Urgently again
October 25, 2012 | 15,00 EUR | answered by Dr. med. Ralf Berg
Hello,
I am currently undergoing training to become a geriatric nurse. I have been given a task and am allowed to seek help for it. Here is the issue: The patient has been experiencing pain and severe cramps in the abdominal area for weeks and has been receiving subcutaneous Buscopan for weeks. However, there has been no improvement. A doctor ordered an ultrasound of the abdomen. Near the intestine (not inside the intestine) there is a tumor approximately 7*3cm in size. This tumor is not malignant. The patient is receiving medication to reduce the tumor size and eventually make it disappear. After consulting with my teacher, it is confirmed that it has nothing to do with the gallbladder. It is an abscess or a cyst!!!
Now, my questions are:
1. What diagnosis could fit here (which cyst or abscess)?
2. What medication is he receiving to reduce the cyst/abscess?
3. How can the diagnosis of "benign" be made without surgical intervention?
I kindly ask you to only accept the task if you can answer all 3 questions.
Thank you in advance.
Kind regards!
Dear inquirer,
I have to agree with my colleague, the question is unclear, and it leaves room for guessing and speculation rather than providing a clear answer. For exam questions for geriatric nurses, this is extremely unfortunate, to say the least.
Well then, let me answer your 3 questions.
1. (With greetings to your teacher) Every US finding that is collected must be specified with a concrete location. Not specifying a location in the upper abdomen, such as "not in the intestine on the right side", is insufficient. Concrete details about consistency (cyst a hypoechoic, b hyperechoic, or solid tissue) must also be provided.
Now that we know it is not in the intestines, not in the bile ducts, and not centrally located, the question remains unanswered regarding its relationship to the liver.
If it is intrahepatic (inside the liver), it could be an infection with Echinococcus (tapeworm or other liver worm). These cystic structures (with Echinococcus) are so specific that the diagnosis can be made with very high certainty based solely on the US image. Since it can be treated with anthelmintics and can disappear (if it is not in an advanced stage), all conditions would be met. However, it is completely unprofessional to refer to this as a "tumor".
If the US actually shows a "tumor" in the sense of an abscess (e.g. subphrenic or subhepatic abscess) outside the liver, this abscess can naturally be reduced in size with antibiotic treatment if it becomes necrotic. I find it presumptuous to claim that abscesses are always benign. Abscess formation can also occur in tumor tissue, and often this is the only finding that can be observed if the tumor tissue has the same density as the host tissue.
PS I am curious to know what your teacher actually meant. From a didactic perspective, I would definitely grade this task as unsatisfactory.
Best regards, Dr. R. Berg
