Liver Issues: Insights from Ultrasound Reports and Symptoms - Gastroenterology and Hepatology

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Liver issues?


Hello Dr.
Tsai! I would like your help reviewing my abdominal ultrasound reports from two different hospitals, thank you.
First Report:
- Spleen Index: 7.18 × 3.75 cm
- CBD: 0.63 cm
- Portal vein: 1.05 cm
- Normal liver size, bright and heterogeneous parenchyma with mild increased liver-kidney contrast, uneven liver surface, and normal vasculature, with uneven fat distribution; enlarged spleen size with a score of 6.
- An 1.02 cm hyperechoic nodule is found at segment 5.
- No ascites.
- Normal IHD, CHD, and a few small (less than 0.27 cm) gallbladder polypoid spots.
- Patent portal vein, HVS.
- Pancreas is obscured.
1.
Parenchymal liver disease, score 6, with fatty change and uneven fat distribution.
2.
Liver nodule.
3.
Gallbladder polyps.
4.
Splenomegaly.
Second Report:
- Chronic Hepatitis and Multiple Right Liver Tumors, rule out HCC.
- Multiple right liver hyperechoic tumors: The largest one is 0.9 cm at segments 5-6, mild coarse liver echogenicity, mild blurred vessel wall, smooth liver surface, no ascites.
- Gallbladder: GB polyps (0.6 cm in size).
- CBD & IHD: Negative.
- Pancreas: Negative.
- Spleen: Splenomegaly (+).
1.
Multiple right liver tumors, rule out hemangiomas.
2.
Diffuse liver disease (score 0-1) and splenomegaly with mild fatty change.
3.
GB polyps.
Hepatitis B surface antigen is negative, Hepatitis B surface antibody is positive (+115), core antibody is positive, indicating a past infection of Hepatitis B that resolved without treatment.
Hepatitis C antibody is negative (0.08), which is normal.
A recent endoscopy showed gastroesophageal reflux.
Dr.
Tsai, I have been regularly following up at Chang Gung Memorial Hospital for over a year.
What could be causing my liver issues? Is it possible that the cause cannot be identified, and I just need to continue monitoring without treatment? Also, regarding the nodule in segment 5, the doctor mentioned it could be a hemangioma, but then said it might be a calcification.
I requested an MRI, but the doctor said it was unnecessary, which is confusing.
Could you please provide some advice?
Am I in a serious condition?
My blood test results from last month are as follows:
- WBC: 4.3
- RBC: 4.31
- Hemoglobin: 10.4
- Hematocrit: 34.0
- MCV: 78.9
- MCH: 24.1
- MCHC: 30.6
- RDW: 15.5
- Platelets: 241
I have been experiencing anemia; I am taking iron supplements, and my levels normalize while taking them but drop when I stop.
Doctor, could my splenomegaly be related to the anemia? I have many questions, thank you, Dr.
Tsai! I appreciate your help!

Piqiu, 40~49 year old female. Ask Date: 2017/02/16

Dr. Cai Anshun reply Gastroenterology and Hepatology


Hello:
1.
According to the report you provided, the liver appears to be only fibrotic, with no signs of cirrhosis.
Additionally, your platelet count is 241,000; individuals with cirrhosis typically have platelet counts below the normal range (169,000).

2.
Chronic anemia can indeed lead to splenomegaly.
With an MCV of 78.9, which is slightly below the normal range, this suggests microcytic anemia.
It is important to determine whether this is due to iron deficiency anemia, hereditary thalassemia, chronic disease, or long-term gastrointestinal blood loss (such as from chronic ulcers or tumors).
It is recommended to consult a gastroenterologist and a hematologist to investigate the underlying cause.

3.
There are many potential causes for intrahepatic nodules.
Ultrasound can only indicate whether the nodules are hyperechoic or hypoechoic, and it cannot definitively determine malignancy.
Therefore, the report will list several possible differential diagnoses.
If necessary, more advanced imaging, such as computed tomography (CT) or magnetic resonance imaging (MRI), may be required for a more accurate assessment.
A liver biopsy may also be needed.
If you have further questions, it is advisable to discuss them with your clinical physician.

Changhua Hospital cares about your health.

Dr.
Tsai An-shun

Reply Date: 2017/02/16

More Info


Understanding liver issues can be quite complex, especially when interpreting ultrasound reports and correlating them with clinical symptoms. Based on the ultrasound findings you provided from two different hospitals, there are several key points to consider regarding your liver health.


Ultrasound Findings
1. Liver Characteristics:
- Bright and Heterogeneous Parenchyma: This suggests that the liver tissue is not uniform in texture, which can indicate underlying liver disease, such as fatty liver disease or chronic hepatitis. The brightness on ultrasound often correlates with fat content in the liver.

- Mild Increased Liver-Kidney Contrast: This can indicate fatty infiltration of the liver, as a fatty liver will appear brighter compared to the kidneys.

- Uneven Liver Surface: This may suggest the presence of liver disease, as a normal liver surface is typically smooth.

- Hyperechoic Nodule: The presence of a 1.02 cm hyperechoic nodule in segment 5 raises concern. While it could be a benign lesion like a hemangioma, further evaluation, such as MRI, is often warranted to rule out malignancy.

2. Splenomegaly: An enlarged spleen can be associated with various conditions, including liver disease, portal hypertension, or hematological disorders. In your case, the spleen's enlargement could be related to the liver's condition.

3. Gallbladder Polyps: The presence of gallbladder polyps, although generally benign, should be monitored, especially if they grow in size.

4. Chronic Hepatitis and Tumors: The second report indicates chronic hepatitis and multiple right liver tumors, raising the suspicion for hepatocellular carcinoma (HCC). The recommendation to rule out hemangiomas suggests that the tumors may not be malignant, but further imaging or biopsy may be necessary for definitive diagnosis.


Blood Test Results
Your blood test results indicate anemia, which can be related to several factors, including chronic disease, nutritional deficiencies, or bone marrow issues. The spleen's enlargement could contribute to anemia by sequestering red blood cells. It’s essential to address the underlying cause of your anemia, which may involve dietary changes, iron supplementation, or further hematological evaluation.


Recommendations
1. Further Imaging: Given the complexity of your findings, particularly the hyperechoic nodule and the multiple tumors, it would be prudent to pursue further imaging studies, such as an MRI or CT scan, to better characterize these lesions. This can help differentiate between benign and malignant processes.

2. Regular Monitoring: Since you have been under observation for over a year, it is crucial to continue regular follow-ups with your hepatologist. Monitoring liver function tests, imaging studies, and any changes in symptoms is vital for managing your condition.

3. Consultation with Specialists: If you feel uncertain about the management plan, seeking a second opinion from a liver specialist or a hepatologist may provide additional insights and reassurance.

4. Lifestyle Modifications: Maintaining a healthy lifestyle, including a balanced diet and avoiding alcohol, can help manage liver health. If you have any underlying conditions, such as hepatitis B, it’s essential to follow your doctor’s recommendations regarding antiviral therapy or monitoring.

5. Addressing Anemia: Work closely with your hematologist to manage your anemia. This may include dietary adjustments, iron supplementation, or further investigation into the cause of your anemia.


Conclusion
Your liver health is a multifaceted issue that requires careful monitoring and possibly further investigation. The findings from your ultrasound reports indicate the presence of liver disease, and the enlarged spleen and anemia add complexity to your clinical picture. Regular follow-ups, further imaging, and consultations with specialists will be essential in managing your condition effectively. Always communicate openly with your healthcare providers about your concerns and symptoms to ensure comprehensive care.

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