Gastroenterologist, Gastroenterology Journal

Question: Today happened to come on abdominal ultrasonography, there have found enlargement of the liver and pancreas compacted. Discomfort experienced. Recently been ill with flu. We ought to be examined, but the work leaves no time while he was on sick leave, accumulated a lot of cases. I want to put everything in the six months before the next holiday. Need medical advice. Thank you.

Answer: 42 years. It is safe to put everything in six months, provided that you follow a healthy lifestyle without bad habits.

Question: I have hypothyroidism and I therefore tested for thyroid hormones (AT-AT-TG and TPO above normal), but I was advised to just pass the Society. blood and biochem. research. Results of the following: general analysis – within normyAlAT 13 units / L (<30) AST 13 U / L (<30), total bilirubin 22.4 mmol / L (3,4-17,1), direct bilirubin 9.7 mmol / L (<7.9) I understand that I have a reason for concern? I would be very grateful if you make it clear to me a little this situation.

Answer: no cause for worry. Single deflection of bilirubin are not clinically significant in the absence of complaints to the authority, its generating. AT-AT-TG and TPO did not reflect the state of thyroid function.

Question: Doctor, hello! "A year ago, when ultrasound was to identify a moderate increase in echogenicity of the liver. However, due to the work, comply with restrictions on food and alcoholic drinks reception did not work (endless presentations, negotiations, etc.) Now that's afraid of cirrhosis, since read that the fatty liver alcohol intake leads to cirrhosis. Say, a complete rejection of alcohol, can stop this process or have it if he suddenly started, can not be stopped. And yet, what are the signs of cirrhosis?

Answer: Complete denial of alcohol may stop the process. Description of cirrhosis, please find on the Internet alone.

Question: The child is 6.5 months. , Did abdominal ultrasonography. Result: ultrasound signs of increasing strain and gall bladder. Slight increase and reactive changes of the liver. Tell me please, what does this mean? Why did it happen and increase the change?

Answer: There is nothing quite does not mean if the child feels well and developing normally.

Question: I turned to a gastroeterologu with following new problem – the last time was often confronted with the problem of the stomach. Проявляется следующим образом – начинаю ощущать некоторое общее недомогание, тяжесть в желудке, потерю аппетита, если поем – ощущение не перевариваемости, неприятный вкус во рту, и что самое неприятное – головную боль. All this takes not less than one day. Immediately pain or cramps no. Sometimes it leads to nausea and repeated vomiting with the release of the bitter yellow-green mass, or very acidic colorless liquid. If this previously and was shown – it is rare that written off on any poisoning. All this was described by a doctor, was held endoscopy and ultrasonography of the liver and gall bladder. According to the doctor with stomach pischevvodom and 12 duodenal ulcer in principle, all vporyadke, ultrasound of the gallbladder showed a bend and thickening. diagnosis written on paper is as follows: GERD, chronic gastritis, chronic holetsestit. It was said that all major issues related to the gallbladder, were the recommended diet, with recommended choleretic – make a day dyubazh (mineral water + holosas), drink rose, for at least a month. during the week did dyubazh + drink rose in the big count-wah – and throughout the week, I have all of the above symptoms: weight, loss of appetite, and that the most unpleasant – headache, quite tortured. I want to ask your advice – to continue to do dyubazh, drink rose further or to conduct any additional procedures, surveys? Thanks in advance, Igor (27 years).

Answer: I can only say that the diseases of the digestive system does not cause headaches.

Question: my dear doctor! spared a lot of doctors and no one normally could not help me. I really hope that you have something to me will tell! For 2 years I suffer from zhelochnym bubble has done everything possible survey of stones and parasites not, but he twisted, good indicators of the liver. Simtomy: Pain in right side, a very acute sense of smell, mood changes and I become very zloi or very funny, and then emit zhelochi and the day I start to fall into depression and tears, headache and sometimes a temperature of 37 and a very strong pain, fatigue stomach and zhdky chair. This happens often. I have only not probyvala and Diet and zhelechegonnye. regularly engaged in sports. Please'll show something and how to reduce the emotional state during these attacks?? Thanks

Answer: 24 years. You are confusing cause and effect.

Question: Dear doctor! To me stones (7 stones counted) in the gall bladder yielding acoustic shadow. But I did not have seizures and I was not worried. Ultrosonogramma showed that all my organs in the order, nor any complications. Taking medicine GSD. I eat all meals except bitter and too oily. Tell me please, what stones rasstvoryayutsya and what medicine more effectively with GSD? Explain in detail. Thank you.

Answer: Why not talk about the size of stones and the medicine does not call? Why not ask your doctor? Tactics of treatment described in the instructions for medicine bottles. Stones in the gall bladder without typical manifestations of the disease – http://doktor. ru/qa/15613/qa. html? id = 68427.

Question: I am 22 years old. Last 2-3 months I feel discomfort (often a burning sensation), and nausea and hunger and in the intervals between the taking of food. Ultrasound revealed: gallbladder small 5,2 x 1,2 cm, a pear-shaped, walls not more than 3 mm clearance anehogenny with konkremntom 6 mm, with zamazkoobraznoy bile and hempseed calculus in the neck size of about 4-5 mm. Questions: 1. How appropriate, urgently and in general – shows whether the surgery. 2. Возможен ли вариант лапроскопического операционного лечения. 3. Is Diet? 5 in my case. With respect and gratitude for the answer!

Answer: Can attempt to dissolve the stones with medicine. Diet N5 suits, but will not solve the problem.

Question: I have chronic hepatitis for about 10 years. biochemistry for 10 years in the normal range. Uzi pcheni only diffuse changes. HCV RNA rented 2 times both times negative. please tell me if I can take to maintain the liver is now widely advertised gepatosan? thanks for the reply.

Answer: Can. But there is a significant difference between "can" and "need."

Question: Dear doctor! It is clear that giving advice in absentia – is extremely difficult to treat – it is impossible, and the amount set out for part-time consulting big. Given your professionalism Gastroenterology – Hepatology, thank you in advance for any your answer to me. I learned about the possibility of consulting the site http://www. doktor. ru / qa / gastro, so my questions to you with some cuts and placement as on the website. Dear doctor, is it possible to understand what causes the disease, to determine what it is and assign treatment? Son, 23 years old. Do not drink, does not smoke, not prickly. In February-March 2007, after twice endured influenza (?) Escalated mycoplasmal bronchitis (interstitial pneumonia) (anti-Myc. Pneumonia, Ig G titer silnopolozh, anti-Chl. Pneumonia, Ig G, Ig M-put. " experience "- about 2 years old), and while taking summameda fever (37,8), sallow face, urine acquired shade beer, cloudy, chair-light. Weakness, fatigue, irritability, no appetite, lost weight, body skin – pale, with yellowish tinge, dryish skin. Antibiotics were canceled. Results of Biochemistry and wedge an. blood revealed the increase in the amount of bilirubin, ALT, AST, GGTT, monocytes, leukocytes, reduction of lymphocytes, neutrophils, low ESR (see table).. Blood tests for autoimmune hepatitis (25. 04. 07 and 24. 10. 07) – autoantibodies were detected (Technition medico-genetic. RSMU technology). An blood for hepatitis viruses A, B, C, D, E, TTV of 21. 04. 2007. (By ELISA and PCR) were found. An blood for hepatitis viruses B, C, TTV of 24. 10. 2007. (By ELISA and PCR) – TTV DNA detected by PCR, Qual. analysis. * PCR, HepB C (1999, RNA C, qty. – Is found) Repeated analysis – PCR and ELISA – hepatitis C virus and antibodies to it is not detected and cut-t 1999 ". was regarded as a false positive. Thyroid gland – in the norm. Biochim. Al. Blood: Ultrasound 28. 04. 07 Ultrasound 17. 12. 07 07. 04. 07 21. 04. 2007 08. 06. 07 04. 10. 2007 13. 12. 2007 Referee rdg. ALT 41 66 47 28 21 <41 U / l 40 AST 57 89 40 25 25 <37 U / l 39 Bil Society. 27 28.9 47.7 39.6 35.2 3. 4-17. 1 mmol / l 45 Beal Ave 9 12 12.2 13.9 12.8 <7. 9 mmol / l 9,7 Gamma-GT 222 219 95 87 62 <49 U / l F. Schel 168 237 154 137 117 40-150 U / l Iron – - 21.1 20 21.93 11,64-31, 3 mmol / l 14,4 Lat zhelezosvyaz Choco-Th – - 43.8 46.4 51 20-62 mmol / L Transferrin – - 3,09 2,75 2,83 2,00-4,00 g / l. Ferritin – - 36.9 60.9 – 20-250 mg / l transferrin saturation% – - 27.2 28.9 30.8 15-50% C-REACT protein – 5.0 18.1 1.9 0.0 -5.0 mg / l cholesterol 3.46 3.64 2.77 3.53 3.94 3,16-5,59 mmol / l Albumin 44.1 45 41 46 45 35-50 Alpha-1-Globe 2 , 4 2,8 2,6 2,5 1,8 1,0-3,0 g / l. Alpha-2-Globe 7.3 6.4 7.3 8.4 7.1 6,0-10,0 g / l beta-Globe 8.7 8.3 7.8 8.1 8.4 7,0-1,001 g / l Gamma-Globe 11.5 12.3 15.8 11.2 11.4 8.0 — 16,0 g / l Creatinine 110 110 88 99 85 62-115 mmol / l Glucose 5.2 5 4.6 5.3 4.8 3,89-5,83 mmol / L Total protein 74 75 74 76 74 64 — 83g / l. Homocysteine 16,27 3,70-13,90 mmol / l IgE 338. 3 0-150 kIU / L Antibodies to tireperroksidaze 18 0-40 IU / ml Klin. Al. blood Ultrasound 28. 04. . 07 Ultrasound 17. 12. 07Parametry 07. 04. 07 21. 04. 2007 08. 06. 07 04. 10. 2007 13. 12. 2007 Referee rdg. Hematocrit 45.7 44.7 47.5 47.1 47.6 39-49% Hemoglobin 16.2 15.4 16.4 16.3 16.9 13,2-17,3 g / dL RBC 5.78 5 , 57 5,87 5,98 5,93 4,3-5,87 million / microL MCV (Wed volume er) 79 80 81 79 80.3 80-99fl MCN (Wed previous article Hb in Riyadh) 28 27,6 27 9 27.3 28.5 27-34g/dl MCHC (Wed conc. Hb in er) 35.4 34.5 34.5 34.5 35.5 32-37 g / dL Platelets 275 236 324 297 292 150 — 400tys/mkl Leukocytes 4.95 7.90 6.80 9.55 8.49 4,5-11 thousand / mcl Neutrophils 42 20 34.2 58.1 42.2 48-78% Lymphocytes 35 62 49.1 31 1 41,2 19-37% Monocytes 14 21 13.5 10.3 9.2 3-11% Eozinofily 2 2 2.9 2.3 6.9 1-5% basophils 0 1.1 0.3 0 , 2 0,5 ESR less than 1% (by Vestergrenu) 1 – 1 2 1 menee15mm / h ultrasonography (17. 12. 2007): Liver – increased size of the Upper-Lower right lobe of the right cp / clavicular line-13-smVerhne Lower size the left lobe of the right parasternal line-8 cm ECHO-structure of the parenchyma-grained, moderately heterogeneous. ECHO-gennost parenchyma-reduced. Focal amended. – NetVnutripechenochnye vessels-N, intrahepatic bile ducts-N. Choledochitis-0, 5 cm, portal Vienna 1, 2, see Gall bladder, 7×2, 5 cm, the walls thickened to 0, 5 cm, compressed, content-NPodzheludochnaya iron-NSelezenka-raised, S-70 cm, the edges are rounded. Conclusion: Diffuse changes in the liver. Chr. beskamenny cholecystitis (cholesterosis?). The increase in the spleen. Ultrasound (28. 04. 2007) Liver – not increased the size of the Upper-lower right lobe of the right cp / clavicular line-10, 5 smVerhne-lower size of the left lobe of the right parasternal line-5, 5 cm ECHO-structure of the parenchyma-N ECHO-gennost parenchyma-N focal amended. – NetVnutripechenochnye vessels-N, intrahepatic bile ducts-N. Choledochitis-0 4 cm, portal Vienna 1, 1, see Gall bladder-8 x 3 cm, the walls are not changed, the content-anehogennoPodzheludochnaya iron-NSelezenka is not increased, S-60 cm Conclusion: The signs of colitis. Immunogram (25. 04. 2007) – Lack of T-suppressor level. High levels of NK-cells in perifiricheskoy blood. Expressed lack of IgG in serum. Reduced levels of neutrophil phagocytosis. Received treatment (all prescribed by a doctor, April-December): w / vitamins, in / in miksidol, w / medical ozone, Roncoleukin n / a, laser nadvenno, geptral, ursofalk. Geptral (2 tables) and ursofalk (2 Caps at Night) takes now. Following a course of treatment over the next 5 months (April-October) is very slow improvement in some indices of blood. A better feel (cough, which lasted about 2 years old – stopped in the lungs – without pathology) December 2007 – well-being has worsened again, on the face yellowish skin, even thinner. No appetite, weakness, fatigue, irritability. Works, is raising her daughter. In terms of the survey (until 28 December): – ultrasound to determine the function of the gall bladder and be retested for hepatitis viruses (PCR and ELISA). Previously: (main): Resection of small intestine (at the age of 1, 5 days). Chr. cholecystitis. Gastroduodenitis. Polyvalent allergy (hay fever from April – October, allergies, fungal, bacterial). Recurrent urticaria. Secondary immune deficiency (?). In 1994, hospital. Cervical cholecystitis. Jet pancreatitis. Toxic-allergic hepatitis (?). (Och. high values of alkaline phosphatase (until 2200), GGT, ALT, AST. The true cause and the diagnosis is not reliably determined). Tests Used x blood for the period 1998-2006, the city, except almost always slightly elevated values of alkaline phosphatase, bilirubin, frontier values, or some elevated ALT and AST, and without a sharp deterioration in other indicators, but is constantly "on the verge" , or just "beyond", except in periods of acute illness. Wellbeing in the period 2002-2006. – the fairly decent, given the "tail" of disease. All the main discharge (hospital) in 1984 – on his hands. What happened? 1. 1. "Drug" hepatitis? -Almost a year since the acute onset of disease, cure has not come. 2. Because of the weak immune response (judging by the cut-m tests, the work of the immune system and disorganized) – tests for detection of viral infection provide a negative reaction. But he himself viral hepatitis caused by hepatitis B virus itself, or epshteny bar (povyshen. titles in 2002.), Or herpes (obnar. types VI, II) or other viruses, does its work? 3. Reasons number 1 and number 2, together give a picture. Do not understand where the cause and where the investigation. 4. As a result of long-term preservation of cholestasis, and came suddenly such changes, as identified by ultrasound 17. 12. 2007 and is not detected at ultrasound in April, May and October 2007. earlier? 5. Or newly acquired TTV? (read that this virus is almost "home", does not cause liver damage. I doubt it). 6. Alarmed that in the wake of and ongoing therapy, despite improvements in some indices of blood and a transient improvement in well-being, in general – unstable dynamics or nonpositive dynamics. Ultrasound showed changes in the liver, gallbladder, enlargement of the spleen. This feeling also create indices of lymphocytes, monocytes, neutrophils, leukocytes in blood analyzes perifiricheskoy extremely slow decrease in GGT, "jumped" reactive protein and does not reduce the bilirubin level, cut-you ultrasonography (17. 12. 2007.) After and against the backdrop of the ongoing therapy. 6. By Gastroenterology (Hepatology) for the period April-December approached. And if only very briefly – this was not yet. What, how and with what to treat? Gall with its bend in the bottom third? Hepatitis? Would you take up this puzzle? Or can recommend a qualified specialist? Thank you for your attention, with respect, Nadezhda. 21. 12. 2007.

Answer: At the site of the request has been received. With a weak immune response, the number of viruses in the blood is growing and they are found (another thing – antibodies). What prevents to make tagging a liver biopsy?