I have a burning sensation in the lower right abdomen and noticed dark red patches in the stool. Please help.

Hello,

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I have seen the photo of stools you attached (attachments removed to protect the patient's identity), which has some maroonish color impression over one side. Do you think it is blood? Since blood usually washes away and turns the color of the water red. I see this red impression does not stain water red as otherwise, the blood would do.

I agree that you should see a gastroenterologist in person, and there is no harm if you go for a diagnostic colonoscopy to see inside your large bowel and part of the small bowel and make sure there is nothing wrong going out there.

Hello,

Welcome back to icliniq.com.

Yes, from the picture (attachments removed to protect the patient's identity) it is looking like blood, but blood tends to stain red when it comes in contact with water. This frequent change in the color of the stools is because of inflammation going on within the gut. Overall, these stools and your symptoms are not normal and need to be treated. CT scan is a relatively safe procedure, and it is just a snapshot of your tummy, and it would guide your further treatment based on the extent of the damage to the gut after those pills intake and baking soda intake. Omeprazole and similar drugs in the group like Esomeprazole, which I suggested, are safe and can use right away without waiting until your gastroenterologist appointment. Colonoscopy can be performed later once you meet a specialist gastroenterologist in person there.

Hello,

Welcome back to icliniq.com.

Well yes, the bleeding often occurs intermittently. Your blood does not seem to be related to H. pylori and that is the reason this test came negative. I suggest you go for a CT scan since it will tell us if there is any gross pathology within the small bowel, large bowel, or any part of the abdomen. Afterwards vivid plan for a procedure like upper endoscopy or colonoscopy in case there is a problem in any relevant part of the bowel like stomach or large bowel respectively. I do not think that you have a gut leakage because if you have gut leakage then you will have diarrhea with excessive loss of sodium and this leads to fluid overload or water retention over the feet. Secondly, you are right about the low and high acid levels, because it has almost the same symptoms but the change in the bowel color particularly that maroon color in your stools last week suggests a problem within the large bowel and not within the stomach. So I do not think acid has any role in your current symptoms.

Also, I do not think there is a problem with low thyroid and IV contrast injection for a CT scan abdomen. you can go for it.

I hope this answers your questions.

Thank you.

Hello,

Welcome back to icliniq.com.

Good to know that your CT is normal. As far as I know, you do not have diarrhea. The main issue was right-side abdominal pain. You probably remember when he had a video conversation I said this can be a nerve pain. A nerve that is compressed in between two muscle layers causing pain. I also suggested you have a local injection of Xylocaine by a trained gastroenterologist in a clinic. Later if you show improvement a 1 mg of injection Triamicilone (steroid) can be given to suppress this pain for a longer duration.

The tests which you have done are all normal. and does not identify a problem or inflammation within your bowel. Since you have Hashimoto's thyroiditis, it is associated with certain gut and stomach-related conditions namely pernicious anemia celiac disease, and autoimmune enteropathy. There are certain blood tests that you can do to confirm the above possibilities. Nevertheless, your symptoms of consistent right-side abdominal pain are not related to the above possibilities. I still feel that the pain is nerve pain and needs a completely different approach which is local injection of the Xylocaine rather than testing you further with blood tests. So plan is to ask your gastroenterologist to give an injection of Xylocaine at the site of pain and see if there is improvement in your pain.

Additionally, you can get some blood testing, since there is no harm in testing it. I suggest you do the following tests,

1. Antinuclear antibody.
2. Anti-parietal cell antibodies.
3. antibodies IgA and IgG.
4. Serum IgA levels.

Get these above tests and kindly send me reports of the CT scan and your current thyroid testing.

Thank you.

Hello,

Welcome back to icliniq.com.

Good to hear from you. I hope everything is alright otherwise. The report you uploaded suggests thyroid disease (attachment removed to protect patient identity). There is no new thing in the laboratory reports. The ANA (antinuclear antibody) and TSH (thyroid stimulating hormone) elevation is expected in your cases given your history of Hashimoto's thyroiditis. I do not see anti-parietal cell antibodies in the given test result. Kindly confirm with them. Raised TSH with normal FT4 levels suggests that you are on medications and it is taking time to improve your thyroid functions. You can consult with your thyroid specialist doctor to give you an expert opinion regarding that, maybe they can consider increasing the dose of thyroxine medication. 5% weight loss in 1 year, and gradually, is an alarming thing, and you need not worry about that. Your CBC showed a normal eosinophils count, which is against the notion that you have a parasitic infection. Eosinophils are usually high in parasitic infections, which you do not have. CBC always gives us a good clue about the type of infection. Since you have had normal CBC for several years now, it is unlikely that you have been suffering from chronic bacterial or parasitic infections.

Hello,

Welcome back to icliniq.com.

You sent me only two snapshots of the CT scan, this is not sufficient for evaluation (attachment removed to protect patient identity). A formal CT scan image file is a large file that has a series of images approximately 100 plus images of the abdomen taken at 0.1 cm intervals. But, if you had a formal voice with the radiologist who did your CT scan, and said it is normal, then there is no problem. I would appreciate it if you could arrange the written report of the CT scan abdomen.

Spice intake causes problems for everybody. Diarrhea, abdominal cramps, and increased feeling of acidity are common and do not suggest a small bowel problem per se. If you have diarrhea without eating spicy meals, then there is a problem. You already had a good autoimmune panel in the first place, which has mentioned various other antibodies namely SM antibodies, DNA antibodies, Sjogren profile, and celiac, and all were negative. The only test which was missing was anti-parietal cell antibodies, and anti-thyroid antibodies namely anti-thyroid peroxidase antibodies (anti-TPO), and thyroglobulin antibodies. I did not mention the two later tests since you are already in follow-up with your thyroid specialist who has been seeing these antibodies already. I do not think there is any other testing required.

A colonoscopy is only for detecting problems with the colon. CT colonography is not required, and the CT SCAN which you already have, can give us sufficient information whatever is necessary without going for a repeat CT scan. Again capsule endoscopy and enteroscopy are not required. But I suggest you get anti-parietal cell antibody tests. You can just have a routine annual check-up, no additional testing is required.

It may be thyroid-related or vitamin B12 deficiency-related. But your complete blood panel includes that also if I have not forgotten. If vitamin B12 levels are normal, then it is simply due to thyroid issues. I suggest you take capsule Pregablin 75 mg at night and see if it improves your symptoms. This medication helps to improve neuropathic pain, pain due to muscle spasms.

I hope this helps you.

Thank you.