Suggest Treatment For Abdominal Pain With History Of Heart Attack

Posted on Thu, 30 Oct 2014

Question: My mother is 80 year old was taken to Hospital had miner heart attack Angiogram was done after two days with balloon blockage was done but the pain in Abdominal region EGR is worse she was admitted on 18th and today is 6th/Oct she is on morphine pain is as soon she takes even water Jello in 22 days she has hardly had anything to eat the endoscopy is done is done Cat scan is done plus Ultrasound is done the only diagnosis she has thickening of the abdomen in EGR part of stomach what should be done next to do to find whats wrong.pl.help she has multiple Health issues Adiabatic.Heart Patient Retorted Arthritis Dr today said they will do Barium-meal X-ray

Answered by Dr. Ahmad Nazzal (1 hour later)

Brief Answer:
Abdominal Angina - Bowel ischaemia

Detailed Answer:
Dear XXXXXX,

Thank you for your question, I have carefully read your query and will try to help you here.
Doctors were right in doing an ultrasound and Cat scan her abdomen I guess they ruled out the possibility of aortic aneurysm.

Since your mom is diabetic, plus had a heart attack soon, It is important to rule out Abdominal angina or even bowel infraction scenario. Heart attack can cause changes in intestinal arteries which leads to pain. Symptoms like pain after eating, postprandial pain, usually it is a hard diagnosis to make since on palpation pain is not prominent and usually pain is out of proportion compared to physical examination, but history of diabetes plus long time not eating is suggestive, please ask the doctors to check the CT scan in case of bowel infarct CT may show gas in various ectopic places such as bowel wall (pneumatosis intestinalis) or portal vein, bowel wall.

Barium meal x ray is used to rule out any obstruction in digestive tract hence doctor ordered for it.

For my patients I order for Angiography which is the gold standard and shows arterial blockage due to emboli or thrombus. Duplex ultrasound but diagnosis can also be easily missed.

If it is due to blockage then for management no medications are available for treatment, Surgical management is the criterion standard for treatment of this disease. Surgery here is endovascular opening of the occluded arteries.

If possible kindly upload reports.

Please discuss this possibility with your doctors, and hope this will help in the deferential diagnosis of your mom's problem. hope she will get better soon.

Best regards,
Dr. Ahmad

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Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju