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Ascites 4 weeks post-op, acute renal failureUpdate: Over 5L of fluid was drained from my dads abdomen today. The fluid was high in creatinine and consistent with urine. He initially felt much better, but then started experiencing extreme pain, likely from muscle spasms due to the drastic change in his body over the course if only 2 hours. His O2 dropped to 86 due to the pain. He is now medicated for pain and sleeping on and off. We are hoping that his status will improve over the next few days. Thank you to everyone that commented.70M, 6ft even, 205 lbs, Barrett's esophagus, eczemaHistory of heavy smoking decades ago that was reduced to once or twice per day in the 1980s. Uses edibles/microdosing to manage anxiety and depression.Regular medications include acid reducers for well-monitored esophagus and fish oils and supplements for controlled eczema. Very active lifestyle for age including managing half acre yard, frequent 15 to 20 mile bike rides when weather permits, strength training at gym multiple times per week.January 12th, dad underwent robot assisted prostate removal. Lymph nodes were clear and there was one area where cancer had spread one millimeter into outside tissues. No radiation is recommended at this time. He was disharged home with a catheter. The catheter was removed one week later, but about 18 hours after it was removed, he was having trouble urinating and developed severe pain. He went to the ER cathed again. He was determined to have continued swelling in his urethra.A few days later, a cystogram with his surgeon revealed a small tear in his bladder where his bladder and urethra meet. His surgeon said that he expects the tear to heal on its own.My dad was admitted to the ER today for increasing discomfort in his abdominal area with pain and diarrhea. When I showed up, I noticed that his abdomen was visibly distended. CT confirmed ascites. Nothing else to note other than a 2 mm calcification in a kidney and cirrhosis. He is a recovered alcoholic that hasn't touched alcohol in 37 years. Labs shows some RBCs and WBCs in his urine. Also indicated acute kidney failure. BUN 56 mg/dL, creatinine 4.54 mg/dL, eGFR-Cr 13 mL/min/1.73m2.It is a lymphatic leak? Maybe urine leak caused it? If so, what next?
gpt
In a patient with cirrhosis and new onset renal failure with swelling by the prostatic urethra, your dad appears to be at risk for urinary retention because of how much inflammation and swelling there is by the pelvis at the neck of the urethra. A simple noninvasive bladder scan can be done at the urologist's office after he voids or is allowed to empty his bladder completely , called a "post void residual". If there is more than 300-450 cc (every doc has their own cutoff) after a reasonable attempt to empty every last drop, he is considered to have urinary retention. This can cause urine to flow backwards and cause backpressure into the kidneys, effectively causing hydronephrosis (which can be picked up on a renal ultrasound (ultrasound of kidneys), or CT scan of the abdomen. Obstructive uropathy is this condition and can be source of renal failureAlso, ascites is not uncommon in decompensated cirrhosis. Make sure your dad is on a low salt diet. Also it is important to check a Complete metabolic panel or hepatic function panel to see his albumin level. Low albumin can contribute to ascites. Your dad could be in what we call hepatorenal syndrome if his cirrhosis is not under control and can lead to renal failure and death.
Trans (FTM) invasive exam at endocrinology visit *repost **is this common practice??4 years ago i had visited a pediatric endocrinologist for my first dose of T after 2 years of therapy. i had done everything i needed to, i was excited, i was desperate the endocrinologist did everything routine blood tests, usual physical examinations during the physical, it was quite apparent that i did have excess hair and signs of hyperandrogenism. the blood work even indicated that my cholesterol was high. the day of my follow-up he had asked me to wear a gown so he can check down there i dont remember ever getting a reason why but he did let my mom stay in the room and brought a chaperone. i was desperate so i let him do it. it haunted me for a while.4 years later. i had learned that that examination apparently isnt routine via my friends and this examination was never reported in any of my records so i decided to give him a call about it to express my concerns. he told me that people who have hyperandrogenism, their clit grows so he wanted to check for signs of that and anything that can indicate for signs of a tumor, that is causing it so that he would order a CT scan if he suspected iti still dont know how a physical examination can make that clear but i felt pressured today so i just agreed just like i did 4 years ago he even admitted to checking several patients clits for a baseline for T but he said he doesnt do it anymore because its uncomfortable or has a (female) nurse do it if he feels its necessary.i still dont have an answer im afraid i gave consent that day under false pretenses i feel strange just leaving this alone even though i dont think he had any ill intentions.should i ask for another opinion? or am i making this a bigger problem than it is?
Sounds like they were assessing for clitoromegaly and they werent very sensitive to your needs or reading the room. I dont think this is common for FTM physical exams, especially when youre displaying signs of hyperandrogenism.What I can say is that my guess is a pediatric endocrinologist is definitely more likely to assess genitalia because they are the ones that first pick up on hormonal imbalances caused by tumors or abnormal genitalia so it may actually be within their scope. I think they were being thorough during a time when trans care was evolving given that they brought a chaperone. If they did a full pelvic exam then that would certainly raise some red flags.I think your being uncomfortable was warranted and I dont think what they did is standard practice. However, Im not sure Id pursue it anymore given that a genitalia exam in some cases might be appropriate. Again, if penetration occurred then Id be more worried. Today, this would typically be monitored by a Gyn as part of a multidisciplinary team.