Expert: Claes-Gustaf Nordquist, M.D. - 6/12/2007

Question
Dr. Nordquist,

A copy of our first exchange (my question/your answer)follows:

Subject: post-colonoscopy concerns

Volunteer Expert: Claes-Gustaf Nordquist, M.D.

Question:
"I am 55 years old, caucasian, Spanish descent, 30 pounds overweight,
take aspirin, hydrochlorothiazide, nifedipine and simvastatin for high
cholesterol and blood pressure.

My father died at 55 of luekemia. My mother died at 74 of a heart
attack. My sibling (four years older)had numerous hyperplastic polyps
removed when he had a colonoscopy 4 years ago.

On Friday,May 2,2007 I had a colonoscopy. My follow up appointment with
my doctor revealed that a large (@2.00 X 1.65cm) tubulo-villous adenoma
polyp was removed.

Previously, in 2005, a sigmoidoscopy was peformed, a small hyperplastic
polyp was removed. In 2006, a second sigmoidoscopy was performed
(triggered by several positive Fecal occult exam tests); nothing was
removed but the colonoscopy was ordered.

By the way, I am a Vietnam Vet, the sigmoids were done at VA clinics;
the colonoscopy was done by a private practice surgeon because in my
state (FL)  there is a shortage of surgeons due to Iraq war.

I did my homework after my colonoscopy and before my follow up
appointment with the surgeon and became concerned because I learned that
colonic adenomas are at a higher risk for malignant transformation.

I have already made the normal corrections to diet (less fat, more
fiber.) The surgeon is recommending that I have another colonoscopy in
18 months (2009).

QUESTIONS: (1)Should I have an immediate ultrasound, MRI, etc.
to discover if any other organ, tissue abnormalities exist?

(2)Based on your experience, and if I were your patient, what would be
your immediate concerns short and long term.

I have an undergrad degree in biology and chemistry (and have been
spending lots of time researching medical journals) so please don't be
afraid to get technical on me!




Answer:
If the pathology report shows no cancer nothing more needs to be done EXCEPT
regular colonoscopies (I would prefer once every year)! That is needed because
it is obvious that you have a genetic tendency for this. If there is no cancer
in any of the polyps and they are removed there is nothing to worry about. The
cancer risk increases with polyp size. Please keep me posted. If you can keep
your colon "clean" with regular colonoscopies your risk should be kept at a
minimum!
END OF YOUR RESPONSE________________________


NEW PREFACE AND QUESTION:
I subsequently had the ultrasound performed. The gist of the results are:

(1) Possible fatty infiltration of the liver.
(2) Left kidney cyst of 2.5cm.

The gallbladder, bile ducts, abdominal aorta, Right kidney and spleen were all normal.  The pancreas had a decreased image (as sometimes happens due to it's location and body habitus) but stated no gross abnormality was detected.
QUESTION:

I do experience a slight pain emanating from the left side location of kidney and now I know of the presence of the cyst. Do I need to do anything immediately such as aliver biopsy, CT scan for the liver, laproscopic surgery to drain/remove the cyst?

What would be your other concerns/recommendations?

Thank you!  

Answer
Thanks for the detailed question. 1. There is hardly any reason to do a liver biopsy based on this ultrasound report. If your liver lab. tests are ok there is most probably no reason to worry at all. Fat infiltration is probably due to either (or a combinaion of) 1. Obesity, or 2. A rather high intake of alcohol. If the liver values are ok the infiltration must however be quite modest and nothing to worry about. Should you recognize any of these factors in your case I'm sure you can on your own deduce the obvious solutions to them in that case.
2. Kidney (and liver) cysts are not uncommon. In a case like this they are not dangerous and need not to be corrected in any way. They rarely give any symptoms at all.
GOOD LUCK!