perihepatic fluid

[Guest guest]

"Perihepatic fluid" was seeing on 's MRCP on Monday. Is this ascites? What it says exactly is as follows: "... There is a small amount of perihepatic fluid, mainly in the subdiaphramic space and the gallbladder fossa. The liver is enlarged and demonstrates irregular contour. There are multiple areas of hypointense signals in the liver post contrast predominantly involving the medial segment of the left hepatic lobe and anterior segment of the right hepatic lobe. There is no enhancement in those areas on the post contrast images. There are mild dilatation of the intrahepatic biliary system, including some of the peripheral ducts, not significantly changed from CT dated 3/15/06. There are multiple mesenteric lymph nodes. The kidneys are unremarkable. The gallbladder is distended and contains sludge in the dependent portion. There is splenomegaly. IMPRESSION: 1. Mild intrahepatic biliary dilatation with stents in place, not significantly changed. 2. Hepatomegaly with irregular perfusion consistent with scarring and/or fibrosis. **" (**His biopsies have showed both scarring and fibrosis.) So, I'm wondering if this indicates ascites? Also, what does anyone know about "mesenteric lymph nodes"? I'm looking it up, but thought maybe someone else might have some information on it, or if it's even something I need to worry about. AND, he still has VRE and the two yeasts in his stool, and now has the nasty Klebsiella in his stool, also. Chrissakes, anyway!!!! This kid is going to have the deadliest poop known to mankind if this keeps up!!!! They're working on trying to continue to (or re-) treat the Klebsiella, because

the doc is worried it's going to cause him to develop another pneumatosis. They stopped his tube feeds today again, and now his nausea seems to have gone away. Big surprise. I'm glad he's feeling better, though. Ami SO, that's what's happening. Ami mom to - 8 yrs - Double Lung Tx 2/26/2006, PSC - Pre-Liver Tx, Central DI, Steroid Induced Diabetes, HypoT, GERD, High BP, ADD, Anemia, Osteopenia, No Motility http://www.caringbridge.com/visit/seanfox mom to Emma - 12 yrs - Migraines, otherwise healthy stepmom to - 13 yrs - ADD, ODD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ __________________________________________________

[Guest guest]

Ami,

Just from my general Medical Transcription stuff Peri means

around…so I would say perihepatic would mean fluid around the liver

itself. (under the diaphragm area and the gallbladder fossa ( A

depression lodging the gallbladder on the undersurface of the liver anteriorly,

between the quadrate and the right lobes.)

I don’t know if that is really ascites…I would be

more concerned about peritonitis but I don’t know if that is a reasonable

thing to fear. That is an uneducated guess on my part. I think of

ascites to be more external than this sounds…and for peritonitis to be

more of an internal fluid issue…neither is great…both can get

infected…but don’t worry and ask the experts don’t freak

because of anything I say…but that is my knee jerk.

Irregular contour? Does that mean it is cutting off in

certain areas?

I am praying for you. How does he seem? Any change

in his PELD? How long is he off list with the ERCP?

Mom of Zoe

(13) super soccer player;

Noah (9) UC,

PSC, enthesopathy and osteopenia and a great soccer and basketball player and;

Aidan (5)

moderately-severely hearing impaired great basketball shot (10-foot

hoop none-the-less)

" Perihepatic

fluid " was seeing on 's MRCP on Monday. Is this ascites?

What it says exactly is as follows:

[Guest guest]

He didn't have an ERCP. Did I write that? It's my migraine. I meant MRCP. Sorry. So, not off the list. PELD remains the same (15) as far as I know. How sick is it to almost hope for ascites if it means a liver quicker??????? I'm just worried that with a PELD of "only" 15 we'll be waiting half of forever. I wish we'd have tx'd the liver first. We only waited 2 1/2 months for his lungs, so we got spoiled with that one. This is frustrating already and he's only been listed 4 1/2 months for liver. I just worry about how sick he might end up having to get before he gets one. I've seen how quickly he can go from fine to very sick, now, and I'm worried what will happen if he hits that point of SICK sick. That he may go straight into TOO sick to be tx'd. Know what I mean? I'm sure I'm just worrying about

nothing. And don't worry, you didn't freak me out. :-) If I didn't want (and couldn't handle) opinions, I wouldn't ask you guys. I hope Noah starts feeling better soon. Poor guy!!! They shut off 's tube feeds again today, and now he's feeling better than he has in 2 or 3 days. Spunky and perky and not pukey. (Little bit of stomach ache, but not pukey.) Ami Ami mom to - 8 yrs - Double Lung Tx 2/26/2006, PSC - Pre-Liver Tx, Central DI, Steroid Induced Diabetes, HypoT, GERD, High BP, ADD, Anemia, Osteopenia, No

Motility http://www.caringbridge.com/visit/seanfox mom to Emma - 12 yrs - Migraines, otherwise healthy stepmom to - 13 yrs - ADD, ODD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ __________________________________________________

[Guest guest]

Oh, poo no that was MY migraine…sorry…have

not read the rest.

Did not want you to think you were crazy…needed

you to know it was me.

Mom of Zoe

(13) super soccer player;

Noah (9) UC,

PSC, enthesopathy and osteopenia and a great soccer and basketball player and;

Aidan (5)

moderately-severely hearing impaired great basketball shot (10-foot

hoop none-the-less)

[Guest guest]

What a total goober am I?! So

tired! Glad not off the list! I just remember you said the ERCP

would take him off for a bit. I gottcha on wishing for the worst to get

the best in the end. You all need more exception points.

I don’t think you are worrying about

nothing. We are responsible for these babes. It is our job.

He is puking left and right (unless you have him on a right only system

LOL!). I don’t know that fluid AROUND the liver would be great…it

might get you exception points. I don’t know what exactly would

cause that. I am sure someone here would know. Kind of sounds like

a portal hypertension type thing…like a backup of fluid/blood

issue. I would be surprised if he does not get varices…or does he

already have them? Which would worry me on the vomiting end. Those things

would work to your advantage on the PELD scoring end. (Gosh this

conversation does suck.)

Good news about the feeding tubes.

Eating on your own is always better…could we just get Noah to do some of

that? He is so nauseous. (but he is fine <insert some more

sarcasm here> I seem to have lots to go around.) Hey…did you say

spunky AND perky. That is fan-freaking-tastic. I think you might

have a gift on its way in the form of him feeling well for Christmas.

Dang woman you deserve it.

Much love,

Mom of Zoe

(13) super soccer player;

Noah (9) UC,

PSC, enthesopathy and osteopenia and a great soccer and basketball player and;

Aidan (5)

moderately-severely hearing impaired great basketball shot (10-foot

hoop none-the-less)

He

didn't have an ERCP. Did I write that? It's my migraine.

I meant MRCP. Sorry. So, not off the list.

PELD

remains the same (15) as far as I know. How sick is it to almost hope for

ascites if it means a liver quicker??????? I'm just worried that with a

PELD of " only " 15 we'll be waiting half of forever. I wish we'd

have tx'd the liver first. We only waited 2 1/2 months for his lungs, so

we got spoiled with that one. This is frustrating already and he's only

been listed 4 1/2 months for liver.

I just

worry about how sick he might end up having to get before he gets one.

I've seen how quickly he can go from fine to very sick, now, and I'm worried

what will happen if he hits that point of SICK sick. That he may go

straight into TOO sick to be tx'd. Know what I mean? I'm sure I'm

just worrying about nothing.

And

don't worry, you didn't freak me out. :-) If I didn't want (and

couldn't handle) opinions, I wouldn't ask you guys.

I hope

Noah starts feeling better soon. Poor guy!!!

They

shut off 's tube feeds again today, and now he's feeling better than he has

in 2 or 3 days. Spunky and perky and not pukey. (Little bit of

stomach ache, but not pukey.)

[Guest guest]

Peri-hepatic fluid is a mild form of ascites. Not surprising with how

his liver looks and what the biopsies show. With all those infections

he's got to be one sick kid. I'm glad he's feeling better off the

feeds. But he'll need the nutrition to help him beat those bugs. I hope

he gets better soon. And gets a new liver soon as well.

Aubrey, MD

PSC '81, UC '90, LTX '98, Recurrence '05