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What Do My Lab Test Reports Indicate?

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Posted on Sun, 2 Aug 2015
Twitter Sun, 2 Aug 2015 Answered on
Twitter Mon, 24 Aug 2015 Last reviewed on
Question : M.R.C.P. OF THE ABDOMEN WITHOUT CONTRAST
INDICATION: Pancreatic lesion
EXAMINATION: Multisequence and multiplanar MR imaging was performed prior to and following the administration of intravenous contrast (20 mL Multihance). Additionally, a thin slab M.R.C.P. was performed, and 3-D MIP reformatted images were generated from the M.R.C.P. source data.
COMPARISON: 1/2/2015 CT abdomen pelvis..
FINDINGS: The liver is enlarged, measuring 20cm in craniocaudal dimension, and its left lobe of the liver is relatively hypoplastic. There is fatty infiltration of the liver, with relative sparing of the lateral segment left lobe. Multiple subcentimeter T2 hyperintense, nonenhancing lesions in both lobes of the liver likely represent cysts or biliary hamartomata. The largest such lesion measures 0.8 cm in segment 4 A. No enhancing hepatic lesions are observed.
The portal and splenic veins are patent, as are all 3 hepatic veins. The spleen is not enlarged, and there is no upper abdominal ascites.
No gallstones are appreciated within the gallbladder. There is no significant intra-or extrahepatic biliary dilation, and no biliary stricture or filling defects are observed.
The previous CT demonstrated a 1.5 x 1.9 cm hypodense lesion in the uncinate process of the pancreas on image #33. This finding corresponds to a 1.3 x 2.1 cm T2 hyperintense lesion that appears to communicate with the pancreatic duct, which is not significantly dilated or irregular. No definite mural nodularity or enhancement is appreciated associated with this finding. No other focal pancreatic lesions are observed. No peripancreatic fluid or inflammatory stranding.
There is a small accessory splenule in the left upper quadrant. A tiny subcentimeter cyst is seen in the mid pole left kidney, posteriorly. The kidneys and adrenal glands are otherwise unremarkable.
The major arterial vascular structures are patent, and there is no abdominal aortic aneurysm. And no enlarged upper abdominal or retroperitoneal nodes.
The patient has a known hiatal hernia, which appears to have a paraesophageal component. No dilated segments of large or small bowel.
Multilevel degenerative changes in the spineare incompletely evaluated.
IMPRESSION:
1. Hepatomegaly. Hepatic steatosis. Multiple hepatic cysts.
2. The abnormality described on the previous CT corresponds to a 1.3 x 2.1 cm lobular T2 hyperintense lesion within the uncinate process that appears communicate with the pancreatic duct. This finding, which does not demonstrate mural nodularity or enhancement, has imaging findings most consistent with the side branch variant of intraductal papillary mucinous neoplasm. Lesion a appears to have been present on the 8/13/2012 unenhanced CT, at which time it measured 1.2 x 2.0 cm (image #30). Further evaluation with endoscopic ultrasound could be performed. Continued followup is suggested.
3. Tiny subcentimeter left renal cyst.
4. Moderate to large hernia, which appears to exhibit a paraesophageal component.
Transcribed by: Speech Recognition on January 21, 2015 at 17:30

I have been trying to find out what to do about the above findings and no one will help me. I know nothing and it has been since January 2 when I for sick. No one has given me any directions and no one has even mentioned my liver. What should I do? Thanks.

Addendum: I do not drink or do drugs, how can my liver be twice the size of a man's liver? I have been healthy up until this point. I only take one RX for acid reflex. Nothing else.
doctor
Answered by Dr. Vivek Chail (13 hours later)
Brief Answer:
Pancreas lesion is to be closely followed up

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in detail.
Please find my observations below.

1. The liver is enlarged in size and shows fatty changes. There are few possible simple cysts in the liver and the largest being 8 mm in segment 4A.

The normal liver size is taken as 14.5 cm and your liver appears to be one third larger than usual. It is important to know if you are a heavy build person and if yes then this is the cause for an enlarged liver.

2. There is a 1.3 x 2.1 area in the pancreas. This earlier measured 1.2 x 2.0 cm in the CT scan done in December 2012. It appears to be connected to the pancreatic duct and therefore thought to be a intraductal papillary mucinous neoplasm which contains thick fluid.

These are initially benign tumors but rarely they have been seen to transform in to malignant invasive cancer if left untreated. Therefore proper follow up and evaluation by endoscopic ultrasound has been suggested. If confirmed then the intraductal papillary mucinous neoplasm in the uncinate process of pancreas is treated by a surgical procedure called Whipple procedure or pancreaticoduodenectomy.

3. There is a accessory splenule and tiny simple cyst in left kidney inter polar region. This is not a concern and might be ignored.

4. There is a paraesophageal hiatus hernia and this might cause significant symptoms of acid reflux disease.

5. There are degenerative changes in the spine which might probably be age related changes.

6. The problem in pancreas requires regular attention because of the small chance of it transforming in to a cancer. That is why your doctors are more vigilant about the pancreas problem.

7. There are many causes of liver showing fatty changes including the following
(i) Increased intake of fatty foods and alcohol
(ii) Over weight and obese patients.
(iii) Those who have fatty liver running in family members.
(iv) Any liver condition that is changing appearance of liver.
(v) Mild fatty liver can also be there in many normal people

Your liver is one and half times the normal size. Since you also have an enlarged liver with fatty changes, I guess your build is heavy. However any associated problem requires to be discussed on the probable causes after doing clinical examination and liver function tests.

8. For the hiatus hernia following measures are to be taken.
(i) Please avoid bending forwards unnecessarily.
(ii) Have small meals at regular intervals.
(iii) Stop smoking and alcohol if you do it regularly.
(iv) Do not lie down for at least 30 minutes after food.
(v) Keel the head end of your bed 6 inches higher.
(vi) Avoid meals that might cause acid reflux disease.
(vii) Drink adequate amounts of water and fluids.

9. Please take your medicine for acid reflux on time. It is to be taken on empty stomach and 30 minutes before you eat or drink any thing by mouth.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Vivek Chail

Radiologist

Practicing since :2002

Answered : 6866 Questions

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What Do My Lab Test Reports Indicate?

Brief Answer: Pancreas lesion is to be closely followed up Detailed Answer: Hi XXXX, Thanks for writing in to us. I have read through your query in detail. Please find my observations below. 1. The liver is enlarged in size and shows fatty changes. There are few possible simple cysts in the liver and the largest being 8 mm in segment 4A. The normal liver size is taken as 14.5 cm and your liver appears to be one third larger than usual. It is important to know if you are a heavy build person and if yes then this is the cause for an enlarged liver. 2. There is a 1.3 x 2.1 area in the pancreas. This earlier measured 1.2 x 2.0 cm in the CT scan done in December 2012. It appears to be connected to the pancreatic duct and therefore thought to be a intraductal papillary mucinous neoplasm which contains thick fluid. These are initially benign tumors but rarely they have been seen to transform in to malignant invasive cancer if left untreated. Therefore proper follow up and evaluation by endoscopic ultrasound has been suggested. If confirmed then the intraductal papillary mucinous neoplasm in the uncinate process of pancreas is treated by a surgical procedure called Whipple procedure or pancreaticoduodenectomy. 3. There is a accessory splenule and tiny simple cyst in left kidney inter polar region. This is not a concern and might be ignored. 4. There is a paraesophageal hiatus hernia and this might cause significant symptoms of acid reflux disease. 5. There are degenerative changes in the spine which might probably be age related changes. 6. The problem in pancreas requires regular attention because of the small chance of it transforming in to a cancer. That is why your doctors are more vigilant about the pancreas problem. 7. There are many causes of liver showing fatty changes including the following (i) Increased intake of fatty foods and alcohol (ii) Over weight and obese patients. (iii) Those who have fatty liver running in family members. (iv) Any liver condition that is changing appearance of liver. (v) Mild fatty liver can also be there in many normal people Your liver is one and half times the normal size. Since you also have an enlarged liver with fatty changes, I guess your build is heavy. However any associated problem requires to be discussed on the probable causes after doing clinical examination and liver function tests. 8. For the hiatus hernia following measures are to be taken. (i) Please avoid bending forwards unnecessarily. (ii) Have small meals at regular intervals. (iii) Stop smoking and alcohol if you do it regularly. (iv) Do not lie down for at least 30 minutes after food. (v) Keel the head end of your bed 6 inches higher. (vi) Avoid meals that might cause acid reflux disease. (vii) Drink adequate amounts of water and fluids. 9. Please take your medicine for acid reflux on time. It is to be taken on empty stomach and 30 minutes before you eat or drink any thing by mouth. Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek