Abdominal Cysts: Concerns for Elderly Patients with Comorbidities

Abdominal cyst?

Hello Dr.
Chen, I would like to ask for your advice regarding my mother, who is 75 years old.
She has suffered a stroke on her right side and has diabetes, hypertension, and kidney disease, which have severely affected her health.
Two years ago, she underwent surgery to remove her gallbladder due to inflammation, after which the right side of her abdomen became deformed, resembling a half-oval shape.
Four months ago, during an ultrasound of her kidneys, the nephrologist informed us that she has a renal cyst and that it is not a concern.
However, every time I bathe my mother, I notice that it seems to be getting larger.
My mother has been ill for many years and is very afraid of going to the hospital, leading to a negative outlook on life.
She insists on not wanting to go for further examinations, especially since the nephrologist said it was not a problem.
However, every time I see her abdomen slightly protruding, I feel scared and distressed, as I believe the issue is not that simple.
I kindly ask for your guidance, Dr.
Chen.
Thank you.

TAMMY, 30~39 year old female. Ask Date: 2004/12/20

Dr. Chen Zhiping reply Gastroenterology and Hepatology

Hello, after surgery, weakness of the abdominal wall muscles may lead to local hernia formation.
Some individuals may experience a unilateral protrusion in the abdominal area similar to your mother's condition.
It is essential to rule out any internal growths, and both abdominal ultrasound and renal ultrasound have indicated that there is only a renal cyst (fluid-filled sac).
Typically, these cysts are not intervened upon unless they become too large and cause symptoms such as pain, pressure on the intestines, bloating, or even fever, in which case aspiration with a fine needle may be necessary.
However, there is still a possibility of recurrence after aspiration.
I recommend discussing this further with a nephrologist.
Sincerely, Dr.
Chen Zhiping, Internal Medicine.

Reply Date: 2004/12/20

More Info

When it comes to selecting an appropriate internist for your mother, especially considering her complex medical history and current symptoms, there are several factors to consider. Given her age (75 years) and existing comorbidities such as diabetes, hypertension, and kidney disease, it is crucial to find a physician who specializes in geriatric medicine or internal medicine with experience in managing multiple chronic conditions.

Your mother's symptoms, including abdominal pain and the noticeable bulge on the right side of her abdomen, warrant a thorough evaluation. The bulge you describe, which has been identified as a cystic mass (or "water tumor"), could be a renal cyst or another type of abdominal cyst. While the nephrologist has reassured you that it is not a cause for concern, the fact that it appears to be growing is indeed something to monitor closely.
In elderly patients, especially those with multiple health issues, abdominal cysts can sometimes lead to complications such as infection, rupture, or pressure on surrounding organs. Therefore, it is essential to have regular follow-ups and imaging studies, such as ultrasound or CT scans, to monitor the size and characteristics of the cyst. If the cyst continues to grow or if your mother experiences new symptoms (such as increased pain, fever, or changes in bowel habits), it may be necessary to consult a gastroenterologist or a surgeon for further evaluation.

In terms of managing her abdominal symptoms, it is important to address her overall health. This includes controlling her diabetes and hypertension, as these conditions can exacerbate abdominal discomfort. A dietitian can help create a meal plan that accommodates her dietary restrictions while ensuring she receives adequate nutrition.
Additionally, if your mother is experiencing anxiety about her health and hospital visits, it may be beneficial to involve a mental health professional. Many elderly patients face psychological challenges related to their health, and addressing these concerns can improve their overall well-being and compliance with medical advice.

In summary, selecting the right internist involves looking for a physician who understands the complexities of geriatric care and is willing to coordinate with other specialists as needed. Regular monitoring of her abdominal cyst, managing her chronic conditions, and addressing her mental health are all critical components of her care. If you feel that her current healthcare providers are not adequately addressing your concerns, do not hesitate to seek a second opinion. Your mother's health and comfort should always be the priority.

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