Q. According to the reports, do I need an immediate liver CT scan?

Answered by
Dr. Happykumar Kagathara
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jul 23, 2018 and last reviewed on: Oct 05, 2020

Hi doctor,

I am a 46 year old male. I had gastric bypass surgery 7 years ago. Earlier, I was 540 lbs and now, my weight is 300 lbs. About 5 years ago, I started drinking hard alcohol (Vodka) weekly. As of three weeks ago, I started getting a tight, bloated, tingly sensation from my chest down to my pelvic area. There is no real pain. It just feels as if there is a wide band wrapped around me and numbness. It almost feels as I may be collecting fluid in my abdomen and thighs. I also have burning and tingling sensation that runs down my inner legs from my thighs to my ankles. Some days, it is better than others. I feel fatigue and it is a bit hard for me to get out of a chair due to being weak at times. I do have energy though to perform daily activities once I am up.

I stopped drinking two weeks ago. I eat daily. There is no nausea, vomiting, bleeding, spider veins or yellowing of skin and eyes, I have normal bowel movements and there is no blood in stool. The stool color is normal. I do not feel hallucinations or loss of memory. My urine is dark yellow or brown and cloudy at times. I am a bit pale, but I have always been that way. I sleep regularly and have not lost any weight on the scale. But, I feel my muscle may have been replaced with fat.

I went to a GI specialist and he just thinks it is malnutrition issues due to my gastric bypass. My GI specialist ordered blood work and it indicates that I have some liver issues based on my research. Is there a way to determine the stage my liver health based on the laboratory reports below and the symptoms? Is it an emergency that I go to the hospital right away? Do I need to get a CT scan of liver immediately? The flags on my laboratory reports are, RBC 3.64 (low - ref 4.14 - 5.80), MCV 108 (high - ref 79 - 97), MCH 38.2 (high - ref 26.6 - 33.0), RDW 16.3 (high - ref 12.3 - 15.4), serum creatinine 0.56 (low - ref 0.76 - 1.27), serum chloride 94 (low - ref 97 - 106) serum calcium 8.4 (low - ref 8.7 - 10.2), total bilirubin 9.5 (high - ref 0 - 1.2), serum alkaline phosphatase 241 (high - ref 39 - 117), AST 196 (high - ref 0 - 40), ALT 61 (high - ref 0 - 44) and vitamin D, 25-Hydroxy 4.4  (low - ref 30.0 - 100.00). I also attached the full laboratory report. I started Vitamin B12 injections last week, Vitamin D3 drops, B1 and B complex supplements to hopefully help raise my low D3. Thank you.

#

Hello,

Welcome to icliniq.com.

I can understand your concern towards your abnormal laboratory values.

  • Yes, you need a CT scan of the liver. Even, I suggest consulting your GI doctor for hospitalization.
  • Your symptoms of tingling sensation and numbness are due to vitamin deficiencies. As you started taking vitamin supplements, these symptoms would recover in the next few days.
  • Your symptom of burning pain from chest to abdomen might be due to alcohol associated gastritis, which requires prompt treatment as you had a history of gastric bypass.
  • As your liver tests are very abnormal, you require prompt supportive treatment and further evaluation also. You must undergo CT scan. Primarily, it might be associated with alcohol induced hepatitis. But, your history of drinking vodka since many years may produce chronic changes in the liver (cirrhosis).
  • Acute damage to the liver due to alcohol is hepatitis, which is recoverable by medical treatment (might require steroid). The chronic damage (cirrhosis) is irreversible and medical treatment would only relieve symptoms and cure can be achieved by liver transplantation only.
  • It is not a proper time to give you advice on treatment without confirming diagnosis. But, based on the severity of liver dysfunction and need of further evaluation I strictly recommend you to consult a surgical gastroenterologist as soon as possible.

The Probable causes:

Alcohol.

Investigations to be done:

CT scan abdomen and coagulation profile.

Differential diagnosis:

Cirrhosis of liver.

Probable diagnosis:

Alcohol induced hepatitis.

Regarding follow up:

For further information consult a medical gastroenterologist online.---> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist


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