ETIOLOGY OF AN ENLARGED LIVER WITH ASSOCIATED HEADACHE AND FATIGUE

[sanohe]

28 year old daughter seen recently for symptoms associated with a sinus infection and fatigue.  During a routine exam the doctor felt distention under rib cage on right side and scheduled an abdominal and pelvic ultrasound.  A CBC was drawn; results showed an elevated WBC of 12,000 with no other abnormalities.  She was started on a Medrol-Dos-Pak and Augmentum.  Ultrasound report indicated an elarged liver.  Doc ordered repeat lab work done on the 10th day following initial exam/lab and repeat ultrasound in 3 months.  History; occassional headaches and abdominal pain for approx. past 3-6 months. Tendency to be constipated.  Recently emotional stress with a relationship. Drinks alcohol rarely. Non-smoker. Non-drug user. Weight meets standard guidelines.  Exercises regularly.  Hep B vaccine in 1997.  NKDA. Meds: BCP's.  Now, my questions:  Shouldn't a liver profile/panel be orderd by her doc at this time and not just a CBC?  Is the doctor's plan of treatment too conservative at this point?  Should she consider a second opinion or seek out a specialist?  Can an elarged liver ever be considered insignificant?  There was no mention of the degree of enlargement; is that something that would determine a different treatment plan? Is there anything else we should do?  thank you

[chcnme]

Sorry to hear about your daughter. I would think an enlarged liver on exam AND on ultrasound with an elevated WBC would have called for a basic hepatic function, and so my answer is - yes, hell yes a liver panel should have been ordered.  With an enlarged liver, hepatitis should also be ruled out.  I don't know HOW enlarged her liver is, but - I don't think an enlarged liver should even be considered "insignificant" even if the cause is known.  

If it were me (or my daughter), right off the bat I would want to know

- has acute / chronic hepatitis been ruled out?  

- what do the liver function tests look like, specifically what is the SGOT, SGPT, bilirubin, alk phos, etc, i.e. HOW well is her liver functioning?  
Are there any abnormal findings on the liver function tests?

- exactly what did the ultrasound report say (what was the conclusion?)

- what do they believe is causing the enlarged liver?

- what has been ruled out so far?

- what are they treating her for?

- is there infection, and if so - where?  

If the doc can't answer the first two questions, I would ask for a referral to a gastroenterologist (liver specialist) for a second opinion.

Best of luck.  I hope everything will work out OK for her.  

[susan400]

Sanohe,

Can you ask her to ask him to run an LFT, or a Comprehensive Metabolic Panel (which the LFT is a part of)?   She could tell him that she's concerned about her liver and wants to have her enzymes checked.  Most doctors, I think, wouldn't have a problem with that.  I'd say for you to ask them, but if she's 28, I imagine that she sees the doctor on her own?  I know it's hard on a parent to see their child being sick.  I wish I knew more to suggest.

Susan

[copyman]

tell your daughter to make an appointment with a hepatologist(liver specialist) as soon as possible !!!

[jmjm530]

I would think that a liver panel would be ordered as part of anyone's basic check up, not to mention someone with an enlarged liver. Are you sure it hasn't been ordered already? Ask the nurse if they did a liver enzyme test -- ALT and AST. Also best to keep your own copies of all blood tests.

If they didn't run a liver panel, ask them to do it. If they won't, go to another doctor. I agree with "Copyman" that seeing a liver specialist (hepatologist) or at least a good GI is a good idea.



-- Jim

[mkeela]

I completely agree with everyone...I just cant't believe an hepatic panal has not been run. Like chcnme said, ask the questions!

[Evannescence]

Has the anti biotic worked. I hope your daughter feels better soon.  Perhaps it would be an idea to run more extensive blood tests, including liver, bone, kidney panels, and even hormones.  And to do a HepC test, if ALt is raised.