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911DOC
911DOC, Board Certified Dr.
Category: Medical
Satisfied Customers: 5091
Experience:  Emergency Medicine Physician
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Hi doctor...I went to the ER because I am having frequent urination

Customer Question

Hi doctor...I went to the ER because I am having frequent urination a lot and have pressure in my lower belly. I have no UTI. They did blood work and ultrasound and said it was normal. Could you please look over my results as I have some questions. I have extreme generalized anxiety disorder and hypochondriasis...so a compassionate doctor is a must.




Lab

CBC

Lymphocytes 2.57 ref: 1.50-4.00
MPV 6.1 ref: 6.1-9.8
Neutrophil 8.28 ref: 2.00-7.50
Hb 135 ref: 120-160
WBC 11.8 ref: 4-11
RBC 4.62 ref: 3.9-5.6
Hct 0.39 ref: 0.330-0.470
MCV 85.1 ref:80-95
RDW 12.5% ref: 11.5-14.8
MCH 29.3 ref: 27.0-32.0
MCHC 344 ref: 320-370
PLT: 307 ref: 150-400
Monos 0.53 ref: 0.20-0.80
Eosin: 0.34 ref: 0.04-0.40
Basophils 0.06 ref: =61
Bicarbonate 25 ref: 23-29
MDRD GFR 82 ref: >=61
Anion gap 7 ref: 5-11
MDRD GFR 99 ref: >=61

Potassium 4.3 ref: 3.2-5.0
Sodium 138 ref: 135-145
Chloride: 106 ref: 100-110
Creatinine: 72 ref: 50-98

Ultrasound

Abdominal, pelvis, and transvaginal ultrasound

Liver: 14.2cm diffuse mild fatty infiltration
Gallbladder: single 1.6cm calculus. No wall thickening or pericholecysic fluid. Negative Murphy's sign

Biliary ducts:
Intrahepatic bile ducts: not dilated
Common bile duct: 0.3cm

Pancreas: visualized portion normal
Spleen: 11.2cm no focal lesion
Right kidney: 10.7cm normal
Left kidney: 10.6cm normal
Aorta: normal
Ivc: normal
Bladder: not fully distended but grossly NAD
LMP approx. 2 weeks
Uterus 6.8 x3.3x3.0cm normal echo texture
Endometrial thickness 0.8cm
Right ovary size 3.1x1.7x2.0cm
Arterial and venous flow seen
Left ovary: size 3.6x3.3x2.5cm
Largest functional cyst 3.1x2.7x2.0cm
Arterial and venous flow seen

Free intra-peritoneal fluid: yes, small at right adnexa and PCDS

Other findings: appendix could not be identified at RLQ. However no high index of suspicion of appendicitis during examination.

Opinion: no abnormality found.

Does my results all look normal? The ER doctor said my results were normal and said he believes it's stress. I left the hospital feeling relieved until I read over the ultrasound report and panic. I have a history of trying to interpret my tests results and my doctor has already told me to stop doing so as I'm not a doctor and I will just feed into my anxieties.

I panicked when I saw that there is free intra peritoneal fluid. My family doctor believes the PCDS stands for pelvic cul de sac not PCOS.

What does free intra peritoneal fluid mean? Is fluid in those areas normal? What does PCDS mean so my family doctor said that does not mean polycystic ovary syndrome.

Could the functional cyst cause the pressure and frequent urination? If I have a functional cyst on my left side, why is there fluid on my right side as well as pelvis area. I am extremely worried and obsessing over this. Please only compassionate doctors reply

Thank you
Submitted: 10 months ago.
Category: Medical
Expert:  911DOC replied 10 months ago.

911DOC :

hello,

911DOC :

sorry for your troubles

911DOC :

the blood work gives no clues to the cause of your pain and discomfort

911DOC :

it is essentially normal

911DOC :

you have a single gallstone in the gall bladder, it's pretty large and you will likely need to get your gall bladder surgically removed at some point, but nothing in the ultrasound suggests this needs to happen right away

911DOC :

rest of ultrasound is notable for an ovarian cyst on the left

911DOC :

which could, possibly explain your discomfort as it is quite a large cyst

Customer: Ok...my concern is the fluid in the adnexa and pelvic region. I have a functional cyst on my left ovary...I'm terrified about the fluid
911DOC :

in fact, the small amount of intraperitoneal fluid on the right

911DOC :

could be physiological (normal) or could indicate the cyst may have ruptured

911DOC :

and this would indeed cause discomfort, probably for a few days

911DOC :

and since your last menstrual cycle was two weeks ago this would make sense

911DOC :

your doctor will want to know about the single large gallstone and the right ovarian cyst for the purposes of follow up

Customer: Well the cyst is on the left and fluid is on the right and pelvis cul de sac...is that possible that the cyst on the left side would do this? The ultrasound didn't mention a rupture
911DOC :

yes, pcds means 'cul de sac', its an anatomical location

911DOC :

the ultrasound can not tell if fluid is due to a leaking or ruptured cyst

911DOC :

that's for the clinician taking care of you

911DOC :

if your pain was relatively quick in onset this is at least a good bet

911DOC :

and pcos is not diagnosed solely by ultrasound... usually the cysts with pcos are on both ovaries

911DOC :

as mentioned. small amounts of fluid in the cul de sac can simply be normal for women

911DOC :

and as to the fluid being on the righ instead of the left

911DOC :

it can move around, so if you slept on your right side this could explain that, but that's an educated guess

Customer: Oh ok...my liver and kidneys and bladder looked normal...should I be worried that this fluid is cancerous? I suffer from anxiety and I'm in a panic now but the doctor said he thinks the frequent urination and belly ache is from stress. Is my cyst large enough to cause pressure and frequent urination?
911DOC :

the cyst is probably not large enough to cause those symptoms

911DOC :

frequent urination and abdominal discomfort and even diarrhea can be from stress to be sure

911DOC :

if your urinalysis was clean then this is almost certainly not a urinary infection

Customer: Should I be worried about cancer?
911DOC :

no

911DOC :

you state 'i have a functional left ovarian cyst'

911DOC :

so this has been looked at in the past am i correct?

Customer: Yes my urine was clean. Am I just blowing this out of proportion...I've been freaking out but the ER doctor said everything was fine
911DOC :

i also am an ER doctor and there is nothing in this information that leads me to any amount of worry about you at all

Customer: The functional ovarian cyst was found yesterday during the ultrasound along with the fluid
911DOC :

i see

911DOC :

does your primary care doctor do your annual pap smear exams and female health maintenance?

Customer: He does...I had a Pap smear 2 years ago and then last year he did a pelvic exam...he said I didn't need a swab as I was getting them yearly
911DOC :

good

911DOC :

is there any history of pelvic cancer of any sort in your family?

Customer: Not that I know of
911DOC :

that's very good indeed

911DOC :

so

911DOC :

understanding that you are hyper-vigilant about your health i think the following would be reasonable to pursue with your doctor

911DOC :

1. you will need to speak with him about your single gallstone. it would be a good thing to get referred to a surgeon to set up an elective gall bladder surgery. this will avoid the probability that you will have a gall bladder problem in the future such as cholecystitis.... stand by for a reference

Customer: Ok
911DOC :

GALLSTONES

911DOC :

secondly

911DOC :

you will want to speak with your physician about this ovarian cyst

911DOC :

ovarian cysts come and go and are related to your mentrual cycle

911DOC :

i would think it reasonable at least to get a second ultrasound sometime in the next few months to get a second look at this cyst for the purposes of follow up

911DOC :

standing by

Customer: Ok I will ask my doctor about it. Just one last question..what causes the fluid in those regions if my liver, kidney, bladder look normal...besides the fatty liver. I read online that ovulation can do this but my anxiety is in high gear right now
911DOC :

your research is correct

911DOC :

as mentioned, in women, small amounts of free fluid in the cul de sac can be normal, and it can represent a leak from the cyst or bleeding from the cyst

911DOC :

rarely does this need anything other than follow up

911DOC :

standing by

Customer: Ok...thank you very much doctor I appreciate it
911DOC :

you are most welcome

911DOC :

do you have any final questions for me?

911DOC, Board Certified Dr.
Category: Medical
Satisfied Customers: 5091
Experience: Emergency Medicine Physician
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