What could cause weight loss and stomach pain while eating?

Question

Hello doctor,

I have had stomach issues for a long time and had the gallbladder removed around four years back. My stomach issues have gotten worse. Then, ten months back I had started getting this horrible burning sensation on the right side near ribs. The doctor thought it was my liver and did blood work, everything was fine. Then six months back I got to a point where every time I ate I was in extreme pain. I have lost around 60 lbs since then. I went and saw a different doctor, they did blood work which came back abnormal (amylase 24 IU/L, lipase 8 IU/L, narrative current ADA criteria for glucose: normal: 70-99 mg/dL, impaired fasting glucose: 100-125 mg/dL, diabetes mellitus: at or above 126 mg/dL). The diagnosis of diabetes must be confirmed on a subsequent day by measuring fasting plasma glucose, two hour PG or random plasma glucose (if symptoms are present).

Sodium 139 mEq/L, potassium 3.5 mEq/L, chloride 106 mEq/L, carbon dioxide 26 mEq/L, anion gap 7.0 mEq/L, blood urea nitrogen 4 mg/dL, creatinine 0.70 mg/dL, glomerular filtration rate greater than 60 mL/min/1.73 m*2. A persistently reduced GFR is a specific indication of chronic kidney disease. The eGFR calculation has not been validated in patients greater than 70 years. Calcium 9.1 mg/dL (8.4 - 10.5 mg/dL), glucose 88 mg/dL (70 - 100 mg/dL), protein total 6.5 g/dL (6.0 - 8.0 g/dL), albumin 3.9 g/dL (3.5 - 5.0 g/dL), alkaline phosphatase 68 IU/L (40 - 150 IU/L), aspartate aminotransferase 21 IU/L (10 - 40 IU/L), alanine aminotransferase 42 IU/L (6 - 31 IU/L), bilirubin total 0.6 mg/dL (0.2 - 1.2 mg/dL).

Ultrasound impression showed probable cavernous hemangiomas in the left hepatic lobe although the ultrasound appearance is nonspecific. Recommend CT of the abdomen with IV contrast utilizing triphasic hepatic protocol. Then sent for CT and the impression is previous cholecystectomy. The focus of abnormal echotexture on recent ultrasound through the liver is felt to correlate to an area of low attenuation on CT. CT findings are nonspecific. This may represent an atypical hemangioma. Neoplasm is felt less likely. This is well visualized with ultrasound. Short-term follow-up ultrasound in 2 to 3 months recommended to ensure stability. If this is unchanged it can be followed at larger interval increments. Right renal cyst. It states I was given oral contrast, I was not. The doctor had also told me these are something I was born with. I had an ultrasound of liver and they seem nothing on my liver. So is this something I should keep worrying about and get another opinion?

Answer 1

Hello,

Welcome to icliniq.com.

Yes, it is likely to be hemangiomas only. I think your treating doctor is right. Ultrasound is a good investigation for hemangiomas and it definitely shows its presence and also suggested by CT scan. Now, regarding your doubts, firstly ultrasound is a very observer dependent investigation. So, the findings seen by one may be missed by other. And another important thing is, hemangiomas grow with time and hormonal changes, so it might be possible that it was present but of a small size to be detected and has grown over a period of time.

Next thing, if you are worried too much about it then you may get another ultrasound of the abdomen done by an independent radiologist. Also, you should get your CT scan reviewed by another radiologist for his opinion. You may ask for a CD having ct images, and get it reported so as to confirm the findings. No need to repeat CT done now. Also, follow up ultrasound should be done after three months to look for a change in size.

Answer 2

Hi,

Welcome back to icliniq.com.

No, personally I do not think lesions are malignant. Because any malignancy since last 10 months would have progressed and two investigations are not favoring it. The weight loss might have occurred due to the pain you are having with meals, due to which your diet might have reduced. But, such severe pain needs evaluation. Were you on trial of antacids like Pantoprazole or Lansoprazole and was there any relief? Did you have endoscopy for it? These pain are likely not related to your hemangiomas, but to other causes like gastritis, ulcer, etc. So overall, lesions do not seem worrisome after seeing your investigations and overall picture, but cause for abdominal pain should be found.