I’m a 49 year male (6’5” @ 290 lbs) with high blood pressure. I smoke 1 cigar & have 2 -3 drinks daily (wine or spirits) w/dinner. My meds are Toprol XL 50mg, lisinopril 30mg and aciphex 20mg daily. I have IBS (mild sigmiod diverticulosis colonoscopy 11/08), & a fatty liver for 6+ years. My CT scan 1 yr ago was unchanged from last 4 yrs: fatty infiltration of the liver with areas of relative hyperdensity adjacent to the gallbladder/fatty sparing and diverticulosis. Hepatitus panel was normal 2 years ago. I’m experiencing mild pain under my left shoulder blade. It comes & goes daily, no pattern. I occasionally feel pain in the front (at the rib level 2 ½” or so from the middle of my chest even with the area under the shoulder blade) No change with position or meals. My bowels are lighter than 5 yrs ago & somewhat loose but not white or gray. They sometimes float but easily flush. I use psyllium daily. Dr says muscular and/or diverticulosis. Sometimes there are food particles in my stool: corn, lettuce & potato chips pieces. My recent LFT showed a got/ast of 56 and a gpt/alt of 122. Dr said diet and repeat tests in 6 months. Over the last 6 months I lost 17 lbs 4 in the last 30 days. I’m not trying; haven’t made any major changes just some mild cut backs but no effort. The Dr is going to change my blood pressure meds (started taking lisinopril 5 yrs ago, toprol 2 yeas ago). He said they could cause elevated LFT's My elevated numbers have been: gpt, alt, bili(1.6) cholesterol(265), triglycerides(258) & glucose (106)The bili & glucose have been elevated for the past 4+ yrs. My concerns: pancreas (left shoulder pain & stools & weight loss. My Amylase was normal, 83 3 mths ago) & the progression of the LFT's over the last 5+ years. Are they being caused from my meds? Do I have pancreas symptoms? Out of the symptoms I have if they were pancreas related would I have other symptoms and if so what? I am scheduled for another CT scan and blood test next week.
I agree with the CT scan to exclude diseases of the pancreas, liver, gallbladder and biliary tract.
So-called "painless jaundice," where the bilirubin is elevated, can be due to pancreatic cancer. If this is suspected, an MRI, or MRCP can be considered.
Food particles in the stool needs to be evaluated for malabsorption. Sending the stool off for analysis can be done, as well as obtaining blood tests to exclude celiac disease.
If the tests remain negative, and the liver enzymes continue to be high, the next consideration would be a liver biopsy.
These options can be discussed with your GI specialist.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin Pho, M.D.
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