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Normal US but no bilirubin getting through

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Posted 6/18/2014 2:32 PM (GMT 0)
I had an US done, and everything is fine physically according to very experienced ultrasound doc.

Bilirubin is just NOT getting through as my stool is rarely if ever of a brown color.

I'm mildly jaundiced but LFTs haven't ever shown total bilis of above 1.5. total is usually 25-30% direct.

enzymes have been mildly elevated on 3 occassions (oct 55 ALT, nov 50, reduced to 20s then back up to 58 again 2 weeks ago)

other LFTs are normal.

I'm going to have a colonoscopy and the other one through the mouth next week to see if gastritis or anything could be causing a leaky gut or something is haywire...

I have at least got a good doc now... she hinted that a bile duct was dilated but the US doc yesterday said it isn't.

I'm getting worried now about malnutrition. I'm not sure what to do. How can my US be totally clean but there's no bili in my stool....?!

Post Edited (sensitiveinflamed) : 6/18/2014 8:49:40 AM (GMT-6)

Posted 6/18/2014 2:51 PM (GMT 0)
As to the question of whether you have a dilated bile duct or not, you maybe borderline. Did they give you an actual number for the maximum diameter/width based on the imaging? If so, did they indicate where it was and if it was relatively focal or most of the length of the duct?
Posted 6/18/2014 3:03 PM (GMT 0)
Let me check the notes, the normal bile duct is 4mm... but the other one was 13mm in November and 9mm yesterday... I don't know if that's the bile duct or what, but something.

There was no mention of focal or anything like that. It was only from my new doc pointing it out on november ultrasound and being surprised no one else had noticed. I asked US doc yesterday and said it's not dilated.... maybe the thing that was 13 and 9 is something different. I have another appt with new liver doc once other tests performed... in 12 days max but hopefully next week if the results come through. She's reasonably easy to see, no waiting lists where I am.
Posted 6/18/2014 4:09 PM (GMT 0)
Wow, 13 mm and nobody said anything?? Yes, that was very dilated!!

Normal within the liver portion of things - the left & right hepatic ducts are normally around 4 mm. They converge outside the liver to form the main common duct (actually two parts but a minor detail) which is usually around 4 to 7 mm. 13 mm is huge and the 9 mm is borderline using 8 mm as a threshold. For some, they would say a 10 mm threshold but that would usually be the older folks as things have gotten a bit stretched out over the years - add 1 mm per decade past the age of 50.

Post Edited (bblbt) : 6/18/2014 12:02:15 PM (GMT-6)

Posted 6/18/2014 5:55 PM (GMT 0)
My hep told me that the US is almost useless when looking for bile duct blockages. He said when someone wakes up jaundice or suddenly has elevated bilirubin needs to have an MRCP done immediately. My first hep missed that and I had more damage done to my liver as my bile duct become completely constricted due to gall stones or PSC (right now the thought is gall stones and I hope that to be the case). BBLBT is right, 5mm is usually the norm. Mine was like ridiculously large by the time they found it. Your doctor should do a MRCP and if it is still dilated a ERCP to check the duct and possibly clean and stent.
Posted 6/18/2014 8:57 PM (GMT 0)
Ok, I was mistaken. I think it was the porta that was 13.8 and now 9.something. I guess I was a bit confused.... Need to see doctor.... I read somewhere that the portal vein measuring more than 13 could mean hypertension, but that seems to not be the case.

my current doc seems pretty set on finding out what is wrong so once ive had my current studies done , then im sure these along with everything else will be on it's way
Posted 6/19/2014 1:48 AM (GMT 0)
Having some MRI & MRCP work with other testing as well done the next couple of days. Always interesting seeing what my bile ducts look like. They are a mess!
Posted 6/19/2014 4:57 AM (GMT 0)
i should get those done.... i have discomfort all the time but they say no inflamation of liver so it cant be that thats causing discomfort?

i should get those tests done... i think the doc will persue all routes for me
Posted 6/19/2014 8:23 AM (GMT 0)
SI - What do you mean by "that seems not to be the case"? If by that you mean your blood pressure is normal, that's not an indicator.
Posted 6/19/2014 10:39 AM (GMT 0)
my blood pressure is actually a bit low 103/80.

How does one find if there is hypertension?
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