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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18201
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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bowel and liver problems

Resolved Question:

I have a large cyst in the liver in front of the gall bladder also problems with the bowel as sometimes have trouble sometimes getting to the toilet in time before defecation particularly in the middle of the night and have already had a colonoscopy to remove polyps in the colon. Can you advise please.

Submitted: 2 years ago.
Category: Medical
Expert:  Dr. D. Love replied 2 years ago.
Hello from JustAnswer.
It will help if you could provide some further information.
Do you know the size of the cyst in the liver?
Did the ultrasound say that it was a simple cyst?
Were blood tests of the liver done and normal?
Are you having any diarrhea or constipation?
Are you having any pain in the area of the liver and gallbladder?
Have you had a nuclear radiology test of the liver and gallbladder, called a hepatobiliary scan?
Do you have any other chronic medical problems or take any chronic medicines?
Customer: replied 2 years ago.

the only chronic other conditions I have are COPD and also osteopororis.

My doctor at the time seemed to think it was a simple cyst although rather large. The bowel problems I have had for over a year now with diarrhea from time to time. Never heard of a hepatobiliary scan. What is it. I have had 2 colonoscopies over the last 2 years due to severe pain in the lower right hand side below stomach. The last colonoscopy removed some polyps which stopped the pain.

Expert:  Dr. D. Love replied 2 years ago.
Thank you for the additional information.

There are several issues to consider in this situation.

It is good that you have had the colonoscopy, as it would exclude many of the more serious problems that can cause these symptoms.

When considering the causes of fecal urgency associated with recurrent diarrhea and no evidence of colon disease, it could be related to problems with the upper GI tract that affect the ability to digest food, most often diseases of the liver, gallbladder and pancreas. Most people with gallbladder disease have gallstones and the ultrasound is the best test at assessing for gallstones. However, there are a small percentage of people with gallbladder disease that do not have gallstones, and these people are best detected by a hepatobiliary scan. If there is tenderness in the area of the gallbladder, that would be more concerning, but it can sometimes present solely as symptoms of poor digestion. It also would be appropriate to perform blood tests of liver and pancreas function, if not already done.

A CT scan of the liver is better than an ultrasound at detecting small tumors of the liver, but there is no reason to suspect the presence of small tumors from these symptoms, particularly if the liver blood tests are normal.

The other major type of problem that can cause fecal urgency are neurologic diseases, and the nerves to the rectum and anus arise in the lower spine. Consequently, problems in the lower spine also can cause the symptoms that you describe. This is less often a cause than problems within the GI tract, but it would be appropriate to consider this possibility if other causes are excluded or if there are other symptoms suggesting a problem in the lower spine. For example, osteoporosis can cause a compression fracture that can affect the nerves to the rectum and anus.

Therefore, it would be appropriate to first perform an evaluation of the upper GI tract that can cause these symptoms with blood tests of the liver and pancreas and consideration of a hepatobiliary scan, and if this is unremarkable, to evaluate the lower spine.

If can provide any further information, please let me know.
Customer: replied 2 years ago.

Thank you for your reply. As I have an appointment with my own doctor next week is there anything more I should ask her and what is a hepatoilliary scan will it show what's the problem with the bowel and is the bloating stomach down to the large cyst in the liver. Also is a ct scan the best way toput my mind at rest as it would show up any problems in the bowel or liver. I will also have a blood test done next week for the liver when I see her. I am also being prescribed omneprozole 10 mg per day for my indigestion. Thank you

Expert:  Dr. D. Love replied 2 years ago.
If you do not know whether blood tests of the liver and pancreas has been done, it would be appropriate to ask that they be done. It sounds like liver tests are anticipated, but pancreas blood tests should also be considered.

A hepatobiliary scan is a nuclear radiology test that can be done to assess whether gallbladder disease without stones is present.

A CT scan is not good at assessing the colon. The colonoscopy is better at assessing the colon. A CT scan is better at assessing the liver, but the improved sensitivity is to detect small tumors in the liver, and that would not present as fecal urgency and intermittent diarrhea if the liver blood tests are normal. If the liver blood tests are abnormal, then it would be appropriate to consider a CT scan of the liver.

If the GI evaluation is normal, then it would be appropriate to pursue an evaluation of the lower spine, first with an exam and plain x-rays.
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18201
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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