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What Do My Lab Test Reports Indicate?

Posted on Sat, 2 Sep 2017

Question: My daughter, age 34, has had gastric bypass 3 years ago (just putting that out there because of the ramifications that come with that) has had increased swelling since last week. Started in her left leg/ankle and foot on Friday, now has spread to both legs, abdomen and bottom. She has been to the ER twice, had blood tests ran, ultrasound on legs, CT scan on abdomen. They cannot seem to find the cause, and she continues to swell. Two weeks ago she weighed 116 lbs, last night she was up to 123. Assuming all water. She started taking the water pills prescribed, now her tummy is cramping and upset. Looking for answers, as we are all very worried.

Answered by Dr. Ramesh Kumar (52 minutes later)

Brief Answer:
can be cardiac or renal problem.

Detailed Answer:
Hi ,
Thanks for choosing HCM for your query.
As per your query most whenever there is edema in body we initially suspect involvement of either of these three organs.
1)Liver
2)Heart
3)Kidney

As abdominal tests are normal I don't think that abdomen is culprit in her case.
Most likely her edema is related to congestion due to heart or due to kidney problems.

Suggested tests are
2d echo of heart to rule out functions of heart.
Renal function test to see if kidney is functioning normally.

As per her tummy upset is concerned I won't recommend any medication right now because most of them are metabolised and excreted by kidney only.

Initially go for these tests to rule out the cause of acute congestion and edema.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ramesh Kumar (2 hours later)

She has had all tests except the 2D Echo.
She was also told that she is anemic, could that be causing any of the swelling? We are hoping it isn't something serious. Here is the list of tests that she has had in regards to this situation:
Cardiology:
EKG

Laboratory:
CBC w/Diff
Metabolic Panel Comprehensive
Thyroid Stimulating Hormone
Urinalysis with Microscopic
B-Type Natriuretic Peptide
Troponin I
Diff, Auto

Radiology:
US Extremity Ven w/ Compres Bil
DX Portable Chest X Ray
CT Adb/Pelvis W/ Contrast – All of the above done 8/4. CT was done 8/7

Answered by Dr. Ramesh Kumar (13 hours later)

Brief Answer:
Follow up.

Detailed Answer:
Hello there,
Yes severe anemia could be a cause of anasarca(general body edema) but in her case the edema is involving mainly her legs so it can be cardiac also.Blood contains proteins which binds water molecule to them.However in anemic patients due to inability of blood to retain water edema occurs.

Please mention her levels of hemoglobin.
A 2d echo should always be done because bilateral pedal enema is very often related to cardiac problem especially if edema is responding well to diuretics.

As CT Abd was normal most likely its not related to liver or kidney.
So we have to rule out cardiac cause.

Regards.

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