Dr. Ajeet Kumar
Medical Gastroenterology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am in my late sixties. I have a body height of six feet one inches and a body weight of 181 lbs. I have abdominal pain on the right side under the rib cage that worsens after eating. There is also back pain under the rib cage that occurs immediately after eating. I also have daily morning indigestion, itchy skin, swollen glands under the jaw (both sides). All these symptoms I have been experiencing for five months now. I have lost 15 lbs of body weight in the last four months.
I also have a history of GERD. I also got the upper endoscopy done around four weeks back in which gastritis was found.
I am taking the tablet Omeprazole 40 mg, the tablet Metoprolol, the tablet Losartan and the tablet Famotidine 40 mg. Earlier, I also used to take the tablet Nexium.
Hello,
Welcome to icliniq.com.
The site of pain suggests that it is of gas distension of the stomach, that can occur in this age group. Plus some overweight probably is causing this. If it was ulcer-related then the tablet Omeprazole would have definitely helped.
Your ultrasound abdomen is also unremarkable (attachments removed to protect the patient's identity), which again suggests that it is not liver or gall bladder related.
I want you to start an antibiotic for a duration of three weeks to help control the gas production within the small bowel.
Take the tablet Rifaximin (antibiotic) 200 mg thrice daily for three weeks, the tablet Motilium (Domperidone) 10 mg thrice daily half an hour before meals for the same duration.
Also, continue with your current medications.
Looking at your age, I want you to undergo a screening colonoscopy.
Colonoscopy is recommended in every individual of 50 years and above.
Patient's Query
Hi doctor,
Thanks for suggesting the colonoscopy.
I got an upper endoscopy done a few weeks back which suggested gastritis. There was no explanation for the daily morning indigestion, nor for the upper right back pain that worsens after eating. Three other symptoms present are weight loss, frequent itching, and swollen neck glands. All of these are preceded by several months of acid reflux. I got the ultrasound done in search of information regarding the pancreas. My fear is a tumor of the pancreas. Since the pancreas is partly obscured in the ultrasound, we hope to schedule an endoscopic ultrasound. Last week, quite a bit of blood tests were done, some of them relating to the pancreas. The test results are available.
At this point, even before the EUS, can you suggest other conditions that might cause these symptoms? In other words, should I worry about the pancreatic possibility?
Hi,
Welcome back to icliniq.com.
Yes, the pancreas can be a possibility. Again, age is one of the single risk factors for it.
How much weight you have lost? If you have lost more than 10% of your baseline weight in the last six months, then it is mandatory to get a CT (computed tomography) scan abdomen done for pancreatic cyst or tumor.
Endoscopic ultrasound and colonoscopy are equally as important as a CT scan abdomen with the pancreatic protocol.
Patient's Query
Hi doctor,
Around three to four months back, my bodyweight was 195 lbs but now it is now 180 lbs.
Are there other possibilities besides the pancreas?
Hello,
Welcome back to icliniq.com.
If you continue to lose weight then it is significant, otherwise, it is not uncommon to have 15 pounds change in weight due to low oral intake, hospital admission when you feel symptoms on a fed stomach and normally avoid taking full calories in the diet in a day.
Your ultrasound is satisfactory in terms of the liver, gall bladder, and other organs. If it were anything serious with them, it probably would have shown there but the ultrasound has its own limitations. Its window of vision and operation is too narrow, meaning it can miss things easily and is largely user-based.
A CT (computed tomography) scan, however, is much reliable and accurate test of investigation for looking at abdominal problems particularly when looking for cancers, so my recommendation is to go for a CT scan abdomen with pancreatic protocol first. This will give us a 360-degree review of your abdomen.
The other possibilities are many, which is because there are many organs in the abdomen such as retroperitoneal structure, lymph nodes, vessels, and pancreas which are easily missed on ultrasound and can easily be found on CT scan abdomen. Although Ultrasound helped enough to rule out the common diseases of other viscera such as liver, kidney, spleen.
I hope this will help.
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Medical Gastroenterology
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