Lipase High/lesion-Cyst On Liver

[twe0708]

My Lipase levels are a little high. Just had the test done about 2 months ago and then repeated it a month later. The test almost doubled but my body scan shows my pancreas is fine. Amylase test came back fine but scan showed lesion or cyst on liver. Any thoughts of what could be going on? Going to see a GI next week.

[Emilushka]

Lots of options for what could be going on, but it's definitely time to talk to the GI doc. Doesn't sound like Celiac-only damage. Cysts on the liver can be from lots of things, but a rising lipase level is concerning for something going on in the pancreas that didn't show up on the scan. Lipase is made only in the pancreas whereas the amylase can come from pancreas, salivary glands, etc. Multiple locations.

Talk to the GI doc and keep us posted. Good luck to you!

[sa1937]

What's the difference between a lesion on the liver and a nodule...or are they one and the same?

[Emilushka]

What's the difference between a lesion on the liver and a nodule...or are they one and the same?

It depends on what they're made of. A nodule could be the liver tissue itself either scarring or making some kind of weird nodule thingy - hormones can do this, or potentially other things. A lesion is more likely some kind of external damage like a cancer or damage from a previous surgery or other non-liver source.

But that's a strictly medical perspective and without hearing what the radiologist read on the CT scan, it's hard to know exactly what was there. It would matter a lot what the GI doc thinks about the CT as well.

[sa1937]

It depends on what they're made of. A nodule could be the liver tissue itself either scarring or making some kind of weird nodule thingy - hormones can do this, or potentially other things. A lesion is more likely some kind of external damage like a cancer or damage from a previous surgery or other non-liver source.

But that's a strictly medical perspective and without hearing what the radiologist read on the CT scan, it's hard to know exactly what was there. It would matter a lot what the GI doc thinks about the CT as well.

Thanks for your reply! FYI, this was an abdominal CT scan in late May. I previously had a positive celiac panel followed up with an EGD with a positive biopsy on April 9 at which time I went gluten-free. I've never had any abdominal surgeries.

Specifically, this is from the official report, which my dr. referred to as a nodule. "A nonspecific 12 mm focus of hypervascularity is noted anteriorly in the left hepatic lobe on image 13 of series 4. This very well could represent an incidental benign finding, but follow-up is advised in six months to confirm stability as there are no prior studies available for comparison at our institution. There is no biliary dilation."

Follow-up CT scan in mid-Nov. referred to it as a liver lesion and my GI dr. told me at a follow-up earlier in Nov. that he wasn't very concerned about it: "An area of hypervascularity seen in the anterior aspect of the left lobe of the liver is again noted and appears to be less conspicuous than on the previous exam. No new hepatic lesions or intra or extrahepatic biliary dilation is identified.

IMPRESSION:

1. Small focus of hypervascularity seen in the anterior aspect of the left lobe of the liver now measuring approximately 7 mm in greatest dimension. This is less conspicuous than on the earlier exam.

2. No additional liver or abdominal masses, adenopathy or inflammatory changes seen.

Hope this tells you more than it tells me. lol My interpretation is that it's shrunk and that's good!

[Emilushka]

Thanks for your reply! FYI, this was an abdominal CT scan in late May. I previously had a positive celiac panel followed up with an EGD with a positive biopsy on April 9 at which time I went gluten-free. I've never had any abdominal surgeries.

Specifically, this is from the official report, which my dr. referred to as a nodule. "A nonspecific 12 mm focus of hypervascularity is noted anteriorly in the left hepatic lobe on image 13 of series 4. This very well could represent an incidental benign finding, but follow-up is advised in six months to confirm stability as there are no prior studies available for comparison at our institution. There is no biliary dilation."

Follow-up CT scan in mid-Nov. referred to it as a liver lesion and my GI dr. told me at a follow-up earlier in Nov. that he wasn't very concerned about it: "An area of hypervascularity seen in the anterior aspect of the left lobe of the liver is again noted and appears to be less conspicuous than on the previous exam. No new hepatic lesions or intra or extrahepatic biliary dilation is identified.

IMPRESSION:

1. Small focus of hypervascularity seen in the anterior aspect of the left lobe of the liver now measuring approximately 7 mm in greatest dimension. This is less conspicuous than on the earlier exam.

2. No additional liver or abdominal masses, adenopathy or inflammatory changes seen.

Hope this tells you more than it tells me. lol My interpretation is that it's shrunk and that's good!

"Hypervascularity" means a bunch of blood vessels. It's actually not uncommon to get that kind of thing in the liver without it being a problem and without there being any symptoms at all. If the doc is seeing what I'm pretty sure they're seeing, this is called a "hemangioma" ("hem" for blood and "angi" for vessels and "oma" for mass). It's not a tumor. The only problem with them ever is that they can potentially rupture, but for 99% of people they pop up by themselves, are only ever discovered accidentally, and then go away by themselves. No symptoms or problems. The types of people who are more likely to have them rupture (treatable, but unpleasant) are women in their 20s and 30s on combination oral contraceptive pills (the estrogen-progestin combo pills).

But shrinking is good, so it looks like it's just one of those things that's there and you'd never know except that you got a CT for another reason. That's called an "incidental finding" and honestly it's pretty common to have something pop up on a CT that doesn't matter or need treatment, but can totally freak people out. (A nodule? A lesion? What is wrong with my liver? Why are they talking about there being a thing on my liver?) Not scary to docs, but very scary to patients who don't know that many people walk around with those and no problems at all from them.

Sounds like figuring out the lipase business is really the order of the day, and hopefully that's just something benign too.

[sa1937]

"Hypervascularity" means a bunch of blood vessels. It's actually not uncommon to get that kind of thing in the liver without it being a problem and without there being any symptoms at all. If the doc is seeing what I'm pretty sure they're seeing, this is called a "hemangioma" ("hem" for blood and "angi" for vessels and "oma" for mass). It's not a tumor. The only problem with them ever is that they can potentially rupture, but for 99% of people they pop up by themselves, are only ever discovered accidentally, and then go away by themselves. No symptoms or problems. The types of people who are more likely to have them rupture (treatable, but unpleasant) are women in their 20s and 30s on combination oral contraceptive pills (the estrogen-progestin combo pills).

But shrinking is good, so it looks like it's just one of those things that's there and you'd never know except that you got a CT for another reason. That's called an "incidental finding" and honestly it's pretty common to have something pop up on a CT that doesn't matter or need treatment, but can totally freak people out. (A nodule? A lesion? What is wrong with my liver? Why are they talking about there being a thing on my liver?) Not scary to docs, but very scary to patients who don't know that many people walk around with those and no problems at all from them.

Sounds like figuring out the lipase business is really the order of the day, and hopefully that's just something benign too.

Thanks so much for the additional info! Yeah, it is kind of unnerving to have things like this pop up on a CT scan, especially when it's all a foreign language to me.

The only problem I had prior to my celiac diagnosis was the big D...no pain, nausea, some weight loss but not terribly significant and I am still fatigued. I still have problems with D and am trying to figure that out and have started keeping a food diary to see if I can pinpoint it (I figure I'm lactose intolerant). I'm older-than-dirt so no oral contraception, etc. I don't feel that I have a high fat diet either. I looked up lipase here: Open Original Shared Link

I just had a colonoscopy on Thurs. and have a follow-up appointment in early Jan. with my GI doc. So are you suggesting that the next step is a test for lipase to check for pancreatic function?

[Emilushka]

Thanks so much for the additional info! Yeah, it is kind of unnerving to have things like this pop up on a CT scan, especially when it's all a foreign language to me.

The only problem I had prior to my celiac diagnosis was the big D...no pain, nausea, some weight loss but not terribly significant and I am still fatigued. I still have problems with D and am trying to figure that out and have started keeping a food diary to see if I can pinpoint it (I figure I'm lactose intolerant). I'm older-than-dirt so no oral contraception, etc. I don't feel that I have a high fat diet either. I looked up lipase here: Open Original Shared Link

I just had a colonoscopy on Thurs. and have a follow-up appointment in early Jan. with my GI doc. So are you suggesting that the next step is a test for lipase to check for pancreatic function?

I'm suggesting the next step is to keep your appointment with your GI doc in January. Honestly, without seeing all your medical info, I'm not qualified to tell you what to do. And I wouldn't want to overstep your doc, who's been taking care of you and knows what has gone on already.

[sa1937]

I'm suggesting the next step is to keep your appointment with your GI doc in January. Honestly, without seeing all your medical info, I'm not qualified to tell you what to do. And I wouldn't want to overstep your doc, who's been taking care of you and knows what has gone on already.

I'm definitely keeping my follow-up appointment with my GI doc, which I made the day after I had my colonoscopy.

Thanks again...you are a real asset to this forum!

[Looking for answers]

Thanks again...you are a real asset to this forum!

Yeah, I agree. I just read through this post and he/she even made it make sense to me!

[Emilushka]

Yeah, I agree. I just read through this post and he/she even made it make sense to me!

I'm glad! YAY! Also: definitely "she".

[JBaby]

Yes I has elevated lipase, ulrasound showed nothing wrong. DX was pancreatitis. year and half later i self diagnosed with gluten issues.celiac. showed work up to nutritionist and couldnt understand how i fell thru the cracks. elevated lipase is an indicator of potential celiac. Once i went gluten freee, i never had the pain again.