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Anyone ever have problem with spleen?

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Posted 6/26/2013 3:09 AM (GMT 0)
My husband has been having a lot of belly pain. Yesterday he went to the ER. They did a ct scan. The ER doctor said everything looks fine just what you would expect with end stage liver disease. Well today I went online and looked at his test results. This is what I found.---

FINDINGS:
Shrunken liver with heterogeneous density and surface scalloping and splenomegaly, consistent with cirrhosis and portal hypertension. There are splenic and gastroesophageal varices. Small amount of free fluid in the abdomen pelvis, including some perihepatic and perisplenic ascites.

There is pericholecystic fluid, presumably related to ascites.


The words splenomegaly, and splenic are the words that scare me. I looked them up and both could cause pain. why would the doctor tell us there is no reason for the pain he is in with a Ct scan like this? So I was wondering if anyone has had or having belly pain that is related to the spleen? Thanks for your time in always helping me Dorothy

Post Edited (lostwife2) : 6/25/2013 9:12:05 PM (GMT-6)

Posted 6/26/2013 4:13 AM (GMT 0)
I have been having cronic abdominal pain since before I was diagnosed with liver disease. In fact, the pain was the reason I went to the Dr and he found the LD.

I too have portal hypertension and have had esophegeal varices. Currently I am the proud mama of a nice gastric varice which they can't do much about. (Thats the short version, they acually can do stuff, its just invasive and has lower probability of success).

With portal hypertension (which is brought on by cirrhosis), comes an enlarged spleen. His doc was right that its to be expected, and there is nothing to be done about it. The only treatment is removal of the spleen and its simply not necessary in 99.9% of the cases. It occassionally causes me minor yet annoying pain on my left side just below the ribs, but I have had a spleen attack only once. In that case the pain is under the left arm and extends accross the chest like a tight steel band, making breathing painful. I found out later I should have seen the doc for this, but I waited it out and it was gone in 2 days.

Bad ascites (I used to look pregnant with a basketball) can cause abdominal pain as well.

I assume your hubby is seeing a hepatologist. He should be treating the varicies with beta blockers to lower blood pressure and arrange for your husband to have variceal ligation or banding, to get rid of them. I have had bleeding from them multiple times and I bet he really would rather have them treated now before they bleed and you spend 4 days in the hospital after vomiting up a pint of blood. The splenic varice is similar to my gastric varice, he (and ) I will probably need a TIPS procedure to control it, but that is definately a discussion for your hepatologist, everyone is different.

Dont be overly worried about the spleen being enlarged, get the varices that can be banded taken care of and monitor the acities fluid so he can control it with low salt and/or diaretics before it gets out of hand.

-K

Post Edited (Kierstin) : 6/25/2013 10:17:49 PM (GMT-6)

Posted 6/26/2013 2:46 PM (GMT 0)
My spleen is enlarged and I have never had pain associated with it. My doctor was surprised, as he could push really hard on mine and it would not hurt. He said 99% of patients would be suffering but not me.

I guess I have a high pain tolerance.
Posted 6/26/2013 4:24 PM (GMT 0)
Kiersten - did you continue to take your Beta Blockers after you had obliterated the varices?

Doctors are very reluctant to remove the spleen in splenomegaly associated with portal hypertension, because of the role it plays in the immune system. Even when enlarged, it still has a role to play in fighting infection for which the liver is expected to compensated if a splenectomy is indicated. In ESLD patients, the liver is obviously unable to take up the slack and with the risk of further decompensatory sequealae associated with infection, the risk/benefit ratio is weighted in favour of leaving the spleen in situ, despite the pain.
Posted 6/26/2013 4:27 PM (GMT 0)
It's entirely consistent for those with liver disease to have an enlarged spleen. "Splenic" simply refers to the spleen.

I agree that the pain could possibly be from ascites. And also that he should get banded whatever varices it is possible to do.

Hugs,
Connie
Posted 6/26/2013 4:36 PM (GMT 0)
My spleen spontaneously burst in January. They suspect but cannot prove s splenic aneurysm . My only symptoms were nausea, and diarrhea. At the hospital, my blood pressure tanked. They did an emergency ct which noted blood in my gut, and I had an emergency splenectomy. Rare, I know , but it CAN happen!

Post Edited By Moderator (hep93) : 6/29/2013 11:43:57 AM (GMT-6)

Posted 6/26/2013 4:47 PM (GMT 0)
wow, Susie, you were lucky! I'm sure I've read that a ruptured spleen can be fatal due to hypervolaemia. In the UK the law was changed regarding the provision of middle back-seats in cars, which were at a time responsible for a number of splenic injuries.

Off topic slightly but there is another adjective relating to the spleen : lienal. I was perplexed when in Spain a few weeks ago I had to translate for some Spanish doctors from an English-speaking patient. The word in Spanish for spleen is 'bazo', which somehow made its way from the latin 'Lien' via the Italian 'Milza' and French 'Rate'. Hence, the lienal artery is an older name for the splenic artery.
Posted 6/27/2013 2:50 AM (GMT 0)
Thank You Everyone!!! My husband had to get 3 bands in his Esophagus yesterday. This was his 4th time getting them in the last 2 yrs for a total of 24 bands all together. His belly is still hurting really bad. It scares me him having so much pain, because he always has had a high pain tolerance. well thanks again
Dorothy
Posted 6/27/2013 6:41 AM (GMT 0)
I share your hubbys pain... (bad joke). I have had every test in the book, just did a capsule endoscopy in fact and am waiting on results, but so far, in 4 years they haven't found the source of the pain. It severe, crippling pain and I am so frustrated. Luckily they give me almost enough pain relief so I can get by, but a day doesn't go buy without bad pain.

Nicechap: Yes, beta-blockers for as long as I have portal hypertension which means, until I get a new liver or have a TIPS done, something I am trying to avoid because of the potential for HE, but the writing is on the wall.

-K

Post Edited (Kierstin) : 6/27/2013 12:47:55 AM (GMT-6)

Posted 6/29/2013 4:36 AM (GMT 0)
kierstin what do you take for pain? I didnt think pain meds were good for the liver. if you dont mind me asking, because i would love to see if his doctor would give him something for his pain. maybe if he didnt have so much pain he could do somethings he likes to do and not lay in bed all the time. thanks Dorothy
Posted 6/29/2013 5:57 AM (GMT 0)
Well, one must avoid tylenol although a small amount is permitted, in my case 1200mg in 24 hours, but my hep would be unhappy if he heard I took it everyday.

You are correct in that no pain killer is "good" for the liver but opoids when given in controlled doses seem to be the least of all evils. I take 5mg of Oxycodone as needed every 6 hours up to 20mgs a day. I don't like taking a potentially addictive narcotic eveyday, so I take as little as possible, sometimes as little as 5-10 mg in 24 hrs if I can manage it. I also see a clinical phamacist every month, (I think this is a new thing in hospitals), who works with me finding the right pain relief, she is trying to get me on Oxycontin because she feels it will work better for me in the long run but I remain sceptical. I asked her last time to watch me for signs of addiction (Its a great fear of mine since I have been taking Oxy for 4 years) and she said "oh, don't worry I am". !!

I hate that I am forced to seek chemical pain relief but the alternative would me spending my life in bed crying and moaning and rarely getting up. I wish they would find the cause of the pain.

I got the results of the capsule endoscopy, and they found nothing that would be the cause of my pain but they did find a polyp in my small intestine... It never ends.

-K

Post Edited (Kierstin) : 6/29/2013 12:39:33 AM (GMT-6)

Posted 6/29/2013 1:40 PM (GMT 0)
I take norco 3 times a day (5-325) for pain due to a torn disc in my back. My doc said that his experience and research showed less than 2grams a day is fine.

But I think it depends on how damaged your liver is and the cause.
Posted 6/29/2013 6:01 PM (GMT 0)
Kierstin, you are wrong about staying away from Tylenol. It contains acetaminophen, which is okay, up to 1500 mg daily, the dose they cited for me. It is IBUPROFEN that is a no-no! People get this wrong all the time. Also correct that the prescription pain meds are safer than OTC NSAIDs.

I have a lot of bone problems (bil. hip replacements with 3 revisions, 38-yr. neck problem, stress fracture in Lumbar 3, and torn cartilage and arthritis in rt. knee which will need a replacement. I take Lortab 10 mg/500 acetaminophen, so 2-3 a day is under the maximum acetaminophen requirement. My Mayo transplant team and my primary care doc are okay with this.

Just read the small print, or discuss with your doctor about what contains acetaminophen and is safe...all of you!

Hugs,
Connie
Posted 6/30/2013 6:05 AM (GMT 0)
Ibuprophen is off limits for me too as is asprin cause I tend to bleed, but I recently asked again and was told no more than 1200 mg of tylenol per day. Everyone needs to see what their doc says about them. In fact he doesn't even really like me taking the oxy either but just tsks about it mostly. I guess he doest really like me taking anything that harms the liver at all. He won't allow other docs to prescribe me internal fungicides either.

-K

Post Edited (Kierstin) : 6/30/2013 12:15:34 AM (GMT-6)

Posted 6/30/2013 6:23 PM (GMT 0)
My late hubby's pain was pretty much controlled with morphine and then Fentynal patches. We tried oxycodone at first, but the oxycodone created problems, hearing things that weren't there, seeing things that weren't there, but the morphine was much better for him mentally.

He too was worried about addiction, but since he was not interested in a transplant, pain control and quality of life were the goals. Then we moved to the Fentynal patches to even out the pain control, and that worked even better, as with the morphine he would wait until he was in pain before taking the next one, instead of at regular intervals (being afraid of addiction.)

I believe the Dr's are less likely to prescribe the higher dose painkillers for those that are waiting for transplant. So sad to hear of you all being in pain. Hope you find something that works to quell the pain.
Angie1953

Post Edited By Moderator (hep93) : 6/30/2013 12:39:48 PM (GMT-6)

Posted 7/1/2013 6:29 AM (GMT 0)
Thanks Angie
Posted 7/1/2013 2:17 PM (GMT 0)
Addiction should be somethign to worry about, especially from those who have had substance abuse issues in the past. However, there is signficant evidence that if you take medication as prescribed by your doctor, and do not deviate from that without approval that the chances of addiction are low.

What tends to happen is, many pateints start to self medicate because they believe that it is no longer working. Do not make any changes to your dosages until you have it cleared by your doctor. As a patient you have the right to live without pain. My doctor has been great, we work very closely to manage my back pain. She gets all approvals from my hep doctor. I am going to be going to a pain management clinic in a few weeks. Once they determine the best course my doctor has stated she will continue to handle the prescriptions, but wants to see if there is anything out there that might work and be better for the liver.

Post Edited (SyXx) : 7/1/2013 8:21:32 AM (GMT-6)

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