Splenomegaly / Cholelithiasis / Diet

Medical Q&A [Moderated]
1

I reported here in March that my whole-abdomen scan, done as part of a general check up, showed several worrying findings:

· Fatty liver

· Gallbladder / cholesterol polyps

· Splenomegaly

· Prostatic concretions

· Urinary retention

I have since had follow-up scans in June and October.

For context: I am a 45-year-old British male.

I have lost weight, with my waist down from 41" to 38" so far. Thankfully the latest scan shows that the liver is now unremarkable, though still prominent in size.

The splenomegaly remains a problem. My splenic index has risen from 1123 in March to 1080 in June, and now 1297 in October. I have a follow-up consultation in January, including another scan and CBC blood work.

For my gallbladder, the latest scan showed:

· At least three wall-adherent nodular echoes, all around 0.5 cm

· Two mobile bright echoes measuring 0.5 and 0.7 cm

· Gallbladder wall not thickened

I was referred for a surgical opinion to weigh up gallbladder removal. As I currently have no pain, the doctor advised there is no urgency for surgery. On examination he noted significant gas retention.

He has recommended the following:

· Ursodeoxycholic acid (UDCA) to attempt dissolution of the stones. This is pending confirmation from the doctor managing my splenomegaly.

· A restrictive diet aimed at reducing bloating, minimising gallbladder stress, and to lower the risk of a stone obstructing the duct. This is the same diet he gives those patients after having their gallbladder removed, but he advised I follow it now alongside the UDCA.

Diet main points:

· Only water to drink

· No dairy, soups, or fruit except papaya (I live in the Philippines!), pineapple, and oranges

· No beans

· Avoid overeating. Smaller portions

· Max of 3 meals per day

I am to follow this plan for one month before my next review.

I’d appreciate a second opinion. A few questions:

· Do you think UDCA is likely to be effective in dissolving stones of this size or shall I just proceed with the surgery?

· Is this prescribed diet genuinely necessary? I do love dairy and beans!

· I’m also concerned about getting enough protein on this diet. Would whey protein isolate still be acceptable? (I didn’t ask my doctor because I suspected the answer would be, “You don’t need protein powder anyway!”)

· Regarding the splenomegaly, my doctor suggested it may be due to a blood disorder. Does that seem plausible, and are there other possible causes I should raise at my next consultation?

Thank you for any input :blush:

2

As I pointed out in your last thread ( Alter training for poor health? - #3 by Radnor80 ), this is more appropriate for discussion via an individualized consultation, as many of the details here are beyond the scope of what we can realistically cover via the forum.

1- Unfortunately I can’t predict the effects of UDCA here with confidence. Regardless, I’m more concerned with the wall-adherent nodular echoes (which sound like they could potentially represent gallbladder polyps and an associated risk of cancer).

2- I do not think that restrictive of a diet is necessary, especially for an asymptomatic patient.

3- WPI is fine, assuming third-party testing for purity/lack of contamination.

4- The list of potential causes for splenomegaly is lengthy and complex; again, beyond the scope of this forum.

3

Radnor80:

I am a general surgeon in the US and perform gallbladder removal surgeries frequently. I want to reiterate Dr. Baraki’s responses, which I think are spot on. While I cannot give you individualized advice, I can tell you how we generally approach patients with similar conditions. Whenever I see a patient with gallbladder polyps, I recommend elective cholecystectomy (surgical removal of the gallbladder), for the same reason we remove polyps in the colon during colonoscopy. While each individual polyp may have a relatively low risk of malignancy, their presence definitely imparts an increased lifetime risk of developing cancer in the affected organ, and research shows that this is even more prevalent in Asia, India and for Native Americans. For patients unable or unwilling to undergo cholecystectomy, close surveillance with ultrasound or other imaging is mandatory.

Cholecystectomy is a relatively simple, minimally invasive procedure done as a same-day surgery in most locations, with very little downtime associated with the surgery. It is curative even if high grade dysplasia (aka carcinoma-in-situ) is already present in the inner gallbladder lining; at the very least, it will remove concerns over future deterioration of the polyp tissue into something troublesome. In my experience, UDCA is not very effective at dissolving existing stones and is more commonly used as a band-aid approach for patients who are not good surgical candidates. The long term side effects of cholecystectomy are very minimal for most people. Most go on to live an entirely normal life. Sometimes there are mild changes in frequency or consistency of bowel movements, rarely a chronic diarrhea can develop, which is usually controllable with antidiarrheal medication. Most surgeons impose short-term lifting restrictions during the postop recovery period, but there are no persistent activity restrictions.

3 Likes
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Thank you, Dr. Baraki.

5

Many thanks, Dr ‘ecophotog’! I really appreciate your expertise and for the detailed reply.