Answer needed for Stomach Pain

[Susan615]

My father is 82 and just underwent a rather urgent 7 bypass surgery.  He is in extremely good health overall and takes very good care of himself.  He has inherited heart disease and luckily has prolonged his life by his great lifestyle.  Before the surgery he complained of stomach pain, bloating, belching.  The docs said it was his heart.  He also mentioned it to them several times in the hospital.  He had a big set back and had to have a CT and they noted fluid around his gallbladder.  Finally they did an ultrasound which was normal and he just had a colonoscopy which was normal however he was said to be aneimic and there was blood in his stool.  He still says he feels bloated, has pain, and belching.  This occurs mostly in the morning.  They said they might do a HIDA scan.  This is interfering with his recovery from his heart surgery and I feel like no one is taking him seriously.  He has surgery in early Nov.  He has had this stomach issue for over a year and it is getting worse.  He is miserable.

[Susan615]

Thanks!  Maybe that is what he is thinking.  He threw out a lot of terms and I only picked up a few.  Dad did have ischemic colitis before.  The x-ray is to be done soon so maybe I will know more.  They did tell him during his heart bypass that he had a narrowing of an artery to his kidneys.  The GI called him a vaco-path.  Meaning people who have narrowing of arteries in one place are likely to have them in others.

[CalGal]

Susan, the mesenteric arteries supply the small and large intestines, and blockages of those arteries can produce a wide range of symptoms - depending on what is blocked.  Typically, it means that the artery or arteries have blockages and the organs they're feeding are being compromised. I'm not sure where the anemia would fit in, but I may be missing something that should be obvious. Your doc may have ordered the small bowel x-ray to look for any 'gross' changes in the structure of the GI tract. That test can sometimes give indications that might be overlooked on another test.

The typical 'differential' would include ruling out the possibility of ischemic colitis (vs. the mesenteric ischemia), but I assume that was done at the time of the colonoscopy.

But I wonder if the doc might be thinking superior mesenteric artery syndrome? It's not exactly ischemia. It's where the SMA gets 'scrunched' in an area of the 4th portion of the duodenum - it narrows or constricts the SMA and it may produce symptoms similar to the ones your father is having. It's possible that's why the doc wants to do the x-rays. It's often easier to pick up during an x-ray.

[Susan615]

OK, surgeon says no surgery.  GI doc ordered endoscopy.  Now he thinks this might be mesenteric ischemia?  He says he is losing large red blood cells for his type of anemia.  He is still having the morning pain, bloating, and cannot function until late in the day.  He had been told when they diagnosed the heart trouble that he had a blockage in the kidney artery as well but they would address that later.  Could this be a blockage to his small intestine or at least a narrowing?  They have ordered a small bowel x-ray but he said an MRA would for sure tell.  Why not do the MRA?  He did find gastritis and they did 2 biopsies.  Just wondering where this is leading.

[Susan615]

I guess he can't see a surgeon until March 3!!  I know they are all busy but it sure seems to be taking a long time to get this solved.  They didn't tell him  anything about his results either and said they would discuss it at the appointment.  He does see his cardio next week so at least they can discuss it and get his opinion.  In the meantime I guess he is just going to have to be sick every day. :(

[CalGal]

Do check with the cardiologist. All 'bases' need to be covered before surgery is considered. Make sure to check out why to doc says the GB has to be removed - there's needs to be a specific reason - stones, sludge or severely reduced ejection fraction, etc. A small decrease in EF does not warrant surgery.

[Susan615]

Well Hida scan syas gallbladder needs to come out.  Doc did not givge details about the injections(??) rate or anything.  He just said he needed ot see a surgeon.  He said his other blood work came out OK and the gallbaldder would be causing the stomach problems but not his severe fatigue.  The surgeopn will call with an appointment time.  I wonder if his cardiologist should be consulted?  Can he have another surgery so soon after such a big heart opertation??

[Susan615]

Thanks again.  It has been great to have this way to get your views and frankly it just feels better to have someone to talk to about it who understands and your suggestions of things to think about and do really help.   Hopefully next week we will have some answers.

[CalGal]

It sounds as if the tech is suggesting that something that was seen on the HIDA scan is 'saying' there's a greatly decreased ejection fraction which could mean the gallbladder needs to come out. Do make sure that little-to-no fat is eaten.

Make sure you get a copy of the pathology report on the colonoscopy and the doc's written report and read it Just because nothing is specifically stated doesn't mean the report might not contain 'something' that should be discussed.

[Susan615]

Well, Hida scan was done.  No results yet but doc ordered more blood tests.  He asked the tech if things were normal and of course she said she couldn't tell him b/c she wasn't a doctor and could get in trouble.  He said he understood.  She did say she had an "opinion" and she asked if they had said anything about surgery that day.  He said no and she advised he not eat a greasy meal until he heard results.  That was on Friday so I am sure he won't get anything until next week.  He was so weak and uncomforttable this morning he could hardly get out of bed.  They did do random biopsies in the colonoscopy but they didn't make a deal of it so I am sure they are normal.  Told him about the probotics and he is taking imodium.  Any other ideas?
Thanks!

[CalGal]

No, no prescription needed. Just call the drugstore and find out which one carries them.

They probably tested him for C. diff, it's a nasty little bacteria that we all carry, but when you're on antibiotics they can kill off a lot of the good bacteria that keeps the C. diff in check and it 'blooms', causing on heck of a problem. I'm glad he didn't have that.

[Susan615]

Thanks so much!  I know they originally thought he had something that occurs when you have had too many IV antibiotics but they tested for it twice and it was normal.  He has had prostate cancer and I know he is concerned about it being cancer.

  Do the probotics need a prescription?

[CalGal]

Have the docs do a quick and easy H. pylori test to see if it's possible that part of the problem could be acid reflux issues. The symptoms of acid reflux and of gallbladder issues can be very similar. He should also have the HIDA scan to check out issues with his GB.

If he's been on a lot of antibiotics, you may want to consider asking him to try some probiotics - they're the good bacteria that should be in a person's GI system but may not be due to illness and medication use. There are some great brands on the market some of which include Culturelle, Digestive Advantage-IBS (not just for IBS), and FloraQ.