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I Want To Give You Full Story. I Have Been

Posted on Sat, 17 Oct 2020

Question: I want to give you full story. I have been my whole life with gerd, i had recently went to hospital as it was very severe. Upoer gi showed chronic esophagitis and negative biopsy. Also labs at that time showed total bilirubin of 2.2 as I also want to mention intermittent nausea and inability to eat so lost maybe 6 lbs within a yr. Still have intermittent nausea and most recently had labs for coag due to ct with contrast showing mild fatty infiltrate of liver at 13 cm at this time in May everything else was normal. Dr may have tested
Possibly because my labs from hospital were total bilirubin 2.2, albumin 4.9, and nausea combined with inability to eat loss of 6lbs in a yr, but as mentioned ct scan normal aside from what i mentioned. Now ca 19.9 71 now what does this mean? I would like to mention i have 3 auto immune disease and have a hx of high monocytes can be up to 15 sometimes since i am a kid. I also have a hx of my bilirubin total waxing and waning sometimes going up to.1.5 and 1.7 on all bloodwork from.being a child. I am worried. Should i be concernes about ca 19.9? Thank you

Answered by Dr. Dr.P.Ratnakar Kini (1 hour later)

Brief Answer:
Need more information

Detailed Answer:
Hi,
Thanks for posting your query.
I am Dr.R.K and I am pleased to assist you.
I would like to have a look at the liver enzymes number and the direct and indirect bilirubin levels.
Kindly upload the results.
Regards,
Dr.R.K.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Dr.P.Ratnakar Kini (21 minutes later)

I have just uploaded 4 or 5 please lmk if you recieved. I think dr more concerned about pancreas and i am very worried. Ct scan negative aside from mild fatty liver

Follow up: Dr. Dr.P.Ratnakar Kini (3 minutes later)

Lipase and amylase at time was also negative.

Follow up: Dr. Dr.P.Ratnakar Kini (6 hours later)

Ct scan was done in May and results of ca 19 results this month. So three months lapse ffom ct scan to lab draw.

Follow up: Dr. Dr.P.Ratnakar Kini (13 minutes later)

Dr, i have loss of appetite also obviously from the nausea, but this has been going on for aboit a year. I also had antral erythema report says. I havs nevsd had a colonoscopy. Not sure if this may be related to somethinf else but I was recentlt diagnosed with ovarian failure and periods have stopped.

Answered by Dr. Dr.P.Ratnakar Kini (44 minutes later)

Brief Answer:
Answer given below

Detailed Answer:
Hi,
Thanks for uploading the lab test results.
You have two different issues.
Your bilirubin is slightly elevated ( indirect component more than the direct component) and the liver enzymes are normal. Hemoglobin is normal. This points towards a genetic condition called XXXXXXX Syndrome. It is a harmless syndrome and there is no need for any medications. The bilirubin level will be keep fluctuating and increases due to dehydration, fasting, exercise, stress.

The other issue is elevated Ca 19-9. Ca 19-9 is a marker of pancreatic malignancy. You have mildly elevated level. This can occur in benign conditions also. I would advise you to undergo an endoultrasound to scan the pancreas and if needed a biopsy may be done. Since you have autoimmune issues, autoimmune pancreatitis is a possibility which can be diagnosed with endoultrasound and biopsy.
Regards,
Dr.R.K.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Dr.P.Ratnakar Kini (10 minutes later)

Thank you dr.
I recently had a ct scan with contrast 3 months prior without knowing of the ca 19. Pancreas was normal. Would you still advise getting a eus? Do.u normally see mildly elevated ca with malignancy or is the level.higher?

Follow up: Dr. Dr.P.Ratnakar Kini (1 minute later)

Would a mild fatty liver cause elevated ca?

Follow up: Dr. Dr.P.Ratnakar Kini (5 minutes later)

Can ca be elevated in a healthy person?
Also what other benign diseases or illness cause rise in ca 19? Thank you

Follow up: Dr. Dr.P.Ratnakar Kini (8 hours later)

Do you think a pet scan is watranyed in this situation?

Answered by Dr. Dr.P.Ratnakar Kini (6 hours later)

Brief Answer:
Answer given below

Detailed Answer:
Hi,
Elevated CA 19-9 is seen in benign conditions like pancreatitis, cirrhosis, cholangitis and obstructive jaundice.
Simple fatty liver may not cause it, but fatty liver with inflammation may cause it.
If the level is in hundreds, the specificity of CA 19-9 increases in the diagnosis of malignancy..
I consider yours is due to benign cause only. That is why I discussed about benign causes only and not malignancy much.

PET scan is not required. As suggested earlier, you can go for EUS.
Regards,
Dr.R.K.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar