Persistent Health Issues: Seeking Guidance
Hello, I'm a 16-year-old female and have been feeling quite ill for over three weeks. Initially, I dealt with problems like constipation and nausea, along with a sensation that my bowel movements weren’t completing properly. Thankfully, those issues have mostly resolved and things have improved somewhat. However, I still feel largely unwell. I even underwent blood tests and a hospital checkup, both of which yielded normal results. The most worrying development has been my recent experience with a urinary sample. While tests at the hospital showed no issues, shortly afterwards, I was prescribed Trimethoprim for a suspected urinary infection. Unfortunately, following that prescription, I began experiencing severe chest tightness, difficulty breathing, and overwhelming fatigue. We suspected this could be an allergic reaction, leading to a return visit to my general practitioner. She indicated that E. coli might be impacting my health negatively. Consequently, she switched my medication to amoxicillin. Things took a turn for the worse with the new prescription, prompting frantic calls to the help line and numerous visits to my GP. During this time, I even received a note recommending therapy for anxiety, as it was suggested that my worries may be connected to my ADHD and autism. Yesterday was particularly stressful for both me and my parents, culminating in another call to the help line and a late-night trip to the emergency room, where my vital signs were stable. I also requested an ECG, which showed no abnormalities. The medical team speculated that my symptoms might be related to acid reflux and suggested Gaviscon as a remedy, which I have ordered. Despite this, I experienced vomiting after eating, accompanied by heartburn and continued shortness of breath. My parents are growing increasingly frustrated, believing my complaints to be psychosomatic. Right now, I'm finding it hard to sleep, as I'm overwhelmed by symptoms reminiscent of a heart attack. It's worth noting that I struggle significantly with anxiety, especially concerning health issues, due to the loss of my birth mother to a heart attack at age 38—she had issues with addiction and alcoholism. I began feeling unwell on July 7th, but the situation escalated after I started taking Trimethoprim on July 17th, followed by two days on amoxicillin. Despite my hospital visit confirming normal urine results, I was advised to halt the medication. Throughout this ordeal, doctors have proposed a diagnosis of IBS, which responded positively to additional fiber in my diet. I am reaching out for any advice or insights, as I feel caught in a struggle with both physical and likely mental health challenges, and to complicate matters, I seem to be coming down with a cold as well.
Answers (1)
7/24/2025, 11:31:04 PM
OpenHealth AI
I'm sorry to hear about the distressing symptoms you've been experiencing. It's understandable how overwhelming this situation must feel, especially given your recent health history and personal background. The combination of physical and mental health challenges can be notably complex, but there are actionable steps you can consider to help alleviate some symptoms and improve your well-being.
Main Points Summary:
- Your symptoms may be interconnected with anxiety, gastrointestinal issues (IBS), and possibly acid reflux.
- Strategies to manage anxiety and improve digestive health are essential.
- Monitoring your symptoms and self-care practices can be incredibly helpful.
Explanation:
Your description indicates that you’ve been through a lot recently, and it’s important to recognize the potential interplay between your mental and physical health conditions. Anxiety can indeed amplify physical symptoms, making it hard to distinguish between them. The medication adjustments by your healthcare provider suggest they are also seeking to address these overlapping issues.
Given your previous experiences with antibiotic medications that complicated your symptoms, it's wise to take a cautious approach moving forward.
Next Steps:
-
Gastrointestinal Health:
- Continue the Gaviscon: Since you have it ordered, start taking it as directed to help relieve acid reflux symptoms.
- Dietary Adjustments: Consider a low-FODMAP diet, which can be beneficial for IBS. This means reducing certain carbohydrates that can cause bloating and discomfort. Gradually introduce fiber as it helps with constipation, but do it slowly to avoid gas and cramping.
-
Anxiety Management:
- Explore relaxation techniques such as deep breathing, mindfulness, or gentle yoga, which can help ease symptoms of anxiety and improve sleep quality.
- Therapeutic Support: Since therapy has been suggested, it may be helpful to engage with a mental health professional who understands chronic illness and anxiety management. They can provide personalized coping strategies.
-
Symptom Monitoring:
- Keep a detailed symptom diary to track what triggers your nausea, heartburn, and any episodes of chest tightness. Noting whether specific foods or activities precede symptoms can help identify patterns and potential triggers.
- Share this diary with your healthcare providers to facilitate better understanding and support.
-
Cold Symptoms:
- For your cold, rest and hydration are critical. Make sure to drink enough fluids and consider over-the-counter medications for symptom relief if necessary.
-
Seek Immediate Help if Necessary:
- If you experience severe shortness of breath, chest pain, or significant changes in your symptoms, don’t hesitate to seek urgent medical care.
Please remember that you are navigating a multifaceted health journey, and it's okay to advocate for yourself during appointments. A supportive network of family, friends, and healthcare professionals can make a crucial difference. If you need further advice or specific resources, feel free to ask.
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7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options
# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - **Portocaval shunt size: 9.9 mm** (blood bypassing the liver into the inferior vena cava) - **Arteriovenous shunt size: 4.4 mm** - **Portal vein size: 6.1 mm** (patent) - **Three nodular cystic lesions** located in the perivascular area, with largest measuring 11.6×20.7 mm, enhancing during the venous phase - Liver features a heterogeneous architecture, exhibiting irregular enhancement - Gallbladder appears elongated and slightly enlarged - Other abdominal organs exhibit normal findings **RADIOLOGIST’S ASSESSMENT:** "Congenital portosystemic shunt indicative of Abernethy malformation; less likely arteriovenous malformation (AVM); cannot dismiss the possibility of localized liver lesions." **ADVICE:** Seek consultations with an abdominal and vascular surgeon. ### Blood Tests (August 1, 2025): **Complete Blood Count:** - WBC: 10.44 × 10⁹/L (normal range) - **RBC: 2.1 × 10¹²/L** (LOW - indicating severe anemia) - **Hemoglobin: 69 g/L** (CRITICALLY LOW; normal is 117-166) - Platelets: 403 × 10⁹/L (elevated) **Biochemistry Analysis:** - Urea: 1.80 mmol/L (normal) - Creatinine: 33.4 μmol/L (normal) - **ALT: >1000 IU/mL** (EXTREMELY HIGH - severe liver dysfunction) --- ## FOLLOW-UP IMAGING (December 16, 2025 - 5.5 Months Old) ### Liver Ultrasound: **RESULTS:** - Right lobe: 64 mm, left lobe: 43 mm - Liver capsule appears irregular and vague - **Parenchyma: heterogeneous, showing 7 hypo-isoechoic nodules** (sizes range from 11.5×10.7 mm to 17.6×15.4 mm) - Capsule features uneven contours - Blood flow noted during Doppler examination - No dilation in intrahepatic bile ducts - **Portal vein: 3.9 mm** (decreased from 6.1 mm - indicating improvement) - Common bile duct: 1.4 mm - Gallbladder: measures 43.7×9.2 mm (pear-shaped, wall thickness 2.0 mm, homogeneous, free of stones) **ULTRASOUND ASSESSMENT:** "Presence of liver volumetric formations (specifically liver hemangiomas)." --- ## LATEST MSCT (February 6, 2026 - 7 Months Old) ### MSCT with 3-Phase Contrast: **FINDINGS:** - Liver remains normal in size, but shows heterogeneous structure with uneven contrast enhancement - **Portocaval shunt: 9.9 mm** (no change, continues to drain directly into the inferior vena cava avoiding liver acinus) - **Arteriovenous shunt: 4.4 mm** (no alteration) - **Three nodular cystic lesions** in perivascular space, maximum size 11.6×20.7 mm, enhancing in the venous phase - **Portal vein: 6.1 mm** (noted during porto-venous phase) - Arteries show no filling abnormalities - Intrahepatic bile ducts remain non-dilated - Gallbladder is elongated and slightly bigger, free from stones - Pancreas: normal - Spleen: measures 66.9×38.5 mm (not enlarged), splenic vein is 3.6 mm - Kidneys: normal placements and structure - No excess fluid detected in the abdominal cavity - No visible changes in lymph nodes **MSCT ANALYSIS:** "Congenital portosystemic shunt indicative of Abernethy malformation, unlikely to be AVM, presence of focal liver lesions cannot be ruled out." **RECOMMENDATION:** Engage with an abdominal and vascular surgeon. --- ## RECENT BLOOD WORK (December 2025 - January 2026) ### Complete Blood Count (January 19, 2026): - WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. 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