Question: Current Hep C with 3 weeks Harvoni treatment. Liver stage 3. Enzymes very high initially, fibrosis, spleen normal size.
Labs:
March 2, 2015: ALT = 97, AST = 69, Alk. Phos, = 122, GGT = 83, MCV = 87.5, MCH = 29.4, MCHC = 33.6
May 28, 2015: ALT = 18, AST = 25, Alk. Phos, = 208 (?) GGT = 47, MCV = 86.8, MCH = 29.9, MCHC = 34.4

HCV quant not yet completed; about 6,000,000 IU/ml at initial diagnosis. Small tumor at thoracic T-5. Referred to neurosurgeon. Myelomalacia at cervical C5-C7 following double laminectomy w/fusion in 2007. Cord impinged and lesions present. Chronic pain and mobility dysfunction.

Primary Concern: Elevated Alk. Phos. with GGT in range. Any significance/opinions?

Thank you! CB

History: Hepatitis.

Comparison: None.

Technique: Real-time ultrasound examination of the abdomen was performed. Ultrasound images of the liver, gallbladder, spleen, kidneys, pancreas, aorta and IVC were obtained.

Findings:

Liver: The liver measures 16 cm. No discrete liver abnormalities. No prior study shows to compare. There is overall course echotexture the liver.

Portal vein: Main portal vein is patent with hepatopetal flow.

Spleen: The spleen measures 10.8 cm. No focal splenic abnormalities.

Ascites: None.

Gallbladder/biliary tree: No definite gallstones. No wall thickening. The common duct measures 4 mm.

Pancreas, IVC and abdominal aorta: Grossly unremarkable.

Right kidney: The right kidney measures 11.8 cm.

Left kidney: The left kidney measures 12.4 cm.


Impression: Coarse echotexture of the liver consistent with hepatic parenchymal disease. Correlate with LFTs.


Electronically signed by: XXXXXXX O. NUNES, MD