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Calculus seen in kidney, gall bladder not seen in the scan. What to do ? - Online Doctor Chats

Date : 08-Jun-2013
User rating for this question
Very Good Posted in: Kidney Conditions
Answered by

General & Family Physician
Practicing since : 2002
Answered : 106 Questions
User:Hello Doctor
Doctor:Good evening
User:Very Good Evening
Doctor:Please proceed with your query
User:my brother who is 40 years and suffering from stone problem from long
Doctor:Sorry to hear that
User:today we went to take a scan
User:and noticed that Gallbladder is not seen
User:as per the report
User:can you pls put little light on the same we all are worried
User:In the Right Kidney there is a 14mm calculus
Doctor:Please relax
User:and Left NIL
Doctor:It is still fine if the gall bladder is not seen
User:how do you say that
Doctor:Gall bladder may not be visualized due to many reasons
User:will that not create a problem
Doctor:The actual method of performing the scan itself may not be adequate to make the gall bladder visible
User:so no issue you mean to say
Doctor:The Gel used may not be adequate
Doctor:The patient may be overweight
User:no he is very medium
Doctor:Or was on a full stomach that the gall bladder would have been obscured to the view
User:he was on empty stomach
Doctor:There are so many technical and normal physiological variations itself
Doctor:Yes, an empty stomach can also come in way of veiwing the gall bladder
User:what will happen to the calculus of 14mm in his right kidney
Doctor:Please confirm again if the calculus is in the kidney or the ureter
Doctor:Management will be different for each
User:mid ureter
User:with central sinus separation
Doctor:The calculus seems to be a bit bigger
Doctor:more than 10 mm
Doctor:however, it is in the mid ureter
User:yes it's 14mm
Doctor:That makes it easy for the removal
User:how it will be removed
Doctor:A surgical technique called Dormia Basketing can be tried in this situation
User:will that pain him
User:is there only surgical way to remove
Doctor:Here a scope will be passed through the ureter and the stone will be basketed out from the ureter through the external urethral orifice
Doctor:It will be done under anesthesia so that there would not be much pain
User:is this only way to remove
Doctor:For stones more than 10mm surgery is the preferred mode as medical methods fail to cure it
User:also i would like to know what is Hydroureteronephrosis
Doctor:It is a condition where there is backward flow of the urine into the kidneys
Doctor:With subsequent enlargement of the urinary tract
User:will this have any problem to kidney
Doctor:Significant Hydroureteronephrosis is an absolute indication for surgery in Ureteric calculi
User:will the 14mm calculus get flush thru the urine
Doctor:It is difficult to pass down the urine steam
Doctor:Patient should consume plenty of water for that
Doctor:More than 5 L per day
Doctor:And also it depends on what type of stone it is
User:ok so if he take more than 5 l per day the chance of going thru urine is possiable correct pls
Doctor:It is possible
User:3 month before he had 7mm calculus in the left kidney now in todays scan it's not there
Doctor:But wait and watch policy cannot be prolonged for more than 6 months from the time of diagnosis of the stone
User:His Liver is small in size right lobe is contracted with altered echoes. portal vein is dilated measuring 19mm sortuous but at hilum looks to be blocked
User:intrahepatic biliary radicals and hepatic veins are normal. CBD normal in size
User:what dose this mean pls
Doctor:I am sorry, please answer me this
Doctor:Does he consume alcohol?
User:6 years before he stoped
User:his Spleen ENLARGED IN SIZE
User:it measures 168mm
User:in its long axis and 82mm IN ITS SHORT AXIS.
Doctor:Seems like there is portal hypertension
Doctor:It needs to be further evaluated
User:sorry not getting you
Doctor:Sorry, I will explain to you
Doctor:The portal vein is dilated in him
User:he is also losing weight very badly
User:pls help
Doctor:Please let me know his age
User:what is dilated
User:he is 40 yrs
Doctor:The portal vein is dilated
Doctor:It is one of the blood vessels in the liver
Doctor:When there is a damage to the liver, the size of the blood vessel increases
Doctor:That is called portal vein dilatation
User:what will happen if vein is dilated
Doctor:His liver on the scan shows contrasting features
Doctor:It indicates that there is a block somewhere in the portal vein
Doctor:It needs to be evaluated further
Doctor:The liver does not seem to appear normal
Doctor:Do you have the scan report with you?
Doctor:Can you mail it to me?
Doctor:Please mail it to YYYY@YYYY
User:sorry i will not able to scan
Doctor:Can you do it now?
User:i can type the same to you now
Doctor:I wish to see the entire report at one stretch to come to a conclusion
Doctor:Please type the full report
User:i will type
Doctor:Would you like a telephone discussion about this?
Doctor:Are you comfortable typing?
User:Liver : Small in size right lobe is contracted with altered echoes. Portal vein is dilated measuring 19mm tortuous but at hilum looks to be blocked. intrapepatic biliary radicals and hepatic veins are normal.CBD normal in size
User:Gall bladder : Not seen
User:Spleen : Enlarged in size. It measures 168mm in its long axis and 82mm in its short axis.
User:no collaterals at hilum.
User:Right Kidney : Normal in size and shape. A calculus measuring 14mm noted in the mid ureter with central sinus separation perinephric area normal. Corticomedullary differentiation well maintained.
User:Left Kidney : Normal in size and shape. Central sinus separation. No calculus. Perinephric area normal. Corticomedullary differentiation well maintained. The following measurement in noted
User:Right Kidney :129mm in length with 20mm parenchyma
User:Left Kidney : 135 mm in length with 27mm parenchyma
User:* urinary bladder well distended. Wall thickness normal. No intra luminal pathology noted.
User:* Pre void volume : 507 ml. Post void residual urine : 41 ml
User:PROSTATE : Is normal in size, shape and echopattern. It measures 46x21x26mm of volume 13ml.
User:*Para aortic, pericaval and paracolic areas and normal.
User:*No ascites / No Pleural effusion noted.
User:* both ileac fossa are normal. No abnormal bowel loops.
User:im thru with scan report
Doctor:Thanks for typing
Doctor:I was reading them through as well
User:we are tensed with his report
User:ho thanx
Doctor:You need to act swiftly now
Doctor:The advise given about LFT, RFT and MRI is ideal
Doctor:I would also suggest the same thing
Doctor:The impression says
Doctor:Chronic parenchymal disease
Doctor:Which may be difficult to be completely cured
Doctor:Please do not hesitaite
Doctor:Follow my suggestions below
Doctor:1. Go ahead with the MRI at the earliest
Doctor:2. Along with Liver function test and Renal function test
Doctor:3. For the liver problem, MRI can help us in assessing the condition of the liver and to look for any defect there
Doctor:It can be corrected as well after the MRI
Doctor:About the Renal stones
Doctor:Surgery seems to be the only option as there is Hydroureteronephrosis
Doctor:Medical management will not help him
Doctor:The liver problem is more concerning than the kidney problem
Doctor:And he is losing weight as well
User:we have given for LFT today
Doctor:Please get back to a good Gastroenterologist and proceed further but quickly
User:will share the report to you
Doctor:Because the derangements in both kidneys and liver can worsen faster
Doctor:Where are you located?
Doctor:In Bangalore?
User:in bangalore
Doctor:Where is your husband getting treated?
User:im just waiting for his blood report
User:with Dr. XXXXXXXXXX
Doctor:In which hospital?
Doctor:Sorry to bother you with more queries
User:that ok
User:we are from chennai
User:im working here in blr
User:and he came here and got this problem
User:i will share the blood report to you
User:help guide me so that we can go back to chennai
Doctor:I understand
Doctor:Are you AAAAA?
User:yes pls
User:yes pls
Doctor:Seems like the problem with your husband is not to be neglected
Doctor:Are you taking him back to Chennai for the treatment?
Doctor:The point is, he needs to be managed quickly before the symptoms worsen
Doctor:He has to be under continuous supervision under a Gastroenterologist
User:yes i would like to take him back to Chennai for the treatments
Doctor:Please go ahead with it
Doctor:The damage on the liver may not be completely cured
Doctor:But the stones in the ureter can be removed successfully
User:but why is he losing weight
Doctor:I am sorry but the chronic disease process in the liver could have lead to a cancer like situation as well
Doctor:Due to malnutrition and inadequate functioning of the liver
User:ho no
Doctor:Please get the serum markers like Alkaline phosphatase
Doctor:I am sorry, but it may be a possibility
Doctor:I cannot comment for sure on that
User:serum markers like Alkaline phosphatase
User:what is for this
Doctor:To look for cancer like state
Doctor:This will be done in Liver function test mostly
Doctor:If not done, it has to be done seperate
User:i will go with this tomorrow
Doctor:Please get back to me with the Liver function test report
Doctor:I would like to help you further
User:i will sure
Doctor:Thank you too
Doctor:Is that all for now?
User:yes pls thanx
Doctor:Thank you too
Doctor:I wish your husband quick recovery
Doctor:Take care
Doctor:Bye for now
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