Ok, my hubby, 40 years old, in great health, spent the day in the er with intense abdominal pain. He had his gall bladder removed 3 years ago and at that time I remember his doc telling him that he may occasionally have a particular food disagree with him and cause pain. Never became an issue, but now I’m wondering if that’s what’s going on. The CT scan ruled out appendicitis, intestinal blockage, and anything “bad” as the nurse practicioner called it. She referred him back to his gastro, who now apparently specializes in gastric bypass, so we may need to look elsewhere. Also, he does have some kidney stones but the pain doesn’t present as typical; no back pain or tenderness. Any opinions? I appreciate the help!
Has he been checked for diverticulitis?
No, but he doesn’t have a fever or diarrhea. Does he need a colonoscopy to diagnose that? If so, I’ll have to have him read the ST posts…he’ll be thrilled.
Thank you!!
I’m not a doc, but I do spend a fair amount of time driving a CT scanner. Anyway, give my opinion on this about as much credence as you ordinarily would for an anonymous poster on an internet forum.
I think that most radiologists would tell you that CT is somewhat limited in its ability to evaluate the biliary ducts. If this is in fact the source of the trouble, it would probably be better evaluated by ultrasound, MRI, or ERCP (endoscopic retrograde cholangiopancreatography, which although not entirely pleasant, at least approaches the problem from the opposite direction than does colonoscoopy). Follow up with your primary care doc would be your best way to determine how best to pursue it.
Renal calculi (kidney stones) seem unlikely, as they would most likely be detected on a standard CT of the abdomen and pelvis. Slightly different protocols would be used, but anything sensitive enough to rule out inflammation of the appendix or sigmoid colon would be able to detect hydronephrosis, perinephretic stranding, or the calculi themselves.
Bear in mind, however, that several factors could decrease the sensitivity of the scan. An empty bladder can sometimes make it tricky to distinguish between calculi near the bladder and phleboliths. Also, if your husband is thin, that can make it challenging in general for a radiologist to identify inflammation, i.e. diverticulitis, low-grade appendicitis, etc., seen as stranding in intraperitoneal fat. (My dad, a retired radiologist, says that CT is the one area in which your health outcome is positively affected by being overweight.)
Anyway, all I can really suggest is follow-up with your primary care doc or a gastroenterologist- and don’t put too much weight on medical advice offered by anonymous internet posters.
Has he been checked for diverticulitis?
CT is pretty decent for detecting this, provided that the patient has adequately followed the oral prep. Again, easier to see inflammation on heavy people rather than skinny ones. Can’t really comment as to the relative utility of colonoscopy or sigmoidoscopy compared to CT for diagnosis of diverticulitis - that’s getting away from my area of familiarity.
Whew, that’s a lot of information! I appreciate the feedback. I just checked on him and he said the pain is spreading to his lower back and it hurt to pee. So first thing tomorrow I’ll call his urologist and approach it from that angle.
Thanks for your help.
the pain is spreading to his lower back and it hurt to pee
Echoing what xraycharlie said, this is free advice from an internet forum. That being said… Your husband seems to be having symptoms consistent with acute bacterial prostatitis. 2-3 weeks of antibiotics will clear that up.
Best course of action (which it sounds like you’re doing): get in to see his provider! It could be a number of things, and only a good history and exam will tell. Hope he gets better soon.
I’m kinda enjoying the fact that I can tell you more than I’d be allowed to tell a patient at my facility. Ordinarily, I’d just have to refer any and all of your questions to the ordering doc.
Still might be a decent approach in this case. Take everything I say with a few big grains of salt, and find a good doc whom you trust.
Oh, and one other thought - sensitivity of CT for several conditions (especially those involving the urinary system) would depend greatly upon the protocol used - use of IV contrast, acquisition of delayed images, etc. I’m guessing that your husband was probably given IV contrast, as this is a pretty typical protocol, but it’s not universal. (The radiologists at my hospital are of the minority opinion that IV contrast is not necessary for cases of nonspecific abdominal pain.) Urologist might want to do further scanning, depending upon how the one in the ED was done.
Good luck to you both.