right side discomfort

[stancarey]

Third year post transplant. 300 mg ursodiol x3. 6 previous ercp for stents after tx for stricture. ERCP three months ago. Impression: 1. mild intrahepatic and pre- anastomotic common bile duct dilation, likely post surgical. No evidence for stricture or obstruction in the visualized biliary system. 2. Small stone in cystic duct remnant of the donor system. 2. Subsegmental vascular perfusion abnormality at the dome of the liver in segment II. 3. splenomegaly and splenic varices. A 3cm region of hypervascularity in segment II of the liver adjacent to the confluence of the left hepatic vien. Question: Do you see anything in the ERCP results that could be a concern to me? They are talking about taking me off ursodiol, Do you see any thing that would be prohibitive to coming off ursodiol ?  bilirubin level fluctuates .9 to 1.6  Symptoms since tx fel bad after eating and when first waking in morning discomfort right side that changes in intensity. Thank you very much  Dr.

[Thomas D Schiano, MD]

i am not sure that there is a problem with taking the actigall at the same time as vitamins.  The ERCP suggests that there could be a stricture at the bile duct anastamosis, whether it is critical or non-critical.  if the liver tests are abnormal it could suggest biliary obstruction which can also lead to relative malabsorption.

[Thomas D Schiano, MD]

the findings you summarize seem to pse no contraindication for the discontinuation of URSO.  however, as its an inocuous medication I would consider continuing it (no obvious downside to doing so) for the time being.

[stancarey]

I have poor absorption malnutrition and the manufacture says not to take with vitamins. taking it 3x is interfering with vitamins intake. are the manufactures wrong? taking vitamins or urso all at one time doesn't seem to agree with me. also do you see anything in the ercp results that could potentially be a concern to me ? thank you Dr Schiano