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53 Y.o. Caucasian Male. Morbidly Obese With Mild Hypothyroidism &
Question: 53 y.o. Caucasian male. Morbidly obese with mild hypothyroidism & prehypertension; excellent labs otherwise (excellent cholesterol levels, glucose @ fasting 85, et.)
Developed lower left flank pain, more anterior than posterior x 5 days. At times, pain is almost debilitating, then eases or completely subsides. Relief seems to come from finding ways to expend gas.
Area is not painful to the touch. There is no associated groin pain, no sense of nausea, no diarrhea, no fever.
There is a constant feeling of dry mouth/thirst. No urine flow obstruction or increased/decreased sense of urgency to urinate.
Appetite is normal.
Frequently used Rx includes: -60mg Duloxetine 1x daily for peripheral nerve pain (developed after multiple surgeries following an injury & subsequent treatment for MRSA),
-20mg Lisinopril 1x daily for prehypertension.
-ProAir HFA as needed.
-15mg Oxybutynin 1x daily, not regularly used.
-100mg Gabapentin up to 3x daily, also not regularly used.
-OTC generic pain relief containing Acetaminophen, Aspirin & Caffeine.
-Occassional multi vitamin.
Thoughts?
Thank you in advance.
Developed lower left flank pain, more anterior than posterior x 5 days. At times, pain is almost debilitating, then eases or completely subsides. Relief seems to come from finding ways to expend gas.
Area is not painful to the touch. There is no associated groin pain, no sense of nausea, no diarrhea, no fever.
There is a constant feeling of dry mouth/thirst. No urine flow obstruction or increased/decreased sense of urgency to urinate.
Appetite is normal.
Frequently used Rx includes: -60mg Duloxetine 1x daily for peripheral nerve pain (developed after multiple surgeries following an injury & subsequent treatment for MRSA),
-20mg Lisinopril 1x daily for prehypertension.
-ProAir HFA as needed.
-15mg Oxybutynin 1x daily, not regularly used.
-100mg Gabapentin up to 3x daily, also not regularly used.
-OTC generic pain relief containing Acetaminophen, Aspirin & Caffeine.
-Occassional multi vitamin.
Thoughts?
Thank you in advance.
Brief Answer:
Very likely Diverticulitis.
Detailed Answer:
Hello and thanks for choosing 'Ask a Doctor ' service for your query.
Lower left flank pain the first and the foremost differencite diagnosis is diverticulitis.
Diverticulitis is a condition of the colon in which small inflammaed pouches are formed. In diverticulosis, the wall of the large intestine develops weak spots which bulge outward to form little pockets, which are called diverticula. When these diverticula become inflamed or infected, it is called diverticulitis. Diverticulosis and diverticulitis are together known as diverticular disease.
Advice
Get a CT abdomen done if not possible minimum ultrasonogram of abdomen should be done
Get a stool test done to check for bacterial and protozoal infection.
Depending on the reports you would either be kept on injectible antibiotics like clindamycin and metronidazole followed by oral therapy for a minimum of 2weeks.
In case you can buy antibiotics without prescription start taking Ciprofloxacin 500 mg twice daily with Metronidazole 400 mg thrice daily orally till reports are available.
In case you can't then get an anti inflammatory medicine like ibuprofen (over the counter) for symptomatic relief in pain.Acetaminophen won't help much.
Hope I was helpful,
Follow ups are welcome,
Regards!
Very likely Diverticulitis.
Detailed Answer:
Hello and thanks for choosing 'Ask a Doctor ' service for your query.
Lower left flank pain the first and the foremost differencite diagnosis is diverticulitis.
Diverticulitis is a condition of the colon in which small inflammaed pouches are formed. In diverticulosis, the wall of the large intestine develops weak spots which bulge outward to form little pockets, which are called diverticula. When these diverticula become inflamed or infected, it is called diverticulitis. Diverticulosis and diverticulitis are together known as diverticular disease.
Advice
Get a CT abdomen done if not possible minimum ultrasonogram of abdomen should be done
Get a stool test done to check for bacterial and protozoal infection.
Depending on the reports you would either be kept on injectible antibiotics like clindamycin and metronidazole followed by oral therapy for a minimum of 2weeks.
In case you can buy antibiotics without prescription start taking Ciprofloxacin 500 mg twice daily with Metronidazole 400 mg thrice daily orally till reports are available.
In case you can't then get an anti inflammatory medicine like ibuprofen (over the counter) for symptomatic relief in pain.Acetaminophen won't help much.
Hope I was helpful,
Follow ups are welcome,
Regards!
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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