Brief Answer:
Though possibility of bowel ischemia is present, more likely enteritis

Detailed Answer:
Hi XXXXX for writing in to us.

Hoping your father has improved and is getting better.

1. There is a possibility of small bowel ischemia in patients getting chemotherapy. The cause for such an occurrence is that the chemotherapy might cause some deficient blood supply to the bowel through the small vessels and this leads to a condition when the blood supply to the bowel is compromised and this leads to ischemia.

2. The other entity is neutropenic enteritis which can cause fever, abdominal pain and diarrhea. This is a chemotherapy induced mucosal injury and secondary superinfection in the bowel.

3. Both the above conditions cause loss of appetite which is followed by pain abdomen and fever. Loss of appetite is a non specific symptom in both the conditions. However the bowel ischemia might show more severe changes than what is mentioned in the report. Ultimately infection can happen in both situations. As the fever is under control with antibiotics and the doctors have been constantly observing him, it is possible that he had enteritis from which he is recovering.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
TPN duration is variable depending on patient requirement

Detailed Answer:
Hi XXXXX,
Thanks for writing back with an update.

1. Any inflammation causes pain and irritation in the bowel leading to discomfort and a loss of appetite. Since it is severe in nature therefore it can be present for 2 weeks.

2. Giving only IV fluids is replenishing the electrolytes. TPN also includes other diet components like carbohydrate, lipids and amino acids which will be a replacement for oral intake. Vitamins and essential nutrients are also given.

3. TPN duration is variable. It can be given for a week to many months, depending on the patient condition and requirements. If he has totally stopped oral intake and the doctors feel his bowel requires rest then TPN can be given for few weeks till his bowel condition improves. This decision it to be taken by his treating doctor.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Feeding through NG tube is an option available

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. Providing nutrition through a NG tube is one of the other options that might work for him. Since his upper gastrointestinal tract is normal therefore this is a technique that can be used. This has been used as a temporary solution in those who refuse feeds. Once he is better then a switch to normal feeding might be resumed.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Many patients give up on will power to live due to weakness

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. Unfortunately this is the commonest cause for losing patients getting treated for cancer.

2. The cancer does not kill but the patient gives up on his will power to live.

3. I want your father to pull himself out of this critical situation. Please try everything possible to get him have his fluids orally.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
The bilirubin is extremely high

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. His bilirubin is extremely high if it is 74 mg/ dl. Please discuss his health condition in detail with attending doctors immediately.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Please confirm whether the units of bilirubin is 74 µmol/L

Detailed Answer:
Hi XXXXX,
Thanks for writing back with an update.

1. I think we have some confusion here. Please recheck if the bilirubin level given is 74 µmol/L (micromoles per liter) or 74 mg/dL (milligrams per deciliter).

2. If it is 74 µmol/L then it corresponds to 4.3 mg/dL which is not too much and just about mildly increased.

3. Please confirm the above. Bilirubin might rise due to infection or chemotherapy.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
At present it is unlikely to be a liver failure, pending confirmatory tests

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. The liver is a big organ in the body and even if half of it is diseased then also it will compensate for the functions.

2. I dont think your father has a liver failure at present.

3. The entire liver panel test results need to be scrutinized to know how the liver is doing right now.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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