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What Causes A Distended Abdomen When Diagnosed With Diverticular Disease?
Question: My mother XXXXXXX , has a distended abdomen and is voluntarily guarding the area...she had a fistula between the bladder and a pelvic abscess drain and a high anterior resection all in mid 2010 and together it was called diverticular disease..
would the distended Abdo in her lower left abdomen be a reoccurance of Diverticular disease...the geriatric doctor knows her history as the 3 conditions were all treated in the hospital..back in 2010should i request a.CT SCAN or xray or should the Dr request these diagnostic imaging I am concerned of bowel perforations. He thinks if could be aortic blood vessel blockage located behind abdomen.he is doing nothing
would the distended Abdo in her lower left abdomen be a reoccurance of Diverticular disease...the geriatric doctor knows her history as the 3 conditions were all treated in the hospital..back in 2010should i request a.CT SCAN or xray or should the Dr request these diagnostic imaging I am concerned of bowel perforations. He thinks if could be aortic blood vessel blockage located behind abdomen.he is doing nothing
Brief Answer:
Suggests of obstruction
Detailed Answer:
Hi,
Welcome to HealthcareMagic .
According to your history I conclude that her probable cause of distension could be intestinal obstruction. Usually those who have previous abdominal surgery may go for adhesions and obstruction. Yes if left untreated it may go for bowel perforation and gangrene(death of part of bowel).
It is unlikely recurrence of diverticular disease.
I suggest you to go for plain x Ray of abdomen. Obstruction and perforation both may be diagnosed by it. If it is normal then you may go for Ct scan or ct angiogram to know the aortic vessel branch block. Treatment depends upon the cause and also since she has distension she needs to be investigated.
Hope I have answered your query. If any further queries are there I would love to help.
Regards
Dr Deepika Patil
Suggests of obstruction
Detailed Answer:
Hi,
Welcome to HealthcareMagic .
According to your history I conclude that her probable cause of distension could be intestinal obstruction. Usually those who have previous abdominal surgery may go for adhesions and obstruction. Yes if left untreated it may go for bowel perforation and gangrene(death of part of bowel).
It is unlikely recurrence of diverticular disease.
I suggest you to go for plain x Ray of abdomen. Obstruction and perforation both may be diagnosed by it. If it is normal then you may go for Ct scan or ct angiogram to know the aortic vessel branch block. Treatment depends upon the cause and also since she has distension she needs to be investigated.
Hope I have answered your query. If any further queries are there I would love to help.
Regards
Dr Deepika Patil
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you, XXXXXXX has pain and is unable to talk and her white blood count is high and her CRP has increased from 42 to 348 her legs and arms have swollen right up actually the leg and arm swelling have been swollen for the last 5 days since she has been in hospital..they IV hartmans sub cutaneous in her thighs as they think she has a UTI and is dehydrated...shall i insist on a CT scan to see what going in her body as she is becoming worde..
Brief Answer:
Yes request for CT
Detailed Answer:
Hi,
The raised White cell count and CRP indicates she has infection or inflammation in the body. These are not specific of any disease.
Her swelling of legs and arms I feel is due to fluid over load. One more cause is low protein in body. So I suggest you to discuss with your doctor about her albumin levels. If albumin is normal then the swelling is due to more IV fluids. That needs to be reduced.
Yes since she is not improving request for CT scan of abdomen to diagnose the cause. If UTI was there she should had improved .
Hope I have answered your query. If any further queries are there I would love to help.
Regards
Dr Deepika Patil
Yes request for CT
Detailed Answer:
Hi,
The raised White cell count and CRP indicates she has infection or inflammation in the body. These are not specific of any disease.
Her swelling of legs and arms I feel is due to fluid over load. One more cause is low protein in body. So I suggest you to discuss with your doctor about her albumin levels. If albumin is normal then the swelling is due to more IV fluids. That needs to be reduced.
Yes since she is not improving request for CT scan of abdomen to diagnose the cause. If UTI was there she should had improved .
Hope I have answered your query. If any further queries are there I would love to help.
Regards
Dr Deepika Patil
Above answer was peer-reviewed by :
Dr. Yogesh D
Doctor, my observation today is that her legs are swollen to bursting point, the nurse said phlebitis ?
I'm worried because of DVT , mum is 79 and has been immobile for a number of months.and as a flyer im concerned about clotting. XXXXXXX does not take any medication however gentamycin for her present UTI..her albumin has been dropping 23,19 and now 17..No anticoagulants no stockings and she is b thalassemia minor.her Bilirubin is down to 5 from 37.ECG is abnormal sinus tachycardia with short pr..non specific T Wave abnormality ...should i ask for CT on her heart blood vessels as tommorrow she is having the CT Abdomen scan.
I'm worried because of DVT , mum is 79 and has been immobile for a number of months.and as a flyer im concerned about clotting. XXXXXXX does not take any medication however gentamycin for her present UTI..her albumin has been dropping 23,19 and now 17..No anticoagulants no stockings and she is b thalassemia minor.her Bilirubin is down to 5 from 37.ECG is abnormal sinus tachycardia with short pr..non specific T Wave abnormality ...should i ask for CT on her heart blood vessels as tommorrow she is having the CT Abdomen scan.
Brief Answer:
DVT needs to be ruled out
Detailed Answer:
Hi,
Since DVT is dangerous, it is advised to rule it out. For this, I suggest you to ask for arterial Doppler study of both legs. Chances of DVT are more for her because of old age and immobility.
Usually for such patients we put on anticoagulant drugs like heparin and stockings. I suggest you to discuss this with your doctor.
Low albumin also cause swelling. I suggest you to discuss with your doctor regarding giving albumin supplement. If her urea and creatinine values are high then gentamicin needs to be switched to other renal safe antibiotics.
For her abnormal ECG findings, get echocardiogram which tells condition of heart. CT of heart, blood vessels tells blood supply to heart which is useful when chest pain is there and they are suspecting block. If she don't have chest pain then you may not go for this. But echocardiogram and Doppler of leg are needed.
Hope I have answered your query. If any further queries are there I would love to help.
Regards
Dr Deepika Patil
DVT needs to be ruled out
Detailed Answer:
Hi,
Since DVT is dangerous, it is advised to rule it out. For this, I suggest you to ask for arterial Doppler study of both legs. Chances of DVT are more for her because of old age and immobility.
Usually for such patients we put on anticoagulant drugs like heparin and stockings. I suggest you to discuss this with your doctor.
Low albumin also cause swelling. I suggest you to discuss with your doctor regarding giving albumin supplement. If her urea and creatinine values are high then gentamicin needs to be switched to other renal safe antibiotics.
For her abnormal ECG findings, get echocardiogram which tells condition of heart. CT of heart, blood vessels tells blood supply to heart which is useful when chest pain is there and they are suspecting block. If she don't have chest pain then you may not go for this. But echocardiogram and Doppler of leg are needed.
Hope I have answered your query. If any further queries are there I would love to help.
Regards
Dr Deepika Patil
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thank you Doctor ...the urea is quite high and creatinine is steady..they found a 15mm blood clot in mums pad , that's the 2nd time we have found blood clot in 10 days this is becoming quite concerning.
I'm worriedabout this abdomen aorta, as the nurse believes why mum is in pain..will the doppler test confirm details of a blockage in her abdomen aorta..maybe this is why she us immobile and in pain...what test can we request for this...also the blood clots and the distended abdomen and swollen legs...i have the bloods test ..tell me exactly what details you need..still.awaiting the CT to be done..also her INR was 1.1 and ptime is 11 seconds..
I'm worriedabout this abdomen aorta, as the nurse believes why mum is in pain..will the doppler test confirm details of a blockage in her abdomen aorta..maybe this is why she us immobile and in pain...what test can we request for this...also the blood clots and the distended abdomen and swollen legs...i have the bloods test ..tell me exactly what details you need..still.awaiting the CT to be done..also her INR was 1.1 and ptime is 11 seconds..
Brief Answer:
Get CT angiogram of abdomen
Detailed Answer:
Hi,
Doppler study tells only the blockage of artery and vein in legs and hands. To rule out her abdomen aorta block I suggest you to get CT angiogram of the abdomen as I already mentioned in my previous answer. It will tell about the block in the abdominal all arteries not only aorta.
In routine CT the condition of the intestine and any fluid collection will be made out. Get Doppler of leg venous system to rule out DVT. You have provided sufficient lab reports. Since urea is high discuss with your doctor the need to continue gentamicin and shift to safe drug like ceftriaxone.
Don't worry for bleeding. Little bleeding is not a problem. It may be seen in stress also. With above mentioned 3 investigations It will be possible for getting a possible diagnosis.
Her INR and PT are normal.
Please update me with the CT report and electrolytes levels. Waiting for the report.
Regards
Dr Deepika Patil
Get CT angiogram of abdomen
Detailed Answer:
Hi,
Doppler study tells only the blockage of artery and vein in legs and hands. To rule out her abdomen aorta block I suggest you to get CT angiogram of the abdomen as I already mentioned in my previous answer. It will tell about the block in the abdominal all arteries not only aorta.
In routine CT the condition of the intestine and any fluid collection will be made out. Get Doppler of leg venous system to rule out DVT. You have provided sufficient lab reports. Since urea is high discuss with your doctor the need to continue gentamicin and shift to safe drug like ceftriaxone.
Don't worry for bleeding. Little bleeding is not a problem. It may be seen in stress also. With above mentioned 3 investigations It will be possible for getting a possible diagnosis.
Her INR and PT are normal.
Please update me with the CT report and electrolytes levels. Waiting for the report.
Regards
Dr Deepika Patil
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thanks again Doctor, if her INR & PT are normal then she is not a bleeding risk..I will insist they give her all the anticoagulants or thrombolytic therapy as i am concerned that clots are forming pending this doppler screening. I need to look at worse case scenario due to age and immobility also as she had a abnormal ECG with her breathing being more rapid maybe clots have been formed. It all make perfect sense now that i think of it.. XXXXXXX leg swelling and no movements of her legs she must have DVT and the blood supply must be cut off from a blockage in her aortic abdomen....that's why she immobile blood supply is not filtering down into her legs..also she is looking very white and her lips ..Am i thinking this is her diagnosis..shall i call for a vascular specialist or a hematologist..I have access to all.these services my.insurance is unrestricted.
Brief Answer:
Get CT abdomen contrast
Detailed Answer:
Hi,
First I suggest to get CT abdomen contrast done. And get ECHO of heart. Meanwhile discuss with your doctor to start DVT prophylaxis like heparin and stockings. After leg Doppler if no DVT is detected then you may continue prophylaxis and if DVT is present proper treatment may be started.
Yes if INR and PT are normal then she is not at bleeding risk.
Cause of breathing problem could be due to fluid over load or low albumin or decreased haemoglobin. I suggest you to consult a cardiologist for heart problem .
If her CT abdomen has any positive findings then consult a surgical gastroenterologist . If CT abdomen is normal then consult cardiovascular surgeon.
Hope I have answered your query. If any further query is there I would love to help.
Regards
Dr Deepika Patil
Get CT abdomen contrast
Detailed Answer:
Hi,
First I suggest to get CT abdomen contrast done. And get ECHO of heart. Meanwhile discuss with your doctor to start DVT prophylaxis like heparin and stockings. After leg Doppler if no DVT is detected then you may continue prophylaxis and if DVT is present proper treatment may be started.
Yes if INR and PT are normal then she is not at bleeding risk.
Cause of breathing problem could be due to fluid over load or low albumin or decreased haemoglobin. I suggest you to consult a cardiologist for heart problem .
If her CT abdomen has any positive findings then consult a surgical gastroenterologist . If CT abdomen is normal then consult cardiovascular surgeon.
Hope I have answered your query. If any further query is there I would love to help.
Regards
Dr Deepika Patil
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Dr XXXXXXX doppler reveal she has extensive bloodclots in both calves and thighs..CT reveals 2 or possible 3 perforations in the sigmoid colon..have not had CT angiogramm as yet..awaiting Doctors advice...any advice will appreciated..the liver appears gingermeg ?
Brief Answer:
She needs a aggressive management
Detailed Answer:
Hi,
She needs aggressive management now. She should be started on heparin treatment for the blood clots and have ECG monitoring. Don't squeeze the limbs or do any massage or movement. This may cause clot to dislodge and go to lung veins.
Your doctor needs to decide - if it is sealed perforation then surgery may be delayed till DVT subscides but if it is not sealed perforation then she needs to be taken up for surgery as soon as possible or else atleast a tube may be passed into abdomen to drain the fluid. CT scan will help us assess whether or not this is sealed perforation.
I suggest you to get it done by surgical gastroenterologist.
Hope I have answered your query. If you have any further queries I would love to help.
Regards
Dr Deepika Patil
She needs a aggressive management
Detailed Answer:
Hi,
She needs aggressive management now. She should be started on heparin treatment for the blood clots and have ECG monitoring. Don't squeeze the limbs or do any massage or movement. This may cause clot to dislodge and go to lung veins.
Your doctor needs to decide - if it is sealed perforation then surgery may be delayed till DVT subscides but if it is not sealed perforation then she needs to be taken up for surgery as soon as possible or else atleast a tube may be passed into abdomen to drain the fluid. CT scan will help us assess whether or not this is sealed perforation.
I suggest you to get it done by surgical gastroenterologist.
Hope I have answered your query. If you have any further queries I would love to help.
Regards
Dr Deepika Patil
Above answer was peer-reviewed by :
Dr. Prasad
Dear Dr XXXXXXX XXXXXXX is being attended to however a CT was carried out and the results are severe aortic atherosclerotic and block/calcified illiac vessells both sides.and moderate 3 vessel coronary artery atherosclerotic...and choledocholithiasis..do you think they operate..she she seems to be stable..i guess the bowel first and then stent the aortic vessel..The CT has determined her condition now to proceed with attending to the escalating issues..i await you view.the blood anticoagulants are working well.
Brief Answer:
First is leg clots
Detailed Answer:
Hi,
Sorry for late reply.
The usual protocol is
The first thing is to attend her leg blood clots. It may turn life threatening. It usually comes in control within 2-3 days. After this next step is to operate on her abdomen preferably laparoscopic and if needed later open completely. Yes once leg clots reduce they may take up for operation. In the same setting stenting of the block in the aorta and its branch may be planned.
She needs to be put on anti cholesterol drug like atorvastatin later to reduce atherosclerosis.
Consult a cardiovascular surgeon and discuss the need for IVC filter placement to prevent migration of clots .
Hope I have answered your query. If any further queries are there I would love to help.
Regards
Dr Deepika Patil
First is leg clots
Detailed Answer:
Hi,
Sorry for late reply.
The usual protocol is
The first thing is to attend her leg blood clots. It may turn life threatening. It usually comes in control within 2-3 days. After this next step is to operate on her abdomen preferably laparoscopic and if needed later open completely. Yes once leg clots reduce they may take up for operation. In the same setting stenting of the block in the aorta and its branch may be planned.
She needs to be put on anti cholesterol drug like atorvastatin later to reduce atherosclerosis.
Consult a cardiovascular surgeon and discuss the need for IVC filter placement to prevent migration of clots .
Hope I have answered your query. If any further queries are there I would love to help.
Regards
Dr Deepika Patil
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Above answer was peer-reviewed by :
Dr. Prasad
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