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Medical Forum / General / General / August 2005Question about radiologists comments. (What does this mean?)
I had a "Radiology Diagnostic flat and upright or decub ABD" It said: " Air-fluid levels identified throughout nondistented colon. No definite air-fluid levels identified within small bowel and no abnormal distention of small bowel. No organomegaly or pathological calcifications. Skeletal functions within normal limits." "Metallic density overlying gastric air shadow is indeterminant. This could be a foreign body extrinsic to the patient r injested. It measures approximately 9 mm in diameter." Conclusion: 1. The air - fluid levels and nondistented colon could represent laxative or enema use or gastroenteritis. No evidence of obstruction at this time. 2. Radiopaque somewhat curvilineat structure overlying gastric shadow on upright view (This area not included on supline view). This could be artifact extrinsic to patient or ingested item. It measurses 9 mm in greatest diameter. This is I guess an x-ray I had last year. I just got a copy of my medical records and hope to make an appointment with another doctor in a larger town. What exactly does this mean? 'If you want me to explain, make another appointment, and I will happily do so." What? > 'If you want me to explain, > make another appointment, and I will happily do so." > I had a "Radiology Diagnostic flat and upright or decub ABD" > [quoted text clipped - 21 lines] > medical records and hope to make an appointment with another doctor in > a larger town. What exactly does this mean? The image shows gas in your colon. Did you use laxative or enema? If not, it could be inflammation. In your stomach view of standing upright, there is something of 9mm. It could be film artifact or the object that you swallowed. Otherwise, no worry. If you really need to find your abnormality, go for contrast studies -- fluoroscopy. Such as a double-contrast barium enema. What "object I swollowed?" This is funny. This test was done in April of 2004. In may of 2005 I had a Galiuum Scan because of "fever of unknown origion" It has since went away. But I remember the Gallium scan showed something "on my left side next to my diagaphram." I want to say it was 2 centimeters or so. I had a follow up chest ct which was normal. Could this be the 9mm thing they were talking about a year earlier? I have to take milk of magnesia or a tap water enema every day in order to use the bathroom. I usually take it at night. This test I believe was around noon. Whould that have showed up on this as the gas? (I never use stimulant laxatives). > > I had a "Radiology Diagnostic flat and upright or decub ABD" > > [quoted text clipped - 29 lines] > If you really need to find your abnormality, go for contrast studies -- > fluoroscopy. Such as a double-contrast barium enema. > What "object I swollowed?" The radiologist used the term "ingested". I rephrased it for you. > This is funny. This test was done in April of 2004. In may of 2005 I > had a Galiuum Scan because of "fever of unknown origion" It has since [quoted text clipped - 3 lines] > > Could this be the 9mm thing they were talking about a year earlier? It could be artifact. The radiologist didn't identify the same thing in another view, did he? The dictation didn't sound serious to me, so don't worry. > I have to take milk of magnesia or a tap water enema every day in order > to use the bathroom. I usually take it at night. This test I believe [quoted text clipped - 34 lines] >>If you really need to find your abnormality, go for contrast studies -- >>fluoroscopy. Such as a double-contrast barium enema. What does "artifact" mean? > > What "object I swollowed?" > [quoted text clipped - 50 lines] > >>If you really need to find your abnormality, go for contrast studies -- > >>fluoroscopy. Such as a double-contrast barium enema. > What does "artifact" mean? Artifact could be produced by a speck of dust stuck on the film or screen. For the upright abdomen projection, the wall bucky surface could be dirty with something like barium or gastrographin drop. Your gown could be soiled by those contrasts (highly unlikely). The tech used a bad film-screen contact cassette. The film processor messed the film up. > What "object I swollowed?" > [quoted text clipped - 5 lines] > > Could this be the 9mm thing they were talking about a year earlier? Extremely unlikely. It was probably something on the film (dust, tech's thumb, etc). > I have to take milk of magnesia or a tap water enema every day in order > to use the bathroom. I usually take it at night. This test I believe > was around noon. Whould that have showed up on this as the gas? (I > never use stimulant laxatives). That qualifies as laxative/enema overuse. In other words, as the report states, 'The air - fluid levels and nondistented colon could represent laxative or enema use or gastroenteritis. No evidence of obstruction at this time.'  Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather How does laxative use cause this? > > What "object I swollowed?" > > [quoted text clipped - 22 lines] > "Did Father shoot him? I will eat Grandfather for dinner." > - Helen Keller, on learning of the death of her grandfather > How does laxative use cause this? Laxative abuse will "train" the colon, often to the point where it won't work without laxatives. One typical xray finding of an advance state of this condition would be dilatation of the colon with air/fluid levels. It is *so* typical, that a radiologist suggested that diagnosis on the basis of a flat/upright film with almost zero clinical information about you. As we have wound our way throught the saga of your colon over the years, it's clear that laxative abuse through your life is by far the most likely reason for your colon inertia. Don, I thought you had found a surgeon that was going to take your colon out. What ever happened to that? HMc I have only used laxatives for 2 years. Why do you think I have used it "my entire life?" And when I do, it is milk of magnesia, never stimulant laxatives. It is because I can go without it. I have had abnormal transit studies. It just scares the heck out of me having this surgery. The doctors dont even like doing it. Plus, the problems afterward are sometimes worse than the problems you had before. I just want this bloating to go away.... I am only 33 years old and too young to have this problem. I just dont undeerstand. > I have only used laxatives for 2 years. Why do you think I have used it > "my entire life?" And when I do, it is milk of magnesia, never [quoted text clipped - 7 lines] > I just want this bloating to go away.... I am only 33 years old and too > young to have this problem. I just dont undeerstand. Now I can tell why we shouldn't discuss diagnostic results with a patient. One thing I can tell you positively Mr. Stryped that my clinical instructor said to me, "Never ever have any surgery in your alimentary canal. You'll have to go back to your doctor again for more help." Almost all patients of mine who had the Small Bowel Series had had experiences of such surgeries. The major symptom was obstruction. By the way, dairy products such as milk, cheese and so on causes gas in your intestine. Eat a lot of fiber food, drink water, and exercise. > Now I can tell why we shouldn't discuss diagnostic results with a patient. > [quoted text clipped - 6 lines] > By the way, dairy products such as milk, cheese and so on causes gas in > your intestine. Eat a lot of fiber food, drink water, and exercise. Such bullshit. The reason why you shouldn't discuss diagnostic results with a patient is that it is far beyond the scope of your technologist-level training. It's good advice, and you should take it, even when posting anonymously on the internet. HMc >>Now I can tell why we shouldn't discuss diagnostic results with a patient. >> [quoted text clipped - 8 lines] > > Such bullshit. That's a very encouraging word for an X-ray student! > The reason why you shouldn't discuss diagnostic results with a patient is > that it is far beyond the scope of your technologist-level training. > > It's good advice, and you should take it, even when posting anonymously on > the internet. You shouldn't have to. It's all up to the patient. SO such a surgery to remove part of your colon is bad? > SO such a surgery to remove part of your colon is bad? I think that it's usually bad to remove any organ if you don't fully understand the pathologic basis of the problem, and this is especially true of a major abdominal operation and it's potential complications where there is no way to accurately guess at what the ultimate effect will be. If they don't understand the pathology, they can't fully understand what the effect of removing all or part of your colon would be on curing the problem. HMc > > SO such a surgery to remove part of your colon is bad? > [quoted text clipped - 6 lines] > > HMc So. Let me hypothesize here: if a surgeon didn't understand the role statins played in causing my gall bladder disease and pancreatitis, it wouldn't be a good thing to remove my gall bladder? Zee >> > SO such a surgery to remove part of your colon is bad? >> [quoted text clipped - 16 lines] > > Zee Uh huh. Except statins aren't causing your gallbladder disease and pancreatitis - gallstones are. And the pathology of chronic or acute calculous cholecystitis is very well understood. Lame try, Zee. HMc > >> > SO such a surgery to remove part of your colon is bad? > >> [quoted text clipped - 24 lines] > > HMc So now gallstones are causing my gall bladder disease and pancreatitis. But my diseased gall bladder (mit gall stones) isn't gall bladder disease... We've known for some time statins have potential to cause gallstones*. Now we know they have potential to cause pancreatitis. In case you missed it: http://www.joplink.net/prev/20 0507/11.html Zee *http://groups.google.ca/group/sci.med/msg/da3ebf1710361403?hl=en& > So now gallstones are causing my gall bladder disease and pancreatitis. > But my diseased gall bladder (mit gall stones) isn't gall bladder [quoted text clipped - 5 lines] > missed it: > http://www.joplink.net/prev/20 0507/11.html Your gallbladder disease is caused by your gallstones. Removing the gallbladder will cure you of your gallbladder disease. Stopping the statins after your gallstones have formed will have no effect on your gallbladder disease. Now that the stones are there, statins are totally irrelevant to your gallbladder disease, and are totally irrlevant to the cure. Likewise, statins are totally irrelevant to your gallstone pancreatits. Now, if it can be proven that you have *chemical* pancreatitis, whether it's from your use of statins, alcoholism, or your hyperlipemia, and proven *not* to be due to your gallstones, then cholecystectomy shouldn't be done. I grasp the depth of your fixation, and the desperation you feel in your crusade, but this is all really a simple concept that I've explained to you on at least two other occasions. HMc The cite for statin induced pancreatitis. Zee http://www.joplink.net/prev/20 0507/11.html Full text available free, a letter to the editor JOP. J Pancreas (Online) 2005; 6(4):380. Drug Induced Pancreatitis Might Be a Class Effect of Statin Drugs Sonal Singh "Clinicians need to be aware that drug induced pancreatitis might be a class effect of statin drugs and the newest statin, rosuvastatin is as likely to be associated with pancreatitis as the other statins." Evidence and Citations Keywords Anticholesteremic Agents; Pancreatitis; Poisoning; Salicylates References 1.. Antonopoulos S, Mikros S, Kokkoris S, Protopsaltis J, Filioti K, Karamanolis D, Giannoulis G. A case of acute pancreatitis possibly associated with combined salicylate and simvastatin treatment. JOP. J Pancreas (Online) 2005; 6:264-8. 2.. Singh S, Nautiyal A, Dolan JG. Recurrent acute pancreatitis possibly induced by atorvastatin and rosuvastatin. Is statin induced pancreatitis a class effect? JOP. J Pancreas (Online) 2004; 5:502-4. 3.. AstraZeneca. Rosuvastatin product information. AstraZeneca Pharmaceuticals LP 08/2003. ~~~~~~~~~~~~ > >> > SO such a surgery to remove part of your colon is bad? > >> [quoted text clipped - 24 lines] > > HMc > The cite for statin induced pancreatitis. Zee > [quoted text clipped - 13 lines] > to > be associated with pancreatitis as the other statins." Totally irrelevant to the discussion regarding gallstones. A surgeon would not remove your gallbladder for drug or chemical induced pancreatitis. HMc > > The cite for statin induced pancreatitis. Zee > > [quoted text clipped - 18 lines] > > HMc COMMENT: Not only that, but this whole argument that statins cause pancreatitis is based on reports of TWO patients who got pancreatitis while taking one statin, then later got pacreatitis again while taking another. Duh. I've got a newsflash: pancreatitis happens often enough that every doctor has seen at least dozens and probably hundreds of cases, and it's more common in the kind of people who take statins (obese diabetics with high triglycerides-- who are also--- surprise the people who make gallstones). If you've been on one statin, your doctor is likely to switch you to another, if something funny happens. But now the rub: people who've had one bout of pancreatitis are likely to have another one, and that was true before statins were invented. And if they do these days, they'll still be on that second statin. What do you do then? Why, blame the whole CLASS of drugs, apparently. On the basis of N=2 patients. Sweet. And I suppose if they stopped the statins altogether in favor of another anticholesterol drug, and the patient got pancreatitis *again,* they could hypothesize a general "anti-cholesterol drug pancreatitis." >From there we go to an "general medication pancreatitis", a "hospitalization pancreatitis," and "fengshuious pancretitis" cause by bad couch placement and bad window treatments, and finally (if necessary) a terraneo-pancreatitis, caused by the gross effects of living on this imperfect orb. That's a toughie, because your control group has to be in orbit. SBH > I have only used laxatives for 2 years. Why do you think I have used it > "my entire life?" And when I do, it is milk of magnesia, never [quoted text clipped - 7 lines] > I just want this bloating to go away.... I am only 33 years old and too > young to have this problem. I just dont undeerstand. I asked you some time back about consulting a registered dietician. Since it appears the docs find nothing organically wrong, it would be a very sensible, and probably helpful, approach. You are too young to be a chronic worrier or chronic laxative user if not absolutely necessary. Sooooo.....what happens if you get bloated? You also mentioned that you have a new baby, I believe. Enough stress in this whole situation to constipate anyone. Your gut can become physically dependent on laxative, so it is a good idea to try something else. What normally acts as a laxative, can, for some people, have a reverse effect (caffeine). I have known marvelous dieticians who have very definite and positive knowledge that the rest of us do not seem endowed with, including practical methods of making good changes. As for the defect on the xray, call the radiologist and see if he will repeat the film if you are worried. Also ask HIM your question about comparing the previous film. This ain't the place! > As for the defect on the xray, call the radiologist and see if he will > repeat the film if you are worried. Also ask HIM your question about > comparing the previous film. This ain't the place! Oh, yeah, the film could've been taken by an x-ray student or even by a tech's assistant and sent for reading without his or her tech's approval. I soemtimes even wake up this way. > I had a "Radiology Diagnostic flat and upright or decub ABD" > [quoted text clipped - 21 lines] > medical records and hope to make an appointment with another doctor in > a larger town. What exactly does this mean? It means: "We see many impending farts. Also funny shadow we can't identify which may be nothing. Need second X-ray to see if it's real." SBH >> Conclusion: >> [quoted text clipped - 9 lines] > It means: "We see many impending farts. Also funny shadow we can't > identify which may be nothing. Need second X-ray to see if it's real." Oh my God!!!! Not the farts! This is a potentially lethal event... for anyone around you. SignatureMortimer Schnerd, RN mschnerd@carolina.rr.com.REMOVE Would a colon that does not work cause this "accumulation" of gas? Wouldnt my chest ct scan have shown something if it was there? I had one a year later. > Would a colon that does not work cause this "accumulation" of gas? It's normal to have some gas or air in the alimentary canal. But if you have excessive gas, you have a blockage. It is serious. > Wouldnt my chest ct scan have shown something if it was there? I had > one a year later. The lungs are the major air organ. You must be able to see air not fluid. What do you mean? I could have a blockage? I meant wouldnt the ct scan showed the 9mm "spot" if it was truly something other than an wrror in the film? It means: normal abdominal x-ray for a person with chronic laxative/enema abuse. The rest is blah blah blah. ray > I had a "Radiology Diagnostic flat and upright or decub ABD" > [quoted text clipped - 21 lines] > medical records and hope to make an appointment with another doctor in > a larger town. What exactly does this mean? What terms abuse? I have to have it becasue of slow colon motility. (Under doctors orders). > It means: normal abdominal x-ray for a person with chronic > laxative/enema abuse. The rest is blah blah blah. [quoted text clipped - 26 lines] > > medical records and hope to make an appointment with another doctor in > > a larger town. What exactly does this mean? > What terms abuse? I have to have it becasue of slow colon motility. > (Under doctors orders). Or, you have slow colon motility because of laxative abuse. HMc > Or, you have slow colon motility because of laxative abuse. Do small regular doses of psyllium powder laxatives, like Metamucil, cause or contribute to slow colon motility? Or is the effect the same as simply eating more fibre? Metamucil claims: "Fiber supplements may be taken on a long-term basis to help supplement your diet." moo >> Or, you have slow colon motility because of laxative abuse. > [quoted text clipped - 4 lines] > > moo Psyllium or other fiber agents aren't laxatives - their purpose to not to stimulate colon activity, but to prevent constipation by adding bulk to the stool and softening it by allowing it to attract more water, thereby allowing the colon to work normally. Small, hard, dehydrated stools (constipation) do not allow the colon (sigmoid colon and rectum especially) to work normally, and increase sigmoid segmentation pressures. Such small hard stool is not sufficient to generate a mass movement - the patient compensates by using some kind of stimulating laxative and ultimately the colon becomes dependant -> vicious cycle. The use of fiber agents is different than abuse of irritant laxatives, or the abuse of osmotic laxatives (MOM), or the abuse of enemas - all of which can be contributing factors in developing colon inertia. These factors are especially likely when colon inertia develops later in life and intrinsic colon pathology is ruled out. HMc But this problem developed "before" I ever used laxatives. Plus, I thought that MOM was safe becasue it does not contain stimulant. That is at least what the gastroenterologist led me to believe. > > What terms abuse? I have to have it becasue of slow colon motility. > > (Under doctors orders). > > Or, you have slow colon motility because of laxative abuse. > > HMc > But this problem developed "before" I ever used laxatives. > > Plus, I thought that MOM was safe becasue it does not contain > stimulant. That is at least what the gastroenterologist led me to > believe. Milk of Magnesia is a hyperosmotic laxative. It functions by osmotically pulling water into the colon, distending it, and stimulating it to contract. A colon can become dependant on that stimulation in order to function. HMc |
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