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Please Help...very confused
Apr 20, 2010

My father aged 72 was detected with Hep C virus around 3 years back when he had to be hospitalised for esophageal varieceal bleeding.

He is stable since then with only 2 small grade 1 varices. His Liver Functions are as follows:

Bilirubin-0.8, ALT-70, AST-65, Albumin-4.2, Globulin-3.5, ALP-140, GGTP-62.

Successive ultrasound over the last 3 years have not revealed any cirrhotic changes (only once it was mentioned that the liver mergins are minimally irregular). It says that the liver capsule is smooth with no lesions and Normal in echotexture and morphology.No free fluid noted in the abdominal cavity.

My questions are:

1. Our gastroenterologist says that he has mild hepatomegaly (though the ultrasound says the size is normal). Which is more reliable?

2.His abdomen seems a bit distended (very mild though)when he is in the reclining position. He does not have any discomfort though due to this.

3.Can esophageal varices be present in the absence of cirrhosis(as in his case ultrasound does not show any cirrhotic changes)?

His overall health is OK. I mean good appetite, Normal bowel movements, No nausea, vomitting or icterus etc.

Thanks in advance and eagerly awaiting your reply doctor.

Response from Dr. McGovern

An enlarged liver on exam may not be picked up on ultrasound - that is certainly true. It is also possible to have portal hypertension and varices (enlarged blood vessels in the esophagus) without cirrhosis - although this is uncommon. You need to discuss that possibility with his doctor. In light of his abdominal distention, you may want to see if he has gained a lot of weight, which might suggest fluid retention.

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