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Suggest Treatment For Lower Left Flank Pain

Posted on Fri, 17 Feb 2017

Question: I have a question. I have a lower left flank pain, lower left back pain and pelvic twinges. Whn I sit I feel like there is something in my lower ab or pelvic area.

Answered by Dr. T Chandrakant (1 hour later)

Brief Answer:
As detailed below.

Detailed Answer:
Hi.
Thanks for your query.
To recapitulate: Male/42 - lower left flank pain - lower left back pain - pelvic twinges - feel something in lower lower ab or pelvic area on sitting...
The commonest causes for such a problem can be as follows:
Left ureteric stone or stricture
Left sided colitis
Left Hydronephrosis

This can be easily diagnosed by the following preliminary things:
Clinical evaluation and examination
Ultrasonography of the abdomen
Tests of stool, urine and blood

Once diagnosed the treatment is specific for the cause found.
I hope this answer helps you to get an early diagnosis and proper plan of management.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. T Chandrakant (1 hour later)

XXXXXXX 4 i went to er and was diagnosed with colits they put me on two antibiotics when i went they said that I had inflammation in my intestine so the medication was to clear that up but I still have that flank pain and the lower left pain and it's almost like a burning twinge not consistent that comes and goes in the pelvis area

Answered by Dr. T Chandrakant (7 minutes later)

Brief Answer:
pl post reporys.

Detailed Answer:
Was ultrasound or any other investigations done?
Please post reports.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. T Chandrakant (55 minutes later)

CT Scan was done and

Summary of Care: 1/3/17 - 1/3/17 | Florida Hospital Altamonte
CLAUDE XXXXXXX
Race: Black or XXXXXXX XXXXXXX | Ethnicity: Not Hispanic or Latino | Gender: Male | DOB: July 24, 1974 | Language: eng
Patient IDs: 0000
Encounter
Vital Signs
Problem List
Allergies, Adverse Reactions, Alerts
Medications
Results
Immunizations
Procedures
Social History
Assessment and Plan
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Encounter
FH FIN 0000 Date(s): 1/3/17 - 1/3/17
Florida Hospital Altamonte 601 E. Altamonte Drive Altamonte XXXXXXX FL 32701- US (407) 303-2200
Discharge Diagnosis: Colitis
Final: Noninfective gastroenteritis and colitis, unspecified
Discharge Disposition: Home - 01
Attending Physician: Pierson PAC, XXXXXXX R.
Admitting Physician: Pierson PAC, XXXXXXX R.
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Vital Signs
Most recent to oldest [Reference Range]:     1
Temperature Oral [96.4-99.1 DegF]     97.9 DegF
(1/3/17 2:43 PM)
Respiratory Rate Spontaneous [14-20 br/min]     16 br/min
(1/3/17 2:43 PM)
Blood Pressure [90-150/60-90 mmHg]     129/97 mmHg
(1/3/17 2:43 PM)
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Problem List
No Known Problems
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Allergies, Adverse Reactions, Alerts
Substance     Reaction     Severity     Status
sulfa drugs     Unknown          Active
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Medications
ciprofloxacin 500 mg oral tablet
1 tab, PO, BID, # 20 tab, 0 Refill(s)
Start Date: 1/3/17
Stop Date: 1/13/17
Status: Ordered
Flagyl 500 mg oral tablet
1 tab, PO, q12h, # 20 tab, 0 Refill(s)
Start Date: 1/3/17
Status: Ordered
predniSONE 10 mg oral tablet
3 tab, PO, qDay, # 30 tab, 0 Refill(s)
Start Date: 1/3/17
Status: Ordered
Robaxin-750 oral tablet
1 tab, PO, BID, 0 Refill(s)
Start Date: 1/3/17
Status: Ordered
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Results
Patient Viewable Results
Most recent to oldest [Reference Range]:     1
WBC [4.40-10.50 10*3/uL]     12.64 10*3/uL
*HI*
(1/3/17 11:40 AM)
RBC [4.00-5.65 10*6/uL]     4.69 10*6/uL
(1/3/17 11:40 AM)
Hgb [12.6-16.7 g/dL]     13.5 g/dL
(1/3/17 11:40 AM)
Hct [36.9-48.5 %]     41.7 %
(1/3/17 11:40 AM)
MCV [82.4-99.3 fL]     88.9 fL
(1/3/17 11:40 AM)
MCH [27.5-34.1 pg]     28.8 pg
(1/3/17 11:40 AM)
MCHC [31.7-36.1 g/dL]     32.4 g/dL
(1/3/17 11:40 AM)
RDW [11.4-14.9 %]     11.9 %
(1/3/17 11:40 AM)
Platelet Count [139-361 10*3/uL]     249 10*3/uL
(1/3/17 11:40 AM)
MPV [9.7-12.5 fL]     9.4 fL
*LOW*
(1/3/17 11:40 AM)
Neutrophils [50.0-70.0 %]     75.8 %
*HI*
(1/3/17 11:40 AM)
Lymphocytes [20.5-45.0 %]     18.7 %
*LOW*
(1/3/17 11:40 AM)
Monocytes [1-15 %]     5.3 %
(1/3/17 11:40 AM)
Eosinophils [0-5 %]     0.0 %
(1/3/17 11:40 AM)
Basophils [0-2 %]     0.2 %
(1/3/17 11:40 AM)
Abs Neutrophil Cnt [1.50-7.50 10*3/uL]     9.53 10*3/uL
*HI*
(1/3/17 11:40 AM)
Abs Lymphocyte Cnt [1.00-4.80 10*3/uL]     2.36 10*3/uL
(1/3/17 11:40 AM)
Abs Monocyte Cnt [0.00-0.80 10*3/uL]     0.67 10*3/uL
(1/3/17 11:40 AM)
Abs Eosinophil Cnt [0.00-0.50 10*3/uL]     0.00 10*3/uL
(1/3/17 11:40 AM)
Abs Basophil Cnt [0.00-0.20 10*3/uL]     0.02 10*3/uL
(1/3/17 11:40 AM)
Sodium Lvl [135-145 mmol/L]     138 mmol/L
(1/3/17 11:40 AM)
Potassium Lvl [3.5-5.0 mmol/L]     4.1 mmol/L
(1/3/17 11:40 AM)
Chloride Lvl [98-110 mmol/L]     98 mmol/L
(1/3/17 11:40 AM)
CO2 Lvl [24-32 mmol/L]     26 mmol/L
(1/3/17 11:40 AM)
AGAP [5-20 mmol/L]     18 mmol/L 1
(1/3/17 11:40 AM)
Glucose Lvl [70-100 mg/dL]     104 mg/dL
*HI*
(1/3/17 11:40 AM)
BUN Lvl [5-25 mg/dL]     18 mg/dL
(1/3/17 11:40 AM)
Creatinine Lvl [0.60-1.20 mg/dL]     1.31 mg/dL 2
*HI*
(1/3/17 11:40 AM)
GFR Non Afr Amer by MDRD [>60 zzzmL/min/{1.73_m2}]     >60 zzzmL/min/{1.73_m2}
(1/3/17 11:40 AM)
GFR XXXXXXX Amer by MDRD [>60 zzzmL/min/{1.73_m2}]     >60 zzzmL/min/{1.73_m2}
(1/3/17 11:40 AM)
Calcium Lvl [8.5-10.5 mg/dL]     9.1 mg/dL
(1/3/17 11:40 AM)
Total Protein Lvl [6.5-8.0 g/dL]     8.2 g/dL
*HI*
(1/3/17 11:40 AM)
Albumin Lvl [3.2-5.5 g/dL]     4.6 g/dL
(1/3/17 11:40 AM)
Globulin Lvl [1.9-3.9 g/dL]     3.6 g/dL
(1/3/17 11:40 AM)
A/G Ratio [1.1-2.2]     1.3
(1/3/17 11:40 AM)
Bilirubin Total [0.1-1.5 mg/dL]     0.7 mg/dL
(1/3/17 11:40 AM)
Alk Phos [14-127 units/L]     73 units/L
(1/3/17 11:40 AM)
ALT [4-51 units/L]     34 units/L
(1/3/17 11:40 AM)
AST [5-46 units/L]     28 units/L
(1/3/17 11:40 AM)
UA Color [YELLOW]     YELLOW
(1/3/17 11:40 AM)
Ur Clarity [CLEAR]     CLEAR
(1/3/17 11:40 AM)
UA Spec Grav [1.005-1.030]     1.018
(1/3/17 11:40 AM)
UA pH [5.0-8.5]     5.0
(1/3/17 11:40 AM)
UA Albumin [NEGATIVE]     NEGATIVE
(1/3/17 11:40 AM)
UA Glucose [NEGATIVE]     NEGATIVE
(1/3/17 11:40 AM)
UA Ketones [NEGATIVE]     NEGATIVE
(1/3/17 11:40 AM)
UA Bile [NEGATIVE]     NEGATIVE
(1/3/17 11:40 AM)
UA Blood [NEGATIVE]     NEGATIVE
(1/3/17 11:40 AM)
UA Nitrite [NEGATIVE]     NEGATIVE
(1/3/17 11:40 AM)
UA Urobilinogen [NORMAL]     NORMAL
(1/3/17 11:40 AM)
UA Leuk Est [NEGATIVE]     NEGATIVE
(1/3/17 11:40 AM)
Urinalysis Comment     FURTHER MICROSCOPIC ANALYSIS NOT INDICATED.
(1/3/17 11:40 AM)
1Result Comment: Anion Gap is calculated as follows:
(Sodium + Potassium) - (Chloride + CO2)
Hypoalbuminemia can mask a mildly increased
anion gap. For every gram of decreased albumin
there is a 2.5 mmol decrease in the gap
2Result Comment: Results are standardized to the internationally
referenced IDMS (Isotope Dilution Mass Spectrometry)
methodology effective 12/18/07.
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Immunizations
No data available for this section
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Procedures
No data available for this section
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Social History
Social History Type     Response
Smoking Status     Current some day smoker
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Assessment and Plan
No data available for this section

Details
Document Created
January 26, 2017
Encounter Date
From January 3, 2017 to January 3, 2017
Care Team XXXXXXX Pierson, PAC
Tel: (407)875-0555
500 WINDERLEY PLACE
STE 115
MAITLAND, FL 32751-

Follow up: Dr. T Chandrakant (52 minutes later)

i attached labs

Answered by Dr. T Chandrakant (20 minutes later)

Brief Answer:
CT report please

Detailed Answer:
Hi.
What was the report of CT scan - this is the most important.
Get review tests to see whether the raised WBC, Neutrophils and Creatinine and other levels have come back to normal or not.
If there is colitis and not much effect after medical management, get a reference for a Gastroenterologist and get further evaluation, examination, colonoscopy and biopsy done.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. T Chandrakant (31 minutes later)

Document info
Result type: CT Abdomen/Pelvis w/ Contrast
Result date: XXXXXXX 03, 2017, 01:43 p.m.
Result status: authenticated
Performed by: XXXXXXX Sauls
Verified by: XXXXXXX WELDEN
Modified by: XXXXXXX WELDEN
Accession number: 00000CT0000
CT Abdomen/Pelvis w/ Contrast
Patient: XXXXXXX , CLAUDE DOB: Jul 24, 1974
Report
EXAM: CT ABDOMEN AND PELVIS WITH IV CONTRAST

INDICATION: 42-year-old male with left lower quadrant abdominal pain and
constipation.

COMPARISON: No priors.

TECHNIQUE: Contiguous axial images were obtained from the lung bases to
the pelvic floor following the intravenous administration of 100 mL of
Omnipaque. Coronal and sagittal reformations are provided.

FINDINGS:
LUNG BASES: Clear.

LIVER: No mass. No intrahepatic biliary dilatation.

GALLBLADDER: Surgically absent.

COMMON BILE DUCT: Normal caliber. No stones.

SPLEEN: Within normal limits.

Answered by Dr. T Chandrakant (3 minutes later)

Brief Answer:
Is this the full report ?

Detailed Answer:
Hi,

Is this all of the report ?
I think there are additional comments.

Please see and add on the CT report in full.

Awaiting....

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. T Chandrakant (32 minutes later)

no sending the second page

Answered by Dr. T Chandrakant (54 minutes later)

Brief Answer:
Awaiting.

Detailed Answer:
Hi,

Awaiting the remaining report of CT scan.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. T Chandrakant (8 minutes later)

PANCREAS: No mass. No pancreatic fluid collections.

ADRENALS: No masses.

KIDNEYS: No masses. No hydronephrosis.

LYMPH NODES: No adenopathy.

STOMACH, SMALL BOWEL AND COLON: Mild circumferential mural thickening
throughout the descending and sigmoid colon, raising the question of
colitis. Normal appendix.

PERITONEAL CAVITY: No mesenteric stranding or free fluid.

OSSEOUS STRUCTURES: No acute fracture or destructive lesion.

ABDOMINAL AORTA: No aneurysm.

PELVIC ORGANS: Normal.

IMPRESSION:
1. Mild circumferential mural thickening throughout the descending and
sigmoid colon, raising the question of colitis. No evidence of
perforation or abscess.
2. Prior cholecystectomy.

Dictating Dr. XXXXXXX Welden, MD
Dictated 1/3/2017 1:47 PM
Signing Dr. XXXXXXX Welden, MD

WSN:FMRR2

Answered by Dr. T Chandrakant (31 minutes later)

Brief Answer:
Colonoscopy - anti-spasmodic

Detailed Answer:
Thanks a lot again.

I've gone through it in details, the report is suggestive of colitis causing the pain/discomfort.

This needs to be treated with anti-spasmodic (Dicyclomine i.e. Bentyl , and/ Hyoscyamine etc) round the clock and further colonoscopy and biopsy from the affected tissue sample to see for the cause of it.

This may help for any specific treatment, if indicated thereafter.

Get well soon
Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. T Chandrakant (26 minutes later)

is it possibly cancer thats what im afraid of

Answered by Dr. T Chandrakant (5 hours later)

Brief Answer:
Does not look like cancer as per the report provided.

Detailed Answer:
1. Mild circumferential mural thickening throughout the descending and
sigmoid colon, raising the question of colitis.
This is the impression of the Radiologist and I do not think this to be cancer as per the report. The thickening is throughout descending and sigmoid colon - goes in favor of colitis. There are no lymph nodes that are reported nor are there any deposits in liver or so.

Let us see what the report of biopsy on colonoscopy

Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.

Above answer was peer-reviewed by : Dr. Nagamani Ng