Brief Answer:
Contrast enhanced CT abdomen and pelvis with oral, rectal and IV contrast

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in detail.
Please find my observations below.

1. It is probable that gall stones are causing her abdominal discomfort if there are multiple stones in gall bladder. It is said that a single stone in gall bladder measuring up to 10 mm can be left alone if not causing symptoms. Any gall bladder stones causing symptoms is recommended for surgical treatment.

2. For CT scan, I recommend a CECT (contrast enhanced CT) of abdomen and pelvis with oral, rectal and IV contrast. This will show any suspected abnormality which might be causing abdominal pain and discomfort.

3. A serum creatinine test is required before doing the CT scan with IV contrast and is a standard protocol every where.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,

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Brief Answer:
Oral and rectal contrast will give better information on bowel

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. The oral contrast is given to know about any problems in the lumen of the large bowel. Similarly the rectal contrast will show any problem area in large bowel. Therefore doing a CT scan of abdomen and pelvis with oral, rectal and IV contrast will give complete information of the bowel. In the elderly, evaluation of bowel is important for any pain in the abdomen.

2. The oral contrast is a medicine that is mixed with juice and the patient is asked to drink it slowly over 1 to 2 hours to enable it to reach the small bowel.

3. The rectal contrast is given through the rectum before doing the CT scan. It does not cause any pain and a thin tube is used.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,

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Brief Answer:
Features suggest uncomplicated gall bladder stones

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. I have read through the attachments of ultrasound scan. It shows multiple stones and largest is 12 mm in diameter. This size of stone can cause the upper abdomen pain which she had. Everything else seems alright in report. The CBD is 4 mm and is normal. A significantly increased CBD is seen if there is complication. The wall thickness is normal and therefore there is no inflammation.

However there was lot of gas in the abdomen and this caused sub optimal evaluation in the para aortic area. If your doctor suggests then a CT scan abdomen can be done to see these areas in detail.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,

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Brief Answer:
There is small umbilical hernia and weak bones and chest shows age changes

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. The CT scan abdomen shows following points
(i) Small hernia in the umbilicus which is usually seen in elderly people who are over weight. It happens due to weakness of the abdominal wall. In the report it is written as small hernia and therefore does not require any treatment.

(ii) The bones are showing decreased mineralisation and degenerative changes and for this you can give her calcium supplement and vitamin D to protect the bones.

2. The chest x ray shows the heart is having mild prominence if left ventricle and this is a common finding in elderly who have hypertension for years. The lungs are showing changes expected in aged people. The right dome of diaphragm is slightly domed and this is not a significant problem. It can be a variation of normal. There is nothing to worry in the chest x ray.

3. Gall bladder stones are not seen in CT scan probably because cholesterol stones have formed. These type of stones cannot be seen on CT scan and the doctor has not mentioned about it in the report. However stones are there which were seen on ultrasound scan.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,

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