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Gallstones, dilated common duct, enlarged spleen...

So I have been living with unexplained left upper quadrant pain for years. GI Dr. did endoscopy and found grade A esophagitis (gerd), did a colonoscopy and found one 5 5 mm polyp. Did MRI found enlarged spleen, a couple small hemangiomas on my liver, some fluid around my left kidney, (relieved when bloating subsided that episode). The pain comes and goes. I also saw an Endocrinologist who did blood work and said I have slight hyperinsulism and was pre-diabetic. The Metformin however just increased my bloating and gas, so in discontinued it. I went on a diet and lost 40 lbs. I still have left upper quad pain though.  This last August I thought I was having chest pains WITH my side pain and it went around to my back. I went to ER but they tested only for heart issues and released me even when I told them I was still in pain in my side and weren't they testing that? I followed up with my doc who sent me for a CT that still showed my enlarged spleen but not a lot more. My periods were off so he sent me to GYN. They did US and found 8.7 cm ovarian cyst., but on right side. And every 6 weeks they repeated and just found different size cysts that usually followed with irregular bleeding (tmi) ..like through my clothes, sheets, onto work chairs. Bloating, constipation \ diahrea back and forth, estrogen levels high, prolactin high....i thought pre-menopause would lower estrogen...not raise it! (If that is why elevated) they did endometrial biopsy...normal. Then another ER visit July 9. This time US showed Gallstones. This felt so much like pain in August. Could all of this that I have been dealing with for years be gallstone disease!?
My mother just passed away in December. She had Multiple Myeloma and pancreatic cancer. She also had her gallbladder removed, and had the hemangiomas on her liver.  My oldest brother passed away from pancreatic cancer in May of 2005 at 47 years old. He had just been diagnosed with diabetes that January.
Should I just move forward with gallbladder removal or go see another GI doctor? Any other suggestions? I feel as though no one really knows what is going on. I also have elevated white blood cell, glucose, and liver enzymes from ER blood work.
Thank you for any advice.
Erin
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Avatar universal
You need to get a second opinion on this asap. And see a hepatologist (liver specialist), if at all possible. There are a number of things that point towards a chronic liver issue here. And GI's are great doctors, but complex liver issues need to be dealt with by a specialist.

The two main issues are the dilated common bile duct and the enlarged spleen. I think that your elevated liver enzymes are secondary issues that are due to the primary problem, whatever it is that is causing your impeded bile flow. If your bile is blocked (even partially) from getting into your small intestines, it will backup into your liver (like an blocked river overflowing), and the increased pressure also causes your bile ducts to swell.

Bile is made within your liver (partly made up of old red blood cells components) and excreted since it is needed for digestion (helps you digest fatty foods). But if it remains in your liver, bad things happen because it will destroy your liver cells. In particular, it will start to destroy the cells in your portal tracts first (starting point for your bile ductules), which leads to scarring and fibrosis. This fibrosis will also encase your portal veins (also in your portal tracts and right next to your bile ducts) and cause portal hypertension (PHT). And this increased portal blood pressure prevents the blood from going through your liver which then backs up into your spleen, enlarging it.

Are your platelets numbers starting to decrease? And are your alp (alkaline phosphatase), direct bilirubin and total bilirubin levels elevated? You may have loose, pale stools that float and possibly dark urine (direct/conjugated bilirubin can be excreted via the kidneys).

I hope I'm wrong, but if you do have a chronic cholestatic liver problem, it needs to be resolved soon. Take care and let us know how you are doing.
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Fntn- the above scenario is happening to me minus the elevated liver enzymes.  What do you recommend the GI docs do to figure out the lack of bile flow. I have gb attacks almost every day but all my tests come back negative for stones. My HIDA was 70% a week ago.  I have a CT scan next week.  I need help.  
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