 months or so. Can you please advice?

TECHNIQUE: Transverse and sagittal transabdominal sonograms of      
the abdomen, aorta and IVC were performed in conjunction with      
color Doppler.      

FINDINGS:      

Liver: Visualized portions demonstrate increased echogenicity      
without focal masses. No intra- or extrahepatic ductal      
dilatation. There is normal hepatopetal portal venous flow.      
Measures 18 cm.      

CBD: Normal in course and caliber, measuring 4 mm.      

Gallbladder: Unremarkable without gallstones, sludge, wall      
thickening or pericholecystic fluid. No sonographic Murphy's      
sign.      

Pancreas: The pancreas is unremarkable.      

Spleen: No splenomegaly or definite focal splenic lesion.      
Measures 9.9 cm.      

Kidneys: Right kidney measures 10.0 cm. Left kidney measures      
10.0 cm. There is normal renal cortical echogenicity and      
thickness without hydronephrosis, nephrolithiasis or focal renal      
parenchymal lesion.      

Aorta: The aorta is normal in caliber.      

IVC: The IVC is normal.      

Impression:

IMPRESSION:      
Hepatomegaly and hepatic steatosis. Otherwise normal exam.

Thanks.
doctor
Answered by Dr. T Chandrakant 1 hour later
Brief Answer:
Please give details about your symptoms

Detailed Answer:
Hi.
Thanks for your query.
Noted your history.
The ultrasound shows only enlarged liver and increase in fat deposits in it otherwise rest of the visualized structures are normal .
Ultrasound has limitations as it does not not intestines well.
Since you have pain and bloating as the major complaint a contest enhanced CT scan od whole abdomen with Enterography would have been better as it shows all intestines, lymph nodes and such structurs .
Please give additional information about your symptoms as the very detailed history from beginning till now can help me to assist you better.
Also tell regarding any pain in back.
Stool, urine habits, any changes.
And post reports of blood tests.
Stop alcohol and tobacco in any form, if at all you are taking.
Reduce fat intake.
Also get stool and urine tests.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. T Chandrakant 32 minutes later
thanks doc for your reply.. yes my doctor ordered me stool and blood work and going for it tomorrow. about me, im not a smoker and i am a very social drinker and take a XXXXXXX of 2 or 3 beers at a time...the last time i had alcohol was 4 or 5 months before. Reg my symptoms, i get some pain at the back but not always..once in a while and it doesnt bother me as the bloating and tightness and pain of my abdomen is. My stool color appear normal...but the frequency of bowel.movement varies. sometimes i get it n the morning or sometimes it haopens in the evening. Also, the stool sometimes appear very hard and long and the next day it is very soft and sticky. my urine output looks normal and color looks ok too. The pain and tightness around the abdomen is what is discomforting me. I also had a abdomen xray by drinking barium to check for GERD. The findings on xray appears normal but my doctor says i may have some sort of reflux disease going on. i have scheduled my appt only next week. im so worroed abt this pain and the ultrasound result also upset me where it says heptamelogy and fatty liver. please advice why this pain is and is there any food that i have to avoid at home and i eat mostly at home...
doctor
Answered by Dr. T Chandrakant 3 hours later
Brief Answer:
Awaiting for reports.

Detailed Answer:
Thanks for your detailed history.
It is nice to know that you do not smoke or drink alcohol (occasional as you have mentioned).
One of the reasons for hepatomegaly is gastro-intestinal disease as all the things absorbed by intestines go to liver first. Hence can affect the liver. You have problem of bloating and tightness, sometimes sticky stool as as you have explained so well.
Food and beverages: The simple rule is that you make a list of the foods and beverages that instigate or enhance your problems and to stop them altogether.

Rest of the things we can discuss once all the reports are available.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. T Chandrakant 17 hours later
Hello Doctor,
I got my blood test results. Here it is..very much concerned about low neutrophill count. Does it mean something serious? Please advice.

Component     Your Value     Standard Range     Flag
White Blood Cell Count     7.0 K/uL     4.0 - 11.0 K/uL     
Red Blood Cell Count     5.50 M/uL     4.4 - 6.0 M/uL     
Hemoglobin     15.9 g/dL     13.5 - 18.0 g/dL     
Hematocrit     47.0 %     40.0 - 52.0 %     
MCV     86 fL     80.0 - 100.0 fL     
MCH     28.9 pg     27.0 - 33.0 pg     
MCHC     33.8 g/dL     31.0 - 36.0 g/dL     
RDW     13.0 %     <16.4 %     
Platelet Count     268 K/uL     150 - 400 K/uL     
Neutrophil     36 %     49 - 64 %     L
Neutrophil Bands     5 %     0 - 10 %     
Lymphocyte     49 %     26 - 46 %     H
Monocyte     4 %     0 - 12 %     
Eosinophil     6 %     0 - 5 %     H
Basophil     0 %     0 - 2 %     
Differential Type     Manual            
WBC Morphology     Normal            
RBC Morphology     Normal            
Platelet Morphology     Normal
doctor
Answered by Dr. T Chandrakant 5 hours later
Brief Answer:
As explained below.

Detailed Answer:
Hi.
All the 5 components of differential counts make together 100%, hence when the lymphocytes and Eosinophils are increased- the neutrophils will appear less.
Since WBC that is white cell count is normal, nothing much to worry about.
Since your problem is related to intestines , stool tests is more important.
Please get stool tests done.
Liver function reports please.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 38 hours later
Hello Doctor,
Here is my stool test result, metabolic panel and my lipid profile. Along with my other results that I mentioned earlier, did the below test say anything about the cause of my abdominal pain (or anything about my health in general).

Stool Test
HELICOBACTER AG RSLT     Neg

Sodium     141 mmol/L     136 - 145 mmol/L     
Potassium     3.3 mmol/L     3.5 - 5.1 mmol/L     L
Chloride     104 mmol/L     98 - 107 mmol/L     
CO2 (Bicarbonate)     25 mmol/L     21 - 32 mmol/L     
Glucose     87 mg/dL     70 - 100 mg/dL     
BUN     12 mg/dL     6 - 25 mg/dL     
Creatinine     0.92 mg/dL     0.50 - 1.30 mg/dL     
Note New Normal Range
IDMS-traceable method
GFR Est-Other     108 See Cmnt     >60 See Cmnt     
GFR Est-African XXXXXXX 125 See Cmnt     >60 See Cmnt     
Units: mL/min/1.73 m2. Estimated glomerular filtration rate values are
calculated using the CKD-EPI equation
Calcium     9.2 mg/dL     8.2 - 10.2 mg/dL     
Total Protein     7.8 g/dL     6.4 - 8.2 g/dL     
Albumin     4.4 g/dL     3.2 - 4.7 g/dL     
Total Bilirubin     1.1 mg/dL     <1.1 mg/dL     H
Alkaline Phosphatase     107 U/L     26 - 137 U/L     
AST     22 U/L     0 - 37 U/L     
ALT     43 U/L     12 - 78 U/L


and my LIPID profile is below.

Total cholesterol     219 mg/dL     <200 mg/dL     H
Triglyceride     144 mg/dL     <150 mg/dL     
HDL cholesterol     47 mg/dL     >40 mg/dL     
LDL Calculated     143 mg/dL     <130 mg/dL     H
Cholesterol to HDL Ratio     4.7      <5.0     
LDL:HDL Ratio     3.04      <3.51     
VLDL (Calculated)     29 mg/dL     <41 mg/dL
doctor
Answered by Dr. T Chandrakant 3 hours later
Brief Answer:
as explained in details.

Detailed Answer:
Hi.
The reports show only a few things:
Low Potassium - 3.3 below lower level of 3.5; increase intake of banana and coconut water, hopefully will be recovered. Low potassium gives weakness. Kidney functions are normal hence nothing much to worry about.
Total bilirubin at the level of high 1.1; other liver functions are normal.

Mildly elevated Total cholesterol by 19; food changes and exercises can take care of this, does not need any medication.
LDL is increase and is a bad cholesterol and again can be controlled by diet changes and exercises.

Not much related to pain in abdomen or health.
Stool tests shows only Helicobacter - Negative.
Please go for the full tests of stool: routine, microscopy, occult blood as these are going to show whether there is any problem that is detectable in stool.



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 20 hours later
thanks doctor for your immediate reply. These are the tests my doctor referred me to and i have an appointment with him next week. I will try to request him to refer me for a complete stool test for me. I will let you know how it goes and so I can get your opinion as well. Any idea why total XXXXXXX rubin is high, what might be the reason for it and is that anything I need to do to get it down?
doctor
Answered by Dr. T Chandrakant 7 minutes later
Brief Answer:
Bilirubin at higher level of normal range.

Detailed Answer:
Total Bilirubin 1.1 mg/dL <1.1 mg/dL H
It is actually on the highest level of normal range; not high, can be taken as normal. Nothing special needs to be done as other functions are normal.

Will be waiting for stool test reports.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 2 minutes later
Ok Doctor. I will keep you posted after my appointment with my doctor next week. Thanks for your advice and support so far....
doctor
Answered by Dr. T Chandrakant 8 minutes later
Brief Answer:
Thanks for appreciation

Detailed Answer:
You are most welcome

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 17967 Questions

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