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: dear doctor! Thank you for your reply, I have to you one more question. I am concerned about pain in the right hypochondrium, the diagnosis of cholecystitis was confirmed, diskeniziya, the inflection of the gall bladder. Notak also concerned temperature fluctuates within 37,2-37,7 postoyannogoharaktera, ie, reduced only in the evening, morning, as tolkopodnimayus immediately rises. Condition dizziness, darkening vglazah, sometimes a bit feverish, slightly lomyat joints pershiy vgorle, redness of eyes, ie, symptoms similar to viral infection. Sdavalaanaliz HbsAg – 0,591 AU, (below 1-negative) Determination of kroviantitel to hepatitis C virus (Zenyth-1100) Result: The level of antibodies kvirusu hepatitis C – negative. After receiving antibiotics (next year) urine was bright yellow, then another and darkened, after cessation of treatment, the color remains the same. Bilir. On. 11,6 (2-20,5), bilir. Pr. > 4,7 (0-5,1) Ultrasound – Signs of moderate diffuse changes parenhimypecheni. Increasing ehoplotnosti walls of the gall bladder. Agree hofitol, essliver. Amid hofitola, the pain diminished, the temperature of the former whether naetomostanovitsya or take some other surveys. And what can bytprichinoy malaise? Cholecystitis or hepatitis? Can it be gepatitotchastogo medication? What has to be done? Thank you very much. P. S. age 31 years, in a previous post, I asked you about holitsestite, you gave me a complete answer to the councils of all cholagogue (choleretic), vegetable or synthetic origin, unfortunately did not survive from. And can we say something on these data?

Answer: Make General clinical blood and urine tests, x-rays. If the results are normal, then you have nerves.

Question: "A year ago, I was treated in hospital from opisthorchiasis took pills biltritsid. After the treatment, saying that everything is normal. A month ago, I had a spontaneous miscarriage early pregnancy (2-3 weeks), during this period suffered from the left and right sides in infracostal part, and now it hurts. There was liver ultrasound and n / cancer, wrote: "Expression of ductal changes in the liver and u / gland. Recommended: Consultation infectionist" Is it possible that opistorchosis not completely healed? And can opistorchosis provoke miscarriage?

Answer: The fact that opistorchosis provokes miscarriages, messages are not met.

Question: I am 38 years old. Five years ago noticed that the whites of his eyes slightly yellowish (on edges). 2 years ago I appeared on the face of small pigment spots. Then came the invention of new brown spots, much larger in size, some up to 3 cm in diameter, on the face, chest, hands. In January 2007, I had a baby and my condition has worsened – the spots become larger, and the summer of 2007 the night a severe pain in his left knee and sore somewhere in 1,5 months. Even after 4 months there was a sharp pain in the hip joint. Not very much, but it hurts still. Then other joints began to ache a little, even small ones, not very much, and seemed to prick. Ill back muscles of the neck, so that the patient began to turn his head. Even the bones began to hurt, then one, then another, then on hands, then feet. Joints become crisp. Thyroid gland was normal. Thyroid hormones – the norm. Liver function tests – normal. Although some of the right hypochondrium are in pain. On ultrasonography of the liver – 2 calcinates in the liver. Revmoproby – positive revmofaktor, increased amounts of uric acid (at a rate of 370 to 340), alpha 1 acid glycoprotein 131, at a rate of up to 120. Hemoglobin – 151, ESR – 2. Elbows were xanthoma, but passed. Also itchy eyelids, nasal mucous membrane was the eyes. Often, a rash on wrists and elbows. Hepatitis B and C – negative. He was advised to donate blood for cytomegalovirus and herpes. Results: Herpes – Ig Y – 3,03 (norm 0,38) Ig M – 0,24 (rule 0.31) Cytomegalovirus – Ig Y – 2,94 (norm 0,3) Ig M 0,20 (norm 0 43) Can these infections be the cause of my condition? Can CMV at these rates of damaging my liver and joints? Doctors refer to each other – an endocrinologist, a dermatologist, a physician, a gastroenterologist, a rheumatologist. Nobody makes no recommendations and could not understand what happened to me. Help.

Answer: described for cytomegalovirus is not typical, the infection primarily affected would have on the child. Data for liver disease there. Temperatures there. Hemoglobin and ESR excellent (ie about., No inflammation). The diagnosis of dermatologic (rash, disappeared "xanthoma") is absent. The volume of movements with the joints saved (?), They do not swell (?). More than a year of pain in the hip joint – do it radiograph. It is to decide in principle: if there is damage to the joints and there is only so-called. myofascial pain. Then we may suspect, in particular, fibromyalgia (polientenzopatiyu).

Question: 4 years ago, one day I woke up with yellow eyes, severe weakness and nausea. The doctor immediately suspected hepatitis. Passed liver function tests: all normal except for indirect bilirubin, which issued more than 70 at a rate of 4. 6. Passed all gepatitnye markers twice, to no avail. Liver was not enlarged, not hurt. Then the ultrasound – liver, biliary ways. Then moved to suspected giardiasis, salmonellosis, has a lot of infections. Found some rudiment pseudotuberculosis, after two weeks of antibiotics he had gone to naught. After some time passed, and nausea and jaundice. Bilirubin still remained 15, but not sick. There has been on the subject of two physicians in parallel. One difficulty with the diagnosis, another set Gilbert's syndrome: [i] hereditary benign giperbilirubiniya, treatment is not required, the quality of life is not affected. [/ i] That sounds nice, but the quality of my life, this is a contagion effect. Exacerbations occur under overload, stress, and incidentally with any other disease. Nausea, weakness to the vibrating conveyor and a cold sweat, work is unreal, is not possible, the eyes are yellow. And out of this state from 2 days to a week, to sit to drink water like a horse show intoxication. From the nausea does not help anything, Tserukal, Motilium – how elephant pellet. Here and now sit at home in that state. Dug the Internet – everywhere the same: the treatment is not required, Gilbert's syndrome live not interfere. I begin to doubt what I just said. Maybe something else to check? I am 33 years old, otherwise healthy, sports teetotal man in his prime. Thank you in advance for your reply.

Answer: It used to be three drugs, now has more than two. Third (noksiron) closed down because it caused the defeat of the peripheral nerves. Second (lipantil) – works slowly and for exacerbations of jaundice is not good. But the application of the remaining damage exceeds the "favor". No sense to drink a day for 2 tablets soporific anticonvulsant (phenobarbital), can be transformed into a zombie. It remains to avoid the known factors that provoke acute and apply what is called symptomatic treatment. Positive is that individuals with Gilbert's syndrome (and elevated bilirubin) are much less likely than others to suffer from heart and vascular atherosclerotic disease. Thus, ischemic heart disease (angina and heart attack) they occur with a frequency of 2%, and in the general population – 12%. Of course, in terms of dignostiki need to think about the ineffective erythropoiesis, hidden hemolytic anemia. *** IMPORTANT The system of "electronic dialogue" on page "gastroenterologist" <http://www. doktor. ru / qa / gastro /> From February 01 2008, at the time stopped for technical reasons. If you have a need for a full-time – paid personal consultation, Dr. Vasilenko, call the telephone number listed here: <http://doktor. ru / articles / article. html? id = 52532>. ***

Question: dear doctor, Please, help me please! My sister's liver problems. In 1991, she had hepatitis A, and since then at times the liver made itself felt. But this year, in December, we seriously ill and my mother died, and while she was in the hospital, my sister took care of her. Naturally – stress, virtually no food: In late December, my sister's condition had deteriorated: yellowed whites of the eyes, skin, appeared pain in the right hypochondrium. January 14, 2008 it was put in hospital Kotovsk such analysis: Biochemistry: total bilirubin – direct bilirubin 45,6 – 5,7 indirect bilirubin – 39.9 total protein – 78 urea – 3,63 creatinine – 0.047 ACT — 24 ALT – 10REZULTATY Ultrasound: Liver not enlarged in size, smooth contours, echogenicity slightly increased, the structure is homogeneous. EPV – 20 mm BB – 11 mm. Diffuse changes in the liver. Gall bladder wall thickened to 3.5 mm in size is not increased, the contents of a homogeneous, without concretions. Treated in hospital for 11 days, received intravenous glucose and esentseale. She also went to a consultation in Tambov, testing. As a result, to be discharged on Jan. 25, 2008 results were as follows: Biochemistry: bilirubin total – 24.6 total protein – 74 urea – 3,26 creatinine – 0.050 ACT – 12 ALT – 11Timolovaya sample – 1Sulemovaya sample – 1,6 PTI – 84PTV — 19Ibrinogen – 3Posle advice from infectious diseases and analysis, the presence of hepatitis B and C have been identified. After his discharge condition improved, proteins yellowing until the end of the day, was registered esentseale capsules. However, a week later the state began to deteriorate again: once again appeared and the severity of pain in the right hypochondrium, yellowed whites of the eyes, skin, appeared bitter taste in the mouth, sometimes dizziness, rapid utomlyaemost8 February 2008 again went to consult a gastroenterologist in Tambov, testing . The results were these: Biochemistry: bilirubin, total – 41 Bilirubin direct – 7 of indirect bilirubin – 34 ACT – 22 ALT – 10Timolovaya sample – 3REZULTATY Ultrasound: Liver is usually sharp edges, with clear smooth contours. Dimensions PZR right lobe 135 mm, left – 99 mm. Normal echogenicity, ehostruktura homogeneous, fine-grained, without focal formations. Vascular pattern of the liver clearly expressed to the periphery, portal vein diameter of 15 mm, in the projection gate liver enlarged lymph nodes were not visualized. Biliary ways structural, not extended, without focal entity and concretions. Gall bladder size increased, extended. The walls are thickened to 3 mm. Contents anehogennoe, homogeneous, without visible shadows concretions. Diagnosis: Chronic hepatitis of unknown origin (?), Gilbert's syndrome (?) T. that is all under question, treatment, of course, not appointed. What can it be? Is it dangerous? What do we do now, what tests to pass and what treatment? Help please! Advance – thank you very much.

Answer: Apparently, this is Gilbert's syndrome + biliary dyskinesia. In this case, can facilitate being sedatives (best Corvalol or valokordin), security measures, tyubazhi (http://doktor. Ru / qa / gastro / article. Html? Id = 52169). What is Gilbert's syndrome. Syndrome (but not the disease!) Gilbert, or benign hyperbilirubinemia – a condition which is based on an innate weakness of some enzyme systems. Treatment _not_ trebuetsya_ (yes, and it does not exist – http://doktor. Ru/qa/15982/qa. Html? Id = 86649). This condition is not all doctors are well aware, it is often confused with chronic hepatitis and prescribe unnecessary treatment. In contrast to chronic hepatitis yellow eyes and skin fickle (intermittent nature), the liver is increased (or increased very slightly), the spleen does not increase. Biochemical blood test reveals only an increase in bilirubin, the results of all other liver function tests have not changed. Patsietov bother most asthenic or autonomic disorders. Strongholds of the recognition of Gilbert's syndrome (and distinguishing it from hepatitis B) are as follows: – found mostly in boys and young men (10-20 years) – Indications of a hereditary predisposition (family affair) – Initially, transient jaundice is detected in early childhood – Jaundice casual and neintensivnaya (mostly yellowing of the eye sclera) – The emergence of (increased), yellowing of sclera with fatigue, the emergence of infectious diseases – Inconsistent feeling of heaviness in the right hypochondrium – slight enlargement of the liver – blood bilirubin exceeds the norm by not more than 3-4 times (mainly due to the free, unconjugated fraction) – bilirubin in the blood increases when the full or partial starvation – liver enzymes (ALT, AST) in the normal range – in the urine bilirubin is not found.

Question: Dear doctor, I found hemangioma of the liver 2 cm, the bend of the gall bladder and sand in the kidneys. Concerned about the heartburn and the last time (month) pain in the right hypochondrium. Read your detailed advice on self-healing sore zhelchevydelitelnosy system – will necessarily apply. My question concerns the possibility of starvation varying degrees of duration (1, 3, 7 and 11 days), subject to the necessary measures to clean up the body through enemas and sufficient drinking water. Previously hungry a couple of times, I felt good. I am 50 years old, no other serious complaints, tests were normal. Thank you. Yours Tatyana

Answer: no contraindications to starvation, but one must bear in mind that fasting for a week and more conducive to stone formation in the gall bladder due to stagnation of bile. Fasting and purification – is the realm of folk medicine.

Question: doctor! Two weeks ago, turned to you with this problem. "Half a year ago, the temperature of 37,2 stayed two weeks, bilirubin was 35, tests for gepetit negative. While waiting for the results analysis, the temperature was, bilirubin decreased. And now, again, the temperature of 37,2 keeps 2 weeks, blood showed: cholesterol, 3 35 bilirubin 43, ALT 9. Encourage please refer to any specialist, and that this could be? " You are advised to contact the therapist. The fact that our therapist can not understand that it does not know what to do. Temperature continues to hold, and the blood showed: total bilirubin 52.7, direct 22, ALT 12 potalogii abdominal ultrasonography did not reveal. Please'll show how to act in this situation? What can it be?

Answer: temperature 37. 2 (at night) can be considered normal, and in the morning – if there is no deviation in the overall analysis of blood (leukocytes, ESR). Perhaps Gilbert's syndrome may be a reaction to medication or birth control pills, may be hemolytic anemia. "Narrow" specialists on this narrow issue is not simply a skilled doctors. The reasons: http://doktor. ru / qa / gastro / article. html? id = 68056. The illness (mood and its dynamics) is not described, prescription deviations as well. Therefore, and advised to go to the therapist.

Question: Good morning, dear Doctor! I am 29 years old, not married, no children. I like to drink, usually it happens on weekends and last for days 2. Previously, after a hangover vomiting, but the organism probably odoptirovalsya and now usually state-nestoyaniya, I can not stand up, all shaking. 2 months ago (in late December 2007) have medical tests: Bilirubin Society. 22.5 (normal 3,4-17,1), 23,0 ALT (normal <31), AST 20.0 (normal <31). Increased bilirubin as can be seen. Decided perezdat analysis of bilirubin in the other hospital a week: Bilirubin Society. 10.5 (norm 8,5-20), a direct 2,1 (normal 2,2-5,1). Now in the general norm. . . Recently (March 12) passed the blood of thyroid hormones and at the same time delivered to a blood on the overall analysis and biochemistry: Bilirubin Society. 40.1 (norm 8,5-20), direct 17.5 (normal 2,2-5,1), an indirect 22.6. ALT, 13.0 (normal 5-40), AST 26.9 (normal 5-40). The general analysis of blood – the norm (if necessary). Nothing bespokot, hands normal color on the sides of the eyeball is slightly zheltinki, but I long ago. Every floor (since 2005) year I hand over the blood from a vein for themselves for HIV, Syphilis, HBS-antigen and hepatitis C (recently have medical tests at the end of December 2007. – The negative.) And also rented swab for cytomegalovirus – The negative. There is one ailment that chronic – genital herpes. It happens 1-2 times a year (in my childhood was herpes simplex). At the time of testing for bilirubin was a relapse of herpes. Doctor, help please, that could mean the tests, which have recently (March 12) and may prompt some still need to pass the tests, at least tentatively. Sincerely, Tatyana. Yes, and yet, nearly a year saw psychotropic pills (antidepressants, sedatives) prescribed by a doctor, because anyone standing in his throat, as it turned out that the thyroid gland

Answer: The implicit question is whether we can continue to drink alcohol and psychotropic drugs and go without fear?