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Suggest Treatment For Lower Abdominal Pain And Constipation

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Posted on Mon, 17 Oct 2016
Question: My father (age 89 yrs) was complaing of lower abdominalpain and constipation and loss of apetite. He visied doctor oand got couple of tests done and the reports are attached here for your second opinion and advise.

Medical History: High BP, Angina, Constipation, Gall Stone detected 3 year ago (unremoved till now), Heart patient with abnormal heart beat, Gas
Medicines: Cholesterol Lowering drugs, BP drug, Asppirin, Ocid and Laxatives (SOS)

My Query:
Based on the reports got day before yesterday, wish to understand the Liver righ lobe SOL its managgement and consequences, significance of dialated bowel loops (x-ray), Kidney cysts etc. Earlier his cardiologists had discouraged him from Gall removal so not removed (year back). Please see the US and X-ray attached.
Ultrasound reports of 16 months back had normal liver pattern (no SOL). Also as advised CT scan, my worry is he is a heart patient so should we go for CT as his creatinine is 1.2 or MRI would be safer and better?
LFT performed after ultrasound is normal report
Alphafeto protein is normal
CBC : low lymphocytes

doctor
Answered by Dr. Ratnakar Kini (10 hours later)
Brief Answer:
? Gallbladder cancer with spread to liver, ?small bowel obstruction

Detailed Answer:
Hi,
Thanks for posting your query.
I am Dr.R.K and I am pleased to assist you.

It looks like your father is having a gallbladder mass which probably is due to cancer. The space occupying lesion (SOL) is probably the spread of cancer from gall bladder.

Dilated bowel loops may indicate small bowel obstruction.
I would advise for a CT scan of the abdomen to get a clearer picture.
Both CT scan and MRI have their own advantages and disadvantages.
I would prefer CT scan over MRI in this scenario.

Let me know if you have any more questions.
Regards,
Dr.R.K.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Ratnakar Kini (3 hours later)
In case CT scan says cancer how can we rescue it? What will be the next treatment? Surgery. ?
Doctor your quick repose will be appreciated.
doctor
Answered by Dr. Ratnakar Kini (27 hours later)
Brief Answer:
Palliative care

Detailed Answer:
Hi,
Thanks for getting back to me with more questions.

It looks like the disease has spread to other parts including liver which indicates it is in advanced stage.

In advanced stages of cancer, the treatment options are limited.
His age also limits the options.
Palliative care will be given.

But first let us confirm the disease.

Let me know if you have any more questions.
Regards.
Dr.R.K.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Ratnakar Kini (10 hours later)
Dear Dr.
Thanks for your response. Attached please find the CT scan reports. I guess the reports have confirmed your findings. I have the following questions.
1. Does it confirm that the cancer originated from GB or liver could be the primary source.(this I'm asking to subside my guilt)
2. Now we will live under guilt the entire life as 1.5 years back wanted to remove the gall bladder after a stone was seen in the Ultrasound reports. However, because he was 87 years age and have heart problems it was told to us not to go for Laproscopic as it could be risky for him. For my understanding can a person undergo Laproscopy at this age ?
Had we removed the GB maybe this situation would not have arrived.
3. Now that CT is available wish to have an honest opinion as to how much will be his survival time period.
4. Is there still a chance to save him for few years.
5. Pallative care should be at home or he has to be in the hospital most of the time?
Thankyou in advance.
doctor
Answered by Dr. Ratnakar Kini (24 hours later)
Brief Answer:
Answer given below

Detailed Answer:
Hi,
1. The cancer has originated from GB and has spread to the nearby liver.
2. No need to feel guilty as one and half years ago he had high risk factors for surgery. Age alone is not a contraindication, but he had associated heart problems also.
3. The 5 year survival rate is about 10%.
4. Get tumor markers and liver function test done. Palliative care can be give for him.
5. Periodic visits to hospital.

Regards,
Dr.R.K.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Ratnakar Kini

Gastroenterologist

Practicing since :1994

Answered : 2208 Questions

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Suggest Treatment For Lower Abdominal Pain And Constipation

Brief Answer: ? Gallbladder cancer with spread to liver, ?small bowel obstruction Detailed Answer: Hi, Thanks for posting your query. I am Dr.R.K and I am pleased to assist you. It looks like your father is having a gallbladder mass which probably is due to cancer. The space occupying lesion (SOL) is probably the spread of cancer from gall bladder. Dilated bowel loops may indicate small bowel obstruction. I would advise for a CT scan of the abdomen to get a clearer picture. Both CT scan and MRI have their own advantages and disadvantages. I would prefer CT scan over MRI in this scenario. Let me know if you have any more questions. Regards, Dr.R.K.