What should I do about gastrointestinal bleeding symptoms?

Question

Hello doctor,

I have been seeing a PCP for a couple of years following my former doctor's retirement. I saw him last time for minor but persistent abdominal pain and blood in the stool which stopped after stopping low dose Aspirin three times a day for one week.

He sent me for a CT which revealed a number of things and referred me to a GI specialist who suggested an upper GI. The technician said it would cost me more and waiting for getting my insurance.

My question is should I get a second opinion from a new PCP for changes in diet, antibiotic for H. pylori and other interventions before going to the expense of upper GI or get a second opinion from another GI specialist about my condition? I am currently taking Sertraline.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I had gone through all the details that are posted. The causes for persistent pain in the left lower abdomen were not answered by PCP or your CT (computed tomography) abdomen. Normally if there is frank blood in stools we need to do proctoscopy or sigmoidoscopy or colonoscopy to look for lower gastrointestinal causes. If there are black colored stools then we suspect upper GI pathology (ulcer). So we go for upper GI endoscopy to look for the bleeding cause.

Aspirin and Naprosyn may cause gastritis and ulceration which might be the cause they wanted to look for on upper GI endoscopy but it will not answer your blood in stools. CT abdomen has shown multiple things. Mainly important are:

8mm nodule in the right lung middle lobe which needs further characterization.
Multiple hepatic cysts were mentioned but characterization was not done. Is it a hydatic cyst or what kind of cyst needs mention?
Left non-obstructive renal calculus and a renal cyst. Again characterization of the renal cyst was not done whether benign or Bosnaik's grade?
This renal thing is the one that fits into the location of your persistent left lower abdominal pain. For gastric ulcer pain, you can take Esmoprazole or Pantoprazole. If it is positive, treatment is for two weeks only, so do not use antibiotics for H.Pylori.
Avoid spicy foods, NSAIDs (nonsteroidal antiinflammatory drugs), and alcohol which will help to reduce acidity.

Kindly consult a new PCP, discuss these issues with him and then decide on further evaluation and management.

I hope this helps.

Thank you.