What does my endoscopy report indicate?

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Posted on Fri, 3 Nov 2017 in Digestion and Bowels
Question: Hi, I am Almabrouk,,
My Gallbladder was removed in January 2016, before that an Endoscopy was preformed to remove some stones from my CBD and CHD. I had many stones in MY CBD and CHDagain in August 2017, some of them were removed in 19.08.2017 and a stent was inserted in my CBD to allow the bile to pass though, and prescribed to me Ursolvan 200mg medicine (Ursodeoxycholic Acid) for 2 months (two tablets, twice a day) . Doctor will remove the stent in 20.10.2017 (after 2 month of inserted it).
The question is what is the reason of the stones developed again in my CBD and CHD. and what is the effective cure to avoid the stones being developed again (Surgery, medicine or diet).
Please explain to me may case in details and the necessary recommended procedure I should follow.
Regards,
Almabrouk
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Proper medicine and diet change is required.

Detailed Answer:
Hi,
Thanks for query.

Have done through attachements.

Choledocholithiasis (also called bile duct stones or gallstones in the bile duct) is the presence of a gallstone in the common bile duct or hepatic duct.about 15 percent of all people with gallstones will have gallstones in the bile duct, or choledocholithiasis

After removal of gall bladder if the problem still continues possibilities are that-
1)too much cholesterol-Get your cholestrol level checked up and if they are high take stains class of drugs like Roauvastatin continuously.Increased amount of cholestrol are the most important facor for recurrent stone formation.
2)too much bilirubin- Which is not your case.

3)
not enough bile salts-For which urodeoxycholic acid is being given to you.


Try to reduce weight.
Avoid oily fatty and fast food.

Diet recommended for you is-

Breakfast-4 egg white.
Half cup boiled kidney beans.
5 almonds
1Banana

Mid day-
1Apple
1tsf peanut butter

Lunch-
Gilled chicken Breast 120 grams
Half cup Brocalli
Half cup Green beans
Half cup kidney Beans.
5 ml olive oil.

Snacks-
Green salad and 1apple

Dinner-
100 gram low fat cheese with seasonal vegetables.

Before sleep-
300 ml double toned milk.
20 almonds.

Get you lipid profile done along with serum calcium levels.

Do yoga thrice a week.
High levels may also indicate an issue related to the bones such as rickets, Paget's disease, bone cancer, or an overactive parathyroid gland.So an wndocrinology consultation should also be taken.
Follow up with reports.

Hope i was helpful.
Thanks!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar 19 hours later
Hi Dr. XXXXXXX
Thanks for your reply. However, I have some other concerns as follow:-

Some questions regarding my health problem:-
The doctor mentioned chronic inflammation in the hepatic bile ducts (see the attached medical report. Is there any medicine specific medicine for that inflammation?
What are the possibilities of having liver failure?
What are the possibilities of having Hepatitis?
Would you please clarify what you can see from the MRI images that I had in 15.8.2017, before I did the Endoscopy? Can you see ant inflammations in CBD and CHD’s?
What is the expected quantity of the stones in the CBD and CHD’d?
Are they severe? Can they be removed completely from my body in the next Endoscopy in the end of this month?
Is it necessary to have a permanent stent? If yes, what kind (material) of stent do you prefer?
To what level should I reduce my Cholesterol level?

Some questions regarding the diet:-
For how many months or years I should stick to the diet you recommended?
Is it ok to eat hot food? Is it ok to eat sweet food?
Is it ok to eat cooked beans and kidney beans, in a form like soup?
Is it ok to eat Spaghetti, couscous and rice?
What about Tuna and fish?

Drinks:-
What about drinking coffee (Nescafe with milk and Arabic Coffee). Is it ok to drink sweet drinks?
Some doctors recommended drinking lots of water 3Liters a day in summer and 1.5liters in winter, is that true?
What about drinking juices, Pepsi and Coca Cola?

Fruits:-
What about eating things like oranges, pear, peach, grape and watermelon…etc.?

Vegetables:-
What about eating things like carrots, tomatoes, potatoes…etc.?
Best regards,
Almabrouk
doctor
Answered by Dr. Ramesh Kumar 23 hours later
Brief Answer:
Follow up.

Detailed Answer:
Hello dear,
Sorry for a bit delayed reply.
No my dear patient as such there is no medication which can directly suppress bile duct inflammation.
Only when the stones are removed inflammation would settle down itself.

0% possibility of liver cancer at present in mri your liver is perfectly normal even all your liver functions are normal.

Hepatitis can be checked by doing minor tests like HAV,HbsAg serology.

Mild inflammation secondary to obstruction caused by stones .

For exact quantity post image to a radiologist we can interpret report but experts are radiologists.


Even if they are severe they could be removed for a surgical gastroenterologist your case is a routine case and prognosis are excellent.

Is it necessary to have a permanent stent? If yes, what kind (material) of stent do you prefer?-This comes under a surgical hepatobiliary surgeon.However no stent could be removed after all stones are drained.

Your cholesterol should be less then 140mg/dl for that you should start doing cardio 30-45 minutes a day with 15 min of weight training.

1) 6 months post operatively.
2)Yes you can eat it,but sweets should be in limit.
3) definitely yes.
All the food mentioned by you are super healthy.


Drinks:-All expect water should not be taken
Strict no.
Water should be taken 8-12 glasses daily.

Fruits and veggies are all good for you you can take them boiled or grilled.Over cooking destroys their minerals and vitamins.
In case you want a proper diet schedule message me you age weight height and a full body picture(physique).
Thanks
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar 45 hours later
Hi Dr. Kumr,
One more question regarding food and drinks. Is eating
cooked red meat like goat, camel and sheep meat ok?
Is drinking red and green tea ok? I mean do these things increase the possibility of developing stones or not.

My tall is 170 cm
Weight is 84 kg
age is 44 years old
Please see also my attached picture.
Regards,
Almabrouk
doctor
Answered by Dr. Ramesh Kumar 37 minutes later
Brief Answer:
follow up.

Detailed Answer:
Hello,
Red meat is not good for you.
Chicken breast and beef stresks would be good for you.

Geern tea is good for you rich in antioxidants.

Thanks!
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar 1 hour later
Hi Dr. Kumr,
I attached to you my body picture for making good diet to me.

Age: 44 y
Hight 170 cm
Weight 84kg

Regards,
Almabrouk
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Follow up answer.

Detailed Answer:
Hello,
Want some informations-
Your gym schedule for example number of sets and reps of particular exercise
Current diet detailed as breakfast bla bla
lunch bla bla
Body fat content if you know?
Supplements?
goal-to bwe lean or muscular or bulky
If you want a proper suggestion give me a proper schedule of yours.

Waiting
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar 42 hours later
Hi Dr. XXXXXXX
Thanks for your reply.
My breakfast is (8-9 am)
A sandwich of tuna and a cup of coffee or tea (green or red).
And sometimes with a cup of soft crashed roasted barely grains, mixed with some water and a little of olive oil.

Lunch is (3-4 pm)
About 300 g of cooked rice, spaghetti, coscus, With some vegetables.

supplement (6 pm)
A cup of coffee or tea with biscuits or a piece of cake.

dinner (7-8 pm)
a sandwich of the wight of 2 boiled eggs and an apple or banana or any kind of fruits.

No idea of the fat content.
No scheduled any daily exercises.
A picture of my body is in the uploaded files.

Thanks,
Almabrouk

doctor
Answered by Dr. Ramesh Kumar 19 hours later
Brief Answer:
Better sore then sorrow.

Detailed Answer:
Hi sorry for a bit delayed response,
Actually i was busy preparing a food plan for you-

From your photo it looks like your body fat content is 30% approx.
So our first aim is to bring to 18 percent fat
This would make your tummy flat and reducing fat would increase yor muscularity


So a fat loss diet is what i would suggest you-

You should maintain your total calorie intake at about 1500 cal/ day.A calorie deficit of about 400-500 per day would help you flatten your stomach fast.

Diet 1- 7 a.m
1 scoob ON whey protein
200 ml of skimmed milk

Diet 2- 9 a.m
50 gram oats
1 banana/apple/peach
5 almonds
4 egg whites


Day 11 am
3 dayes.

Lunch 2:4p pm

100 gram grilled chicken breast or tuna.
2 loafs of brown bread/brown rice
30 gram boiled potato
Use oil less non stick spray to cook.
50 gram green bell chilly
30 gram green beans
30 gram broclii
2 spoons yoghut
3 glass of water


5 p.m
Coconut water
2 egg white


8

Tofu 150 gram low fat
200 skimmed milk
green salad on plate
20 almonds crushded
10 raisins
1 scoob Casein protein.



apart from this you should work out for 1 hour a day for 4 days a week.
Should i give you a workout pan also.


Remember-
The question is not that you can but its whether you will!

Wish you a perfect physique in 12 weeks.
Thanks!
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Ramesh Kumar 32 hours later
Hi Dr. XXXXXXX
Thank you for your help in scheduling the diet for me. Can I start it now however I will have endoscopy to remove the stones from my CBD and CHD? Or after removing the stones.
Would you please give me the workout plan?
Is it normal to drink coffee or tea three times a day with this schedule?
I am not fan of milk, I cannot bear it, can I substitute with something else, juice for example?

I don’t understand the timing in the schedule as follow:-
What is meant by Diet 1- 7 a.m, is it from 1 to 7 am?
What is meant by Diet 2- 9 a.m, is it from 2 to 9 am?
Day 11 am?
3 dayes.?
Can you please clarify?

I also did not understand these.
1 scoop ON whey protein
Tofu 150 gram low fat
10 raisins
1 Casein protein

Best regards,
Almabrouk
doctor
Answered by Dr. Ramesh Kumar 23 hours later
Brief Answer:
Follow up answer.

Detailed Answer:
Hi dear,
Sorry for a bit delayed reply..Ah old age strikes every one!


Yes off course you can start it before endoscopy it has no relation to endoscopy.So the sooner the better.
Gym and fitness has not link to any of the scopies so yes start it from today.

Initially i would keep you on a fat loss schedule for 2 weeks.

Monday Chest and Shoulders
Tuesday Back
Wednesday Rest
Thursday Chest and shoulders
Friday Back
Saturday Abs and cardio
Sunday Rest

Chest and shoulders exercise(can learn them on you tube or through a trainer)
Flat Bench Press 3 sets 12-15 reps
Incline Bench Press 3 set 12-15 reps

Cardio
Treadmill - Running 40 mins
Elliptical-15 mins


BACK
Pullups 3 sets 12-15 reps
Lat Pull Down 3 sets 12-15 reps
Dumbbell Row 3 sets 12-15 reps

ABS-
Crunches 3 sets till failure
Reverse crunches 3 sets till failure.

No coffee and tea should be taken before work out(it acts as your prework out drink).

Replace milk with casein protein supplement.


Diet 1- 7 a.m(First diet of the day at 7 a.m)

3 Dates(fruit)

On is name of whey protein-When you lift weight its always good to have some whey isolates as they help to repair your muscles easily.

If tofu is not available have low fat cottage cheese(they are food)

Casein is a slow digesting protein so you should take it at night before sleeping.Most of the muscles are repaired at night time when you are resting therefore its good if your body gets a constant protein supply over night.


Thanks
Above answer was peer-reviewed by : Dr. Kampana
doctor
Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2405 Questions

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