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What Causes Loss Of Appetite Post Stent Placement In Gastroduodenal Artery?
Question: my grandmother is 62/F years old, at 52 she underwent cholesytectomy due to gallstones. 4 months earlier she began to show symptoms of jaundice and abdominal pain, scans revealed her CBD was blocked. she was admitted to a cancer hospital where the doctors placed a expandable metal stent through laproscopy as D1D2 stricture couldn't allow passage of endoscope. biopsy reports however were negative for malignancy. 20 days after placing the stent, her gastroduodenal artery was poked by the stent which caused GI bleeding resulting in black stools. bleeding stopped after doctors sealed the artery.
concern is that her apettite has reduced considerably resulting in extreme weakness. intravenous saline leads to swelling in parts of body. doctors(at different hospital) are saying that loss of apettite is due to cholangiocarcinoma.. but its hard for me to negate biopsy results.. can i know what is the underlying situation? cause...? and remedy..?
concern is that her apettite has reduced considerably resulting in extreme weakness. intravenous saline leads to swelling in parts of body. doctors(at different hospital) are saying that loss of apettite is due to cholangiocarcinoma.. but its hard for me to negate biopsy results.. can i know what is the underlying situation? cause...? and remedy..?
Brief Answer:
Anemia to be corrected and any persisting blood loss stopped
Detailed Answer:
Hi XXXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. In the latest angiogram done at XXXXXXX there is presence of pseudoaneurysm in the gastroduodenal artery and in the region of the stent. It is also written about a collection of blood that is probably leaking from the area. It might be noted that even a small amount of leak can cause severe anemia and blood loss over a long period of time. Severe anemia is know to cause generalized ill health and weakness amounting to loss of appetite and poor deteriorating health.
2. It is also mentioned that the liver is normal in appearance and this clarifies the absence of any liver pathology. The pancreas is also normal.
3. CBD washing s and brushings have been tested at Tata hospital and found negative for malignancy. In this setting, possibility of a cancer in the biliary tract is remote.
4. The earlier mentioned biliary stricture causing block in the CBD is most likely a benign stricture and this is seen in some patients after few years due to cholecystectomy complications.
5. In my opinion after studying the case in detail, I would like to review any anemia that your grandmother is having at present. This will include complete hemogram with a peripheral blood smear and her hemoglobin count. Accordingly medications need to be given to treat the anemia keeping in mind to provide her a healthy nutritious diet. At the same time a vascular sugeron opinion must be sought to help out with the pseudoaneurysm in the gastroduodenal artery and any surgical treatment options to avoid further complications.
The above opinions are based on the report findings attached with your query and providing the right treatment requires the role of more than one doctor. It is hard for anyone to negate the biopsy results in the above case as Tata hospital is an internationally renowned center for cancer research besides I have served in a cancer institute for few years as a cancer radiologist myself.
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
Anemia to be corrected and any persisting blood loss stopped
Detailed Answer:
Hi XXXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. In the latest angiogram done at XXXXXXX there is presence of pseudoaneurysm in the gastroduodenal artery and in the region of the stent. It is also written about a collection of blood that is probably leaking from the area. It might be noted that even a small amount of leak can cause severe anemia and blood loss over a long period of time. Severe anemia is know to cause generalized ill health and weakness amounting to loss of appetite and poor deteriorating health.
2. It is also mentioned that the liver is normal in appearance and this clarifies the absence of any liver pathology. The pancreas is also normal.
3. CBD washing s and brushings have been tested at Tata hospital and found negative for malignancy. In this setting, possibility of a cancer in the biliary tract is remote.
4. The earlier mentioned biliary stricture causing block in the CBD is most likely a benign stricture and this is seen in some patients after few years due to cholecystectomy complications.
5. In my opinion after studying the case in detail, I would like to review any anemia that your grandmother is having at present. This will include complete hemogram with a peripheral blood smear and her hemoglobin count. Accordingly medications need to be given to treat the anemia keeping in mind to provide her a healthy nutritious diet. At the same time a vascular sugeron opinion must be sought to help out with the pseudoaneurysm in the gastroduodenal artery and any surgical treatment options to avoid further complications.
The above opinions are based on the report findings attached with your query and providing the right treatment requires the role of more than one doctor. It is hard for anyone to negate the biopsy results in the above case as Tata hospital is an internationally renowned center for cancer research besides I have served in a cancer institute for few years as a cancer radiologist myself.
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
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
sir, bleeding was cured after the doctors placed a ring to block the bleeding artery,
and after that CBC revealed haemoglobin count of 9 mg/dl. but many more complications arose after that
1. stomach was filled with fluid, which had to be cleared through nasogastric tube(doctors suspected aseptic menigitis) biopsy of fluid had no traces of cancer cells
2. loss of apettite/anorexia
3. inflammation in stomach after taking food
4. indigestion
5. dialapidation in kidneys(urine was blocked.. for which urine bag had to be attached)
doctors put a nasogastric tube for food intake
blisters have formed inside the mouth which have further reduced her food intake
based on above findings, i dont think anemia could be the sole reason
and after that CBC revealed haemoglobin count of 9 mg/dl. but many more complications arose after that
1. stomach was filled with fluid, which had to be cleared through nasogastric tube(doctors suspected aseptic menigitis) biopsy of fluid had no traces of cancer cells
2. loss of apettite/anorexia
3. inflammation in stomach after taking food
4. indigestion
5. dialapidation in kidneys(urine was blocked.. for which urine bag had to be attached)
doctors put a nasogastric tube for food intake
blisters have formed inside the mouth which have further reduced her food intake
based on above findings, i dont think anemia could be the sole reason
Brief Answer:
Please find clarifications below
Detailed Answer:
Hi XXXXX,
Thanks for writing back with an update.
I would like to add certain clarifications after receiving the update from you.
Anemia shares a complex relationship with infections. Anemia causes a lot of stress on all organ systems in the body. This is because the organs and tissues receive sub optimal oxygenation and nutrition leading to various levels of sub normal function. If the doctors have transfused 10 units of blood to your grandmother then she must have been in a crisis situation at that time due to sudden blood loss. Even after infusing such amount of blood, it takes a lot of care and effort to normalize functioning of various organs in the body and this is more obvious in an elderly patient as your grandmother.
To add to the above, she has also had the stress of undergoing a lot of investigations and procedures. This would also have drained her physically and psychologically. As you have mentioned external biliary drainage and stent placement, biopsy brushings from common bile duct, regular nasogastric tube feeding and fluid suction from the stomach, urinary block and subsequent catheterization, artery sealing among others, these are events that required variable durations of hospitalization and have taken its toll on your grandmother.
Therefore, in the above context sudden blood loss and anemia is one of the broader causes that have led to multiple complexities and a general poor health condition of your grandmother. Along with the above, the presence of any other chronic condition like diabetes, hypertension etc (not mentioned above) can cause a more complex situation involving multiple organ systems. At this age, recovery is also slow and I think your grandmother is getting all the medical attention possible and you and your family have extended all support for her good health and recovery. Given the stress she has gone through, loss of appetite, indigestion and inflammation in the stomach after taking food might be the mental projection of her physical weakness. The blisters in mouth can be due to associated infection or stress.
Hope that she makes a quick recovery with the support of your family and doctors treating her.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please find clarifications below
Detailed Answer:
Hi XXXXX,
Thanks for writing back with an update.
I would like to add certain clarifications after receiving the update from you.
Anemia shares a complex relationship with infections. Anemia causes a lot of stress on all organ systems in the body. This is because the organs and tissues receive sub optimal oxygenation and nutrition leading to various levels of sub normal function. If the doctors have transfused 10 units of blood to your grandmother then she must have been in a crisis situation at that time due to sudden blood loss. Even after infusing such amount of blood, it takes a lot of care and effort to normalize functioning of various organs in the body and this is more obvious in an elderly patient as your grandmother.
To add to the above, she has also had the stress of undergoing a lot of investigations and procedures. This would also have drained her physically and psychologically. As you have mentioned external biliary drainage and stent placement, biopsy brushings from common bile duct, regular nasogastric tube feeding and fluid suction from the stomach, urinary block and subsequent catheterization, artery sealing among others, these are events that required variable durations of hospitalization and have taken its toll on your grandmother.
Therefore, in the above context sudden blood loss and anemia is one of the broader causes that have led to multiple complexities and a general poor health condition of your grandmother. Along with the above, the presence of any other chronic condition like diabetes, hypertension etc (not mentioned above) can cause a more complex situation involving multiple organ systems. At this age, recovery is also slow and I think your grandmother is getting all the medical attention possible and you and your family have extended all support for her good health and recovery. Given the stress she has gone through, loss of appetite, indigestion and inflammation in the stomach after taking food might be the mental projection of her physical weakness. The blisters in mouth can be due to associated infection or stress.
Hope that she makes a quick recovery with the support of your family and doctors treating her.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
sir, i am very thankful for your clarification, and i want your advice upon this:
1. her limbs have swollen(which doctors there are saying, is because of potassium loss) which is causing pain and she is unable to walk
2. she complains about feeling of fullness after eating little
3. we have currently admitted her to PGI XXXXXXX where doctors are maintaining that she suffers from cancer which is in advanced stage
Q1) what is your advice in such situation given that ascitic fluid tested negative for malignancy at XXXXXXX alongwith biopsy at TMC
Q2) what care and precaution should be taken for her speedy recovery
1. her limbs have swollen(which doctors there are saying, is because of potassium loss) which is causing pain and she is unable to walk
2. she complains about feeling of fullness after eating little
3. we have currently admitted her to PGI XXXXXXX where doctors are maintaining that she suffers from cancer which is in advanced stage
Q1) what is your advice in such situation given that ascitic fluid tested negative for malignancy at XXXXXXX alongwith biopsy at TMC
Q2) what care and precaution should be taken for her speedy recovery
Brief Answer:
Please find details below
Detailed Answer:
Hi XXXXX,
Thanks for writing back with an update.
1. In my opinion SGPGI, XXXXXXX is a premier institute for medical treatment and research. They have a very good department for stomach, pancreas, gall bladder and liver disorders.
2. Before accepting a diagnosis of cancer, it is important to collect evidence. It is about 2 and half months since the biopsy at Tata hospital and cancers of the biliary system spread very fast. Therefore the possibility of a cancer being visualized in the CT scan done at XXXXXXX was higher on the scan done in March 2015 at Final diagnosis, XXXXXXX
3. I can suggest you to please contact Final diagnosis, XXXXXXX and ask them to give a CD or DVD containing all images of CT scan done in March 2015. You can then given this CD to doctors in Radiology department at SGPGI, XXXXXXX to review it keeping in mind the advanced cancer that is being discussed as a working diagnosis. Review of this scan will clear any doubts and give a clear picture of the situation. More investigations can be based on the review of the recent CT scan and then additional tests can be performed.
4. The most difficult problem in cases like your grandmother is development of infection and sepsis. This is because the patient has low immunity and in hospital atmosphere she can catch serious infection easily and this can cause more complications. To control sepsis it is best that proper nursing care is taken and not many outside people are allowed in her room.
5. The potassium and other electrolytes should be slowly corrected and brought back to normal.
6. If she is not feeding properly then please give her soft semisolid foods in small quantities at regular intervals during the day. She should be given food and drinking water in sitting position to avoid choking.
7. Please make her emotionally strong and increase her will power to live.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please find details below
Detailed Answer:
Hi XXXXX,
Thanks for writing back with an update.
1. In my opinion SGPGI, XXXXXXX is a premier institute for medical treatment and research. They have a very good department for stomach, pancreas, gall bladder and liver disorders.
2. Before accepting a diagnosis of cancer, it is important to collect evidence. It is about 2 and half months since the biopsy at Tata hospital and cancers of the biliary system spread very fast. Therefore the possibility of a cancer being visualized in the CT scan done at XXXXXXX was higher on the scan done in March 2015 at Final diagnosis, XXXXXXX
3. I can suggest you to please contact Final diagnosis, XXXXXXX and ask them to give a CD or DVD containing all images of CT scan done in March 2015. You can then given this CD to doctors in Radiology department at SGPGI, XXXXXXX to review it keeping in mind the advanced cancer that is being discussed as a working diagnosis. Review of this scan will clear any doubts and give a clear picture of the situation. More investigations can be based on the review of the recent CT scan and then additional tests can be performed.
4. The most difficult problem in cases like your grandmother is development of infection and sepsis. This is because the patient has low immunity and in hospital atmosphere she can catch serious infection easily and this can cause more complications. To control sepsis it is best that proper nursing care is taken and not many outside people are allowed in her room.
5. The potassium and other electrolytes should be slowly corrected and brought back to normal.
6. If she is not feeding properly then please give her soft semisolid foods in small quantities at regular intervals during the day. She should be given food and drinking water in sitting position to avoid choking.
7. Please make her emotionally strong and increase her will power to live.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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