Health Ramble Warning:Long & off topic

I just needed to put this down on "paper" 

So a month or so ago I ended up in the emergency room with abdominal pain.  That was the worst pain I had ever felt.  It took a couple shots of morphine to make it subside.

During that visit they did X-rays and a C.T. scan.  It was discovered that I had some enlarged veins on my liver.  They referred me to a G.I. doctor who looked at my lab tests and the C.T. scan.  He ordered an additional ultrasound and an endoscopy to see if they could confirm the findings of the C.T. scan. 

The ultrasound also showed the varices on the liver and in the esophagus.  They also discovered 6 gallstones.  Because of the bariatric surgery, they need to remove the gallbladder because it is not treatable as they would normally treat that issue.  So I am scheduled to go in and have that removed.  Additionally they will be doing a liver biopsy to see what's going on with my liver.

So now being a direct relative of Eeyore, I get to imagine all the things that are wrong with me until the 28th of this month when I have my surgery and biopsy.  Then I'm sure it will be a few days to get the results back from the biopsy.

So what could this be.  Here are a few things I have found out about what is going on with me.  According to my Dr. this is what they are looking for:
"We will be looking to see if the liver biopsy shows signs of scarring or cirrhosis, which can happen from fatty liver and from rapid weight loss."

Here is some info about fatty liver disease:

Fat accumulates in the liver usually in connection with heavy use of alcohol, extreme weight gain or diabetes mellitus. Fatty liver can also occur with poor diet and certain illnesses, such as tuberculosis, intestinal bypass surgery for obesity, and certain drugs such as corticosteroids.
To find out for certain whether a patient has fatty liver requires that a sample of liver tissue be obtained (biopsy). Images of the liver obtained by an ultrasound test or by a computed tomography (CT) scan can suggest the presence of a fatty liver. In the ultrasound test, a fatty liver will produce a bright image in a ripple pattern. A CT scan will show a liver that is less dense than normal.

Some researchers have connected the development of NASH with poor control of diabetes mellitus, rapid weight loss, or in women, the taking of hormones (estrogen).

Well I'm not a heavy drinker, I don't have diabetes, I'm not female, and I'm not on any medication other than vitamin supplements.  So it looks like this could be related to my weight loss.

Clinical presentation
Gastric varices can present in two major ways. First, patients with cirrhosis may be enrolled in screening gastroscopy programs to detect esophageal varices. These evaluations may detect gastric varices that are asymptomatic. When gastric varices are symptomatic, however, they usually present acutely and dramatically with upper GI hemorrhage. The symptoms can include hematemesis, or vomiting blood; melena, passing black, tarry stools; or passing maroon stools or frank blood in the stools. Many patients with bleeding gastric varices present in shock due to the profound loss of blood.


Treatment:
No standard treatment for nonalcoholic fatty liver disease exists. Instead, doctors typically work to treat the risk factors that contribute to your liver disease. For instance, if you're obese, your doctor will help you to lose weigh through diet, exercise and, in some cases, medications and surgery. If a medication is causing your fatty liver disease, your doctor will try to switch you to a different medication.

Gastric varices are dilated submucosal veins in the stomach, which can be a life-threatening cause of upper gastrointestinal hemorrhage. They are most commonly found in patients with portal hypertension, or elevated pressure in the portal vein system, which may be a complication of cirrhosis. Gastric varices may also be found in patients with thrombosis of the splenic vein, into which the short gastric veins which drain the fundus of the stomach flow. The latter may be a complication of acute pancreatitis, pancreatic cancer, or other abdominal tumours. Patients with bleeding gastric varices can present with bloody vomiting (hematemesis), dark, tarry stools (melena), or frank rectal bleeding. The bleeding may be brisk, and patients may soon develop shock. Treatment of gastric varices can include injection of the varices with cyanoacrylate glue, or a radiological procedure to decrease the pressure in the portal vein, termed transjugular intrahepatic portosystemic shunt or TIPS. Treatment with intravenous octreotide is also useful to shunt blood flow away from the stomach's circulation. More aggressive treatment including splenectomy (or surgical removal of the spleen) or liver transplantation may be required in some cases.

So I plan to get on with my life and continue as I have been until I find out more, but with the addition of imagining the worst case scenario for the next couple weeks.

Thank you for reading my ramblings, it does help to put it down in writing.
Now it's time to get back on that bike. I have a 2 1/2 hour ride scheduled for this weekend.

I have no intention of letting this spoil Christmas for me or my family.  I'm eagerly looking forward to spoiling Caden again this year.

Best wishes

Scott

I can't really offer much but my support and well wishes.  Thanks for putting it out there though, because it is apparantly something that we should all be aware of.

I had my gallbladder taken out in December of '08 (New Years Eve actually). When they did that they did a biopsy of my liver as well and diagnosed me as having NASH.  I have never been a drinker, or hormons, however, I am a woman who was also diagnosed this year with diabetes Mill. So I do wonder if I had it (diabetes) earlier and it just went undiagnosed?

Anyway, best wishes on your upcoming surgery. I'm glad you are able to at least schedule it. Mine was done after going into the emergency room. However, the good news is I had my surgery in the a.m. and I went home that evening.

So was there any treatment for the NASH, what did they do etc.
I guess one of their concerns is the verasis on the liver and esophagus that is associated with this issue they are looking at.

Thanks for any additional information.

Scott

No treatment for the NASH. They (my PCP) thinks with the weight loss most of it will be addressed. But no treatments. I do know they listed that as a "symptom" of being obese when contacting the insurance company for approval for WLS. I don't think they mentioned any verasis on the liver and esphagus but I could be wrong. I'll have to check with the PCP next time I go in.

Scott,

Sorry to hear that you've got this hanging over your head.  I know it's not easy playing the waiting game.    But, it sounds like you're trying to keep your inner Eeyore at bay until you know more.  Focusing on family and your normal routines sound like excellent strategies to get you through the end of the month.

I'll keep you in my thoughts and prayers and ask for the same.    Had a breast biopsy Thursday  and will be reminding myself 'til I get the results that most biopsies are negative.   Gotta keep those rose-colored glasses on.

Cassie