Slightly enlarged liver and spleen

[wb]

Doctor, I just got the results of a second abdominal ultrasound from my gastoenterologist (first one Dec. 2002) which shows a slightly enlarged liver and spleen.  I've suffered from upper back pain on and off for over 20 years (47 yrs. old).  The pain  has always been related to food.  In the past 5 years it's become more frequent, sometimes chronic.  I've had three ultrasounds, three upper endoscopies, and three colonoscopies, along with numerous blood tests.  Until January, 03, doctors could find nothing wrong with me.  My last endoscopy showed irritation of the esophogas from GERD.  Over the years I have been on axid, propulsid ('98), aciphex, pepsid, zantac, and pamine.  My gastro seems to think that my problems are related to anxiety, so I am scheduled to see a psychiatrist for medication.  He doesn't have the best bedside manner, but he's now ordered a CT scan of the abdomen to make sure nothing's wrong.  He seems to think it may be a fatty deposit.  I should note that I'm a recovering alcoholic (13 + years).  Can a fatty liver develop later in life?  Or did I always have it?  Wouldn't it show up on my blood tests?  Or could the medications be causing the inflammation?  He said there's no rush to get the CT scan, and doesn't seem concerned.  However, as I said, he's not very forthcoming with information.  Any help you could give me would be greatly appreciated.

[Kevin Pho, MD]

You have had a pretty extensive GI evaluation including multiple ultrasounds, endoscopies and colonoscopies.  

If the CT scan is negative, you may want to consider further specialized testing.  This would include a 24-hr pH study to make sure that overly active GERD is not causing your symptoms.  If you continue to have GERD despite being on all those anti-acid medications, you may want to consider surgical options.

I would already assume that pancreatitis has already been looked at via enzymes.  The CT scan can also determine if pancreatitis is present.  

Another test to consider would be a HIDA scan with CCK stimulation to make sure that gallbladder dysfunction is not present.  

Fatty liver can develop after years of chronic drinking.  It typically wouldn't show up on blood tests (expect for perhaps elevated liver enzymes).  

There is always the possibility that the pain is not GI related and you may want to look elsewhere.  

Followup with your personal physician is essential.

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.

Thanks,
Kevin, M.D.

[wb]

Some additional information:  
I've been diagnosed with a hiatal hernia.  Also, I suffer from IBS.  The upper back pain I described is in the upper right quadrant, right below the lung.  Last year I also went to the emergency room for shortness of breath.  Was diagnosed with aspiration of acid into the lungs.  Subsequent heart tests show a small mitral valve prolapse, otherwise very healthy.  I'm a former soccer player and still run approximately 10 miles per week.