Dr. Rajesh Gulati
Family Physician
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 20-year-old male. I have been prescribed the tablet Adderall. I do not take drugs or alcohol. Five years ago, I went to the doctor for a palpable cervical lymph node that measured 1.5 cm on an ultrasound. They told me to return if it did not go back in a couple of months, and I was not sick then. However, this lymph node is still enlarged. I just had a CT scan of it again. However, the radiologist did not confirm the same size as the original ultrasounds. I am sure it is the same size as what I can feel. CT scan also revealed a mucous retention cyst in my left sphenoid. My stomach always hurts, and I randomly throw up, usually in the morning. My blood work was mostly normal except for my AST/ALT ratio, which is 2.129. My white blood cell count is also low. All other laboratory reports are normal. My doctor is concerned about lymphoma. I think the next step is undergoing a biopsy. However, I am unsure if I should be worried about that high AST/ALT ratio because the AST is out of range, but the ALT is normal. Is there any correlation between low WBC count and AST?
Hello,
Welcome to icliniq.com.
If it is lymphoma, it would have significantly grown by now. From the attached images (attachments removed to protect the patient's identity), it does not seems to be some benign enlargement. You should not worry about it. Still, a biopsy should be done to confirm the diagnosis. TLC (total leucocyte count) is low. I suggest you repeat the test every two weeks. If it is stable, you should not worry. It also seems to be gastritis. I suggest you take antacids.
Patient's Query
Thank you doctor for the reply,
What is your opinion on my liver enzyme levels (AST/ALT). Should I be concerned about these levels?
Hello,
Welcome back to icliniq.com.
It needs monitoring after two weeks. I suggest you can undergo an ultrasound abdomen to see the liver anatomy. Though I do not suspect any abnormalities, I suggest you get tested for HIV (human immunodeficiency virus) and hepatitis to rule out infection. I suggest you take the tablet Udiliv (Ursodeoxycholic acid) 300 mg twice daily for raised liver enzymes.
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Family Physician
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