Have abnormal liver and stomach tests

[JoanneS1122]

Would anyone know what the following means?
o   Ultrasound showed a prominent common bile duct;
o   liver shows fatty changes;
o   HIDDA scan shows liver enlargement and decreased emptying of my gallbladder;
o   Gastric emptying study shows slow emptying of my stomach.

This information just came to me today in a letter from the Geisinger Health System. I called them, as they requested, but no one has called me back yet. Can anyone put this together?

My symptoms are nausea, vomiting, diarehea, constipation, but mostly vomiting when I try to have a bowl movement. I am surprised to receive a letter telling me I have "abnormal" results. No one called me? What is that about?

Any help would be appreciated.
Blessings,
Joanne

[JoanneS1122]

Hi again, many thanks for simplifying things, Boron. I've been doing a lot of reading, getting ready for my trip to the doctor on 4/30. I can't wait to get there. In the meantime, the vomiting has subsided a tiny bit, and I can almost get through the day without heaving.

Twilight Princess, thanks for the instructions. I'm going there now and will see if I can figure it out!
Blessings to all,
Joanne

[boron]

If I may comment few things:

The "sludge" in the gallbladder is a dense bile, it is like a pre-form of gallstones. If you leave this as it is, gallstones will probably form. 33% functioning of gb is poor. You're candidate for gallbladder removal.

"Fatty liver" is when fats are deposited within hepatic cells. This may develop into hepatitis. It can cause liver pain. Beside alcohol, obesity is the main cause. Weight loss may improve fatty liver.

"Cysts" in the pancreas and kidneys may be connected, but you should ask about the exact nature of these cysts.

Vomiting is probably from gallbladder problem.

[Twilight_Princess]

Hi Joanne,

I hope you are feeling better today?

You made a Profile here at Med Help so you can get into your profile by clicking on "My MedHelp" (in the upper right hand corner). You will see many tabs once you're in your profile - it has "Photos", "Posts", "Friends", "Messages" and so on. I left you a PM and it should be in under the "Messages" tab. To send me a message, just put your cursor (mouse) over my name and a little box with my profile will show up - on the right hand side there are different options and from there you can send me a PM - it should say "Send Message". I hope this helps :)

[JoanneS1122]

Hi TP and all,
   I actually didn't throw up my dinner last night--but that's a first. I have been unable to keep food down for more than 2 weeks. Since I am overweight, I am not worrying, but I am tired of being so sick and tired all the time.
   TP since you had your gallbladder out, do you feel better? Has the pain you had afterwards finally subsided? Have you had any vomiting or nausea issues?
   I am very grateful to you for looking up the Kidney cyst, and I will just put that out of my mind since it does say that "no further imaging" or followup is necessary. Especially since the pain there is so infrequent, and I'm not sure it's from that anyway. It's probably gallbladder pain I'm having on my right side.
   I have just read a diet for fatty liver disease and gallbladder problems, so I am putting together a menu for myself to be sure I don't eat anything that's not on the lists. This way I hope to curb the vomiting and nausea. My GP sent me to the dentist because my teeth are rotting in my  head (despite constant brushing and rinsing) becasue of the acid from vomiting. The dentist gave me an RX for a special toothpaste which has helped and is supposed to put some strength back in the teeth I have left. I actually had to have one pulled last week as it had rotted off at the gum line. I have had 4 do that. Thank God I still have my front teeth.
   That's all for today. I so appreciate your help. I am not sure what a PM is or how to do it? Is it a contact box I have on here somewhere?
Blessings and enjoy your weekend,
Joanne

[Twilight_Princess]

This is what I found about renal parapelvic cysts. I hope this helps ease your mind.


The simple renal cyst is a benign non-neoplastic mass of unknown etiology arising in renal parenchyma (cortical cyst) or within the sinus region (parapelvic cyst). The uncomplicated cyst cavity is typically unilocular, usually filled with clear serous fluid and lined with a cuboidal epithelium with no communication to the renal collecting system. It's believed that these cysts arise from tubular or lymphatic obstruction. The incidence of renal cysts increases with age occurring rarely in neonates and the pediatric group, to over 50% in those over age 50.The simple renal cortical cyst or parapelvic cyst is discovered incidentally so it's important to differentiate it from a true renal neoplasm. Renal cysts account for 60-65% of all renal masses. Large cortical cysts can show up as a palpable flank mass and parapelvic cysts can be detected producing extrinsic compression or mass effect on the collecting system on an intravenous pyelography (IVP) exam. Renal cysts are rarely associated with conditions like tuberous sclerosis, von Hippel-Lindau disease, neurofibromatosis, or Caroli's disease. In most of these cases, the systemic condition already exists prior to the discovery of the renal cysts. Atypical renal cell carcinomas can develop as a complex cystic mass, although its appearance on US, computed tomography (CT) and magnetic resonance imaging (MRI) is easily differentiated from a simple cyst. The parapelvic cyst appears on US as a medially located cystic mass with surrounding echogenic walls since it's located within the fatty renal sinus. Keep in mind that multiple cysts can be confused with generalized or even localized hydronephrosis. Look for a lack of central communication between the cysts as a distinguishing feature. With hydronephrosis, the dilated calyces are seen to coalesce centrally like the fingers of a glove as they connect to the renal pelvis and proximal ureter. If the differentiation isn't clear on US, an IVP or CT exam can help with the diagnosis. If the radiologist is confident that the central renal cystic mass or masses represent parapelvic cysts and the finding is completely incidental, then no further imaging followup or investigation is necessary. MM (Reference: Radiology: Diagnosis, Imaging, Intervention1999;121:1-4.)

[Twilight_Princess]

So you DO have pain. The pain sounds similar to the pain I had, even after the gallbladder was removed, but I had problems with the liver (high enzymes).

I knew I was right about having those blood tests, CalGal mentioned the same tests. I can't believe the doctor didn't do those tests! That is really important.

The liver panel tests would be :
Alkaline Phosphate
GGT
ALT
AST
LDH

The pancreatic enzymes test would be :
Amylase
Lipase

I was thinking, if you can't get into the doctor's sooner, I would just go to the ER - someone HAS to look at you then. They need to take this serious! This whole scenario sounds just like the doctors I have been dealing with. The only time they took me serious is when they got the results from my liver panel test. I had a follow-up with my Cardio doctor and because he listened when I told him about the pain is how I got the attention I needed! My primary doctor wasn't listening, but once my Cardio doctors office contacted him I was admitted into the hospital that night! Thank g*d for my Cardio doctor!!

I will listen anytime you need someone to talk to, just send me a PM.

I hope you are feeling better today :)

[JoanneS1122]

Thanks for the comments, and I will try to answer them as best I can, here.

I have pain on the left side, in the front--that's where it's always been. I have had bad back pain on the right side, sort of in the middle where I'm guessing my kidneys are. I have had the same pain on the left side as well.

I once had the most excruciating pain in my "stomach" (front, all over) that I fell on the bed at home and just laid there, thinking I was dying. It subsided after about 15 minutes, and I could finally reach for a phone and call my husband who was outside doing yard work. I've never had that pain again, yet.

NO ONE has done ANY blood work. So I have no answers there.

Yes, the doctor who did call me back had never seen me as a patient, and she gave me the "report" I stated in my first Comment. She was a little leery of talking to me, but it was HER letter that said to call HER!

I tried again this morning to get into my Gastroenterologist's office sooner thatn 4/30, but they called me back and have no other opening yet. I am on the top of the wait list.

I am going to write down all your good suggestions such as the Liver Function Panel and the Pancreatic ensyme levels and ask the doctor why those have not been done yet.

I am concerned about the "sludge" and if Twilight_Princess' gallbladder was removed, working at 88%, I can only assume they'll take mine out as it's "non-functional." That was a blow to learn from a doctor who never saw me before. But thank God for all of you as you put it in perspective, Twilight_Princess and CalGal, and I feel like at least someone is helping me along! It's a scary road until I figure out what all this means.

I am going to look up pancreas today and see what all that means and how it's connected to my gallbladder and liver and stomach. I don't know what "fatty changes" means, but I'm assuming, like the liver, where there should be good cells there's fatty cells instead?

CalGal has asked for the emptying numbers, so I'll put them here for what they're worth. Perhaps you ladies can help me figure out what it might mean. Here it goes:

o   Nuclear Gastric Emptying Study: The patient is examined following a meal containing 1.3mCi of technetium 99m sulfur colloid. The patient was followed for 90 minutes and during this time, the patient shows a linear emptying pattern, which woudl suggest gravitational drainage and poor peristalsis with a total emptying of only 33%. Normal would be greater than 50% within this time frame.

      o   Conclusion: None written.

o   Hepatobiliary Nuclear Scan: The study is performed following injection of 6.6 mCi technetium 99m Choletec. There is prompt clearance of isotope from the blood pool with good concentration in the liver. The liver sppears to be slightly enlarged and there is satisfactory visualization of the gallbladder and intrahepatic ductal system before the more distal portions of the extrahepatic duct and bowel. However, at 1 hour there is good drainage of the isotope from the liver and good progression into the mid small bowel. The gallbladder is well distended. At 1 hour, the patient is administered Kinevac and followed for 30 minutes and showing only a 10% ejection fraction reaction to the Kinevac, which is abnormal (greated than 35% in first 30 minutes).

     o   Conclusion: Liver enlargement, no ductal obstruction, biliary dyskinesia with only a 10% contraction and evacuation during the first 30 minutes following injection of kinevac.

To top it off, they've found "a small parapelvic cyst...within the left kidney." And, thankfully, "the spleen is normal."

Does this mean anything to either of you or anyone else? I am looking more up today, and appreciate, more than you know (!) any comments or even questions to ask the doctor on 4/30.

Blessings,
Joanne

[CalGal]

There are a couple of things you need to find out before you jump to any conclusions. I'm not sure who you talked with at the facility, but if it was a doc who did not have all of your records and know what was going on - overall - with your health, they really should have kept quiet.

First of all, you need numbers. You need to know how slow your stomach is emptying. You need to know the ejection fraction that was found via the HIDA scan. You need to know how 'prominent' your prominent bile duct is. Everyone's thoughts naturally jump to the 'worst' conclusion when the word abnormal is found, and that DOESN'T automatically mean anything bad. It could mean that you need to make changes and 'watch' things.

With those facts in hand, you need to discuss other blood tests results or other tests that you may have had done with your doc. Hopefully you've already had a liver function panel and had your pancreatic enzyme levels measured.

[Twilight_Princess]

Do you think heterogeneous echo density of the pancreas could mean pancreatitus?

Do you have any pain in your liver area?

[Twilight_Princess]

I don't have my gallbladder. It was removed 2 years ago and mine was working 88%, but yet they still removed it.

Do you think the cholesterol meds can be causing havoc with your liver?

Also have they done any blood work on your liver and pancreatic enzymes?

The word sludge means that there can be sludge in your biliary ducts - it's from the bile that goes through the biliary ducts and I guess sometimes it can get like sludge. I had problems a month ago with my liver and I was told about sludge too. Mind you, I'm also not a drinker and I don't take Tylenol.

I'll send you a PM and talk more to you :-)

[JoanneS1122]

Hi,
   Twilight_Princess, you were right on the money, unfortunately.
   They did finally call me back--it was the radiologist who called me. Hmmm...interesting. She told me this:
o   delayed emptying times of my stomach mean a "motility" issue. (Dyspepsia?) She asked if I was diabetic, but I am not. She suggested when I see the gastroentorologist I take "Reglan."
o   My "gallbladder is not working." It is "non-functional," whatever that means. I know some people live without one, but apparently it has caused some kind of havoc on the rest of my digestive system.
o   She said my gall bladder not working usually means gall stones but she is not sure why on mine. She said the word "sludge." Hmmm.
o   My liver is enlarged, and I am overweight. She said I have "fatty liver disease" and that I need to avoid alchohol (never drank anyway) and tylenol and anything that would be bad for my liver. I asked about my cholestoral meds, but I don't remember her answer.
   Still, I cannot put it all together, but I am guessing my test showed the above. There is something else on the Written Report that bothers me--that she DIDN'T mention:
o   "The pancreas shows a heterogeneous echo density suggesting fatty changes. The bile duct is 6.5mm at the pancreas."
   ANY "translations" or suggestions would be most appreciated. I have an appointment to see the gastroentorologist on 4/30, and I'm lucky to have that. I had to make that appointment BEFORE I left his office to even have the test--he's so booked. We live in a small community in upstate PA and, as an example of how small we are, we don't have a dermatologist within a 50-mile radius.
Hoping for some answers,
Joanne

[Twilight_Princess]

Hi Joanne,

You poor thing :-(

Did they call you yet? I am not a doctor or nurse and I don't really understand the test results, but I'm thinking that one of the results might mean a fatty liver.

Have you done a google search on the results?