What Causes Foul Smelling Loose Stools When Diagnosed With Cholestasis?

Posted on Tue, 3 Jan 2017

Question: my mother is 77 yrs old and is very frail ,wt <40 kgs,she was diagnosed with colesthesis last year . doctors did not operate her last year because of her thin constitution. since today after having sea fish for lunch she is passing loose motion with foul smell.what can be expected

Answered by Dr. Tushar Kanti Biswas (6 hours later)

Brief Answer:
Diarrhoea following sea-fish consumption

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

Diarrhoea following sea-fish may be caused by consumption of Diarrhetic shellfish. Onset occurs within 30 min to 12 h.The illness is usually self-limited; most patients recover in 3 or 4 days .

Treatment is supportive and focused on hydration with oral rehydration solution. Antimotility and antisecretory agents such as loperamide can be useful adjuncts to control symptoms but not to use if there is any fever. Stool can be sent for routine examination and culture /sensitivity test.

Empirically a course of Quinolone, i.e. Ciprofloxacin (500 mg twice daily for 3–5 days) with Metronidazole (250 mg 6th hrly for 3-5 days) is indicated if there is fever. These are all prescription drugs.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

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

Follow up: Dr. Tushar Kanti Biswas (4 days later)

Thanks Doctor Biswas,
Your diagnosis based on the information furnished by me was correct .
The doctor who saw my mother in the very next day's morning prescribed the same medicines ( Ofloxacin - 2wice daily and Metrogyl -3rice daily ) for 3 days . However I am worried about the cause of the infection . Was it because of the sea fish consumed in the day or it can be related to Cholestasis. As I had written to you that the docs at XXXXXXX Bhubnaeswar declined to operate her looking at her age and frail health and told to get a surgery done only she experienced any pain.They only suggested to do a USG at an interval of 6 months . The last USG report on 27th May was ok only with the impression on Cholestasis. However since Oct 2015 when she was diagnosed with Cholestasis she has never had a pain. She has highly controlled diet mostly boiled stuffs.
It would be really nice if you can pen your view on this.

regards,
XXXX
(son of the patient )

Answered by Dr. Tushar Kanti Biswas (2 hours later)

Brief Answer:
Asymptomatic cholelithiasis

Detailed Answer:
Asymptomatic cholelithiasis (silent gall stone) is a common occurrence
in older patients;however most of them never experience complications.The risk of developing symptoms like acute pain or complications requiring surgery is quite small.
Patients remaining asymptomatic for 15 years were found to be unlikely to develop symptoms during further follow-up. Hence ‘wait and see’ approach is advocated
as a reasonable therapeutic option in the management of silent cholelithiasis.

Old age (your mother is 77 years old) and thin built individual with fraility has higher postoperative morbidity and mortality,though Laparoscopic cholecystectomy , a minimal access approach has very low mortality( <0.1%) and is well tolerated by older adults and is now “gold standard”. However laparoscopic cholecystectomy is still operator dependent (surgeon's expertise).

Patients with very large gallstones (>3 cm in diameter) is usually considered for
prophylactic cholecystectomy .
Serial USG (every 6 months as you mentioned) is a reasonable approach in absence of symptoms.

Non-typhoidal salmonellosis (NTS)can cause diarrheal illness but there is no chronic carriage as against chronic carriage of typhoidal salmonellosis in some cases with gall-stones requiring both antibiotic therapy and surgical correction (cholecystectomy). Hence present diarrhea is not related to cholelithiasis.

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Yogesh D