Hope you are doing fine. My son consulted a doctor for diarrheal syndrome. He suffers from diarrhea after having certain types of meals and also when he drinks a glass of wine or beer. Attached to this message, you will find his recent laboratory test results. His liver values seem to be disturbed. He has digestive issues like the feeling of pressure in the belly, flatulence, gas and has undergone treatment for hayfever during the spring and summer months. What are the analysis and diagnosis? What to do next?
I can understand your concern. I have gone through the reports (attachments removed to protect the patient's identity) and found some important things regarding his liver and lipid profile. He has a bad lipid profile. It is bad because he has to keep an eye on this issue and keep following up with his primary care physician. His bad cholesterol (low-density lipoprotein) is high. Good cholesterol (high-density lipoprotein) is low. The total cholesterol level is also increased and needs attention. All of this means it is bad for the heart and blood vessels. The liver is also possibly having some issues with lipid maintenance. His liver enzymes are also raised, which adds up to the cause of his symptoms. Diarrhea related to intake of food and alcohol may be due to liver issues. And this warrants a visit to a gastroenterologist or a hepatologist for proper evaluation and management. He will be able to do a battery of tests on him, including but not limited to hepatitis screening for A, B, C, D, and E, ultrasound of the liver, and, if needed, a biopsy of the liver. In my opinion, this is the next best step for him. Diarrhea causes loss of vital liquids and salts. It is due to prolonged diarrhea. His sodium levels are also high, meaning he has a fluid and electrolyte imbalance. He needs Pedialyte (oral electrolyte solution) to replenish body fluids. It is easily available from any pharmacy. He needs to avoid the known allergens, that is, foods that cause immediate diarrhea. If taking beer causes an issue, he also needs to think about it. It is damaging his liver tissues further. Hope it helps. If you need further assistance, please feel free to ask me. I will be happy to assist.
Thank you for your guidance. My son went back to the laboratory to have a set of blood tests done. I will come back to you when we receive the results.
I really appreciate your kind words and hope your son is doing well. Please feel free to upload the results when you get. I would be more than happy to review and discuss the results. Good day and regards.
Thank you for your response. We received them today. I am sharing it with you. Is there anything more about the interpretation of the results, infection, paracetamol usage for headaches, and degenerative diseases? What else should be done to get a clearer picture of the liver issue? Please share your suggestions.
I can understand your worry about your son's health. I have reviewed the lab reports (attachments removed to protect the patient's identity). Thanks for putting up the effort to upload the reports to assist me in this case. His liver profile is a little better than before but still out of the range. In this case, it is best is to keep him away from alcohol as this can only add up to the worries by directly damaging the liver cells. We cannot say that the previous liver injury was caused solely by alcohol, but this may have contributed to some extent. The avoidance of the foods that cause him to feel sick will help. If alcohol is the sole reason for liver injury, the test results will differ. Now, we can prevent further damage to the liver by avoidance of the known causes. This will allow the cells to heal up quickly and get better. He is young, and his immune system will hopefully combat the disease process. His kidneys are doing a perfect job. There is no issue with the kidneys based on their performance. Your son has no viral infection from hepatitis B and C viruses. His immune system has the best possible capability to fight against hepatitis B. I hope he is already vaccinated against hepatitis B. His physician had not felt a need to go for hepatitis A and E screening, and this choice varies based on the area where the patient lives. If there is a prevalence of a disease, the physicians go for screening in patients more frequently. The liver biopsy is also something his hepatologist can decide about. You may ask what can be the next best step. We have to wait and watch based on the serial liver enzyme studies to get a clearer picture of the liver issue. Periodic consultation with a hepatologist will be helpful. Certain medications also lead to liver injury, and the result is raised liver enzyme studies. In such cases, the numbers go back to normal as the liver cells heal up with time. Hope this helps. Please feel free to ask anytime. I would be more than happy to assist you.
I am sharing the laboratory test results of thyroid, lipids, proteins, and PSA with you that I received today. I would be interested in hearing your medical evaluation of the overall results. Are the problems as shown in the abnormal test result interlinked, for instance, the hypoactivity of the thyroid and the disturbed lipids metabolism? Is the PSA value prone to be checked further? Does it show a starting prostate gland problem? Also, please share the diet that I need to follow.
I understand your health concerns. I want to discuss every aspect of the laboratory tests you uploaded, especially the most critical and out-of-range findings (attachments removed to protect the patient's identity). Folic Acid - Low. (Folic acid is essential for blood functions and keeps the blood cells within limits. If levels are low, it can be treated by giving supplemental Folate. Your physician can assist you further in dosage and prescription for that). Creatinine - Normal but in higher normal limits (Creatinine levels in the blood reflect the functioning of the kidneys. Kidneys are responsible for clearing this waste material from the blood and keeping a balance. If kidneys are not working usually, the creatinine levels go considerably high. Your levels are not that high. The best next step is to keep a follow-up and see how the levels go in the future. At this stage, nothing much to do for it). HDL (high-density lipoprotein) - A little low (Taking a low-fat diet, regular exercise, and a healthy lifestyle with least to no junk foods would help you take these levels in the normal required range). LDL (low-density lipoprotein) - A little high (Taking a low-fat diet, regular exercise, and a healthy lifestyle with least to no junk foods would help you take these levels in the normal required range). Total Bilirubin - In higher normal limits (It does not look serious this time, but in the future, I would recommend keeping a follow-up with your physician to keep an eye on the levels and see how it goes. Bilirubin is a product handled and cleared from the blood by the liver. The liver keeps bilirubin in normal limits in human blood. If the liver is not working perfectly, the levels increase. You are negative for hepatitis C, meaning you do not have hepatitis C. Alcohol consumption and certain medications can also raise the levels. Again it would be best if you kept an eye on these levels in future follow-ups). Alpha-2-globulin (a protein) - In lower normal limits. (It is a protein produced by the liver, and in case of any issues with liver functioning, the levels of proteins produced by the liver may decrease. Fatty liver, alcohol consumption, or certain medications that interfere with liver functions may cause lowering the alpha-2-globulin levels). TSH (Thyroid gland functioning test) - A little high. (If your thyroid is not functioning optimally and as needed, more and more TSH is released from the pituitary gland. In simple words, the hypothyroid gland may be behind high TSH levels. Please discuss the matter with your physician). Your treating physician may refer you to an endocrinologist if he feels it appropriate. PSA (prostate-specific antigen) - A little high. (Not always cancer can raise PSA levels, benign causes can also be the reason for elevated PSA levels, for example, inflammation of the prostate, enlargement of the prostate, etc. Your physician can better assist you in this regard in the light of all of your medical records related to the prostate). The liver issues, especially high levels of liver enzymes, are not a new issue here. I can see in our past conversations you have this issue lingering on from the past. You should consult a hepatologist for this issue to evaluate the reason behind high liver enzymes properly. Your specific questions and explanations to them. Are the problems as shown in the abnormal test result interlinked: for instance, the hypo-activity of the thyroid and the disturbed lipids metabolism? Not precisely, but constantly low thyroid function lowers all the body's metabolic functions, including lipid metabolism. I would like to hear your medical evaluation of the overall results. Also, please suggest a diet that I should follow. It would be best to go for an exercise and physical activity schedule. At least five days a week, light to medium levels of exercise are essential for you. I have already detailed relevant information.
Investigations to be done:
Do liver ultrasound, a hepatologist consultation and thyroid workup by an endocrinologist
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.. profile (attachment removed to protect patient identity) suggests that you have normal cholesterol levels except LDL cholesterol, which is raised.
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