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Forum Name: Gastroenterology Topics

Question: Sick Father


 Eastgate - Wed Jun 09, 2010 11:31 pm

Hi everyone,

This is a desperate plea for help! My 50-year-old father has been sick for the past 18 months and the doctors here in Australia cannot find the problem.

His symptoms consist of:

- Stomach/abdominal pains/cramps
- Vomiting/dry retching

These symptoms may seem quite common, however the frequency and the severity is what makes his case so frustrating and heart breaking. Over the past 18 months he has constantly been in-and-out of hospitals and despite doing "every test they can", there is yet to be a diagnosis. He will be rushed to hospital with pain which has him crippled up on the floor and vomiting which sounds as if he is about to bring his insides up.

Several times I have rushed him to emergency where he just drops to the ground in pain, in front of everyone. Obviously due to the long stints in hospital and the regular vomiting, he has lost a considerable amount of weight and at one stage he was down to approx 55kg.

He has seen Naturopaths, Professors and Dietitians and none of them seem to have the answers. He was advised by a Dietitian that he may have IBS and would need to try gluten-free and also a dairy-free diets. He then proceeded to follow the gluten free diet which consisted of gluten-free products including the conversion to breads made on spelt bread. However, this did not appear to be the issue, neither did the dairy due to the fact he ended up in hospital on several occasions whilst on these diets.

My family and I just do not know where to go from here? We even got him transferred to a larger hospital in Sydney where they did a few more tests but with no good news. They provided him with some antacid drugs which seemed to be working by calming down his stomach and also something else to help his nerves.

The only thing I can think of that may effect him is when he returns from hospital (all be it for a week at the most before being rushed back), he does indulge in quite a large amount of food due to the fact he has been without it for so long. Could this have an effect on things? I am not sure?

We need your help and it would be greatly appreciated!

Kind Regards,
Aaron
 Dr.M.Aroon kamath - Tue Jul 06, 2010 7:19 am

User avatar Hi,
Although you have given ample details of your father's unfortunate suffering, you have overlooked details such as his past medical history, drug history, personal history, past surgical history etc, which are always extremely important, more so, in a forum such as this, where we offer guidance based solely on the information provided.

You indicate that almost all possible tests have been carried out already and came back negative. In this situation, one is compelled to think of some of the less common causes of severe abdominal pain, & one such, is the abdominal pain due to vascular causes.

These can be
- acute, or
- chronic, or
- recurrent.

- occlusive or
- non-occlusive.

- thrombotic or
- embolic.

- arterial or
- venous.

Occclusive causes:
Arterial embolus (> 50%): cardiac failure, valvular heart disease, Coronary artery disease, atrial fibrillation, past history of arterial emboli.

Arterial thrombosis (10%): Generalized atherosclerosis

Venous thrombosis (5–15%): Hypercoagulable states, inflammatory pathologies,(eg, pancreatitis, diverticulitis), cardiac failure, trauma, portal hypertension, renal failure, decompression sickness

Nonocclusive causes (25%): Low flow states such as(shock, cardiac failure, cardiopulmonary bypass) and splanchnic vasoconstriction (eg, cocaine, administration of vasopressors).

Acute mesenteric ischemia ("Abdominal angina" or "intestinal angina"): is defined as a postprandial pain that occurs due to sufficient mesenteric vascular occlusive disease such that blood flow can't cope with the visceral demands. Due to the postprandial nature, a fear of eating develops leading to a significant loss of body weight.

One striking feature often seen in the less serious forms of this condition is that the symptoms are prominent but, there is a paucity of clinical signs.

I wonder if this possibility had been pursued. You may discuss with your doctor regarding this, as well as other obscure causes of recurrent, severe abdominal pain.
Best wishes!
 Eastgate - Tue Jul 06, 2010 4:31 pm

Thank you Dr Kamath.

My father has no history in terms of drugs. In medical terms he has had his appendix removed and also his gal bladder (they removed this since his illness as they thought it may be a factor).

Due to the fact the doctors cannot seem to find anything, they are now going down the path of mental illness - does this seem normal for them to take this step?
 Dr.M.Aroon kamath - Mon Jul 19, 2010 6:59 am

User avatar Hi Eastgate,
Generally, a psychosomatic illness or a psychiatric illness would be given a serious consideration after excluding "all" of the possible organic causes. What is "all", in practical terms, may depend upon variables such as, the available expertise, available investigations and the costs(financial implications) involved. If, after all the 'available' options have been exhausted, no "organic" diagnosis turns up, then naturally, the finger of suspicion will start to point to a non-organic cause.
Best wishes!

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