Dr. Noushif. M
Surgical Gastroenterology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 39-year-old female suffering from abdominal pain and intermittent diarrhea. Had a CT with contrast that revealed bowel wall thickening in ascending and transverse colon- possible transmural thickening, that may just be artifactual, but it did show up and warrant GI consult. Abdominal X-ray was negative for obstruction, but there were distended loops of the bowel where the pain is. The main issue at this time is continued pressure and fullness on RUQ and LLQ. Feels like I need to have more bowel movement and have incompletely evacuated. No nausea or vomiting. All labs are normal including ESR. Colonoscopy and upper GI scheduled in few days. How likely is Crohn's diagnosis with these symptoms and workup?
Hi,
Welcome to icliniq.com.
You have a suspected thickening of the right colonic wall and features of subacute obstruction (attachment removed to protect patient identity). Crohn's can be a possibility but chances are less. The next step would definitely be a complete colonoscopy.
For more information consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist
Patient's Query
Hi doctor,
Thank you very much for your reply.
Since my colonoscopy was not scheduled for four days, I went back to ER with concerns of partial bowel obstruction. Had a CT with IV contrast. All negative so I will wait to complete colonoscopy. Here is my question, the first CT used both oral contrast and IV contrast. Is oral contrast preferable to do in your field of study to enhance bowel pathology? In other words, if CT is only done with IV contrast, could it maybe miss visualization of thickening of bowel wall?
Hi,
Welcome back to icliniq.com.
It depends on the CT protocol of the center. Thin slice CT with IV contrast is taken usually. Oral contrast distended the bowel and helps in a better delineation of luminal pathologies. For colonic lesions a rectal contrast is also added (given like an enema). At some centers, water is used as the negative contrast for bowel. As far as your case, we already have a suspicion of right colon thickening which definitely needs a colonoscopy.
For more information consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist
Patient's Query
Thank you doctor,
That makes sense. With this being said, would it be safe to say I am okay to wait for colonoscopy considering I maintain hydration and do not have severe pain? Unfortunately, when the CT W IV contrast came back negative I felt it did not substantiate me to stay considering labs were normal.
Hi,
Welcome back to icliniq.com.
No problem in waiting for four days. Consider liquid diet till then to avoid any bowel obstruction or pain. It also helps in clearing the bowel to facilitate colonoscopic examination. There is a 50 % chance of colonoscopy being normal, in which case you can be relaxed.
For more information consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist
Patient's Query
Thank you doctor,
That sounds reasonable. And, I feel good as long as I am on liquids only. Also, what other areas would you explore in the event that the colonoscopy is normal, i.e. celiac, IBS, etc?
Hi,
Welcome back to icliniq.com.
Yes, nonobstructive pathologies. Biopsy from distal small bowel or colon will be done if needed. As per CT, the small intestine was normal. So let's wait till colonoscopy is done. Do not get messed up thinking of possibilities. You may or even may not have one.
For more information consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist
Patient's Query
Thank you doctor,
I have attached the files.
Hi,
Welcome back to icliniq.com.
It is nice to hear that your colonoscopy is normal. Had a look at your angiogram report (attachment removed to protect patient identity). Celiac and SMA (spinal muscular atrophy) are the blood vessels from our aorta (chief artery of the body) which supply the intestines. There are few scenarios in which the arterial supply to intestines through these vessels turn insufficient. These are rare scenarios and can happen due to narrowing of the origin of these vessels from the aorta. This results in recurrent abdominal pain, which usually occurs after having food (postprandial pain) when the demand for increased blood by the intestine is not met.
The mere presence of a narrowing does not mean we need to treat it. Our intestines gradually adapt by developing collateral blood vessels. Some amount of narrowing can be present in normal individuals too. Only patients who have the typical features of arterial insufficiency like postprandial pain, weight loss, etc., need to be treated. Regarding your case, the pain is not typical and your symptoms cannot be explained completely with this.
For more information consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist
Patient's Query
Thank you doctor,
Such a mystery. He wants to do a PillCam study as well. Does that sound reasonable?
Hi,
Welcome back to icliniq.com.
PillCam is basically a capsule endoscopy. You swallow a capsule which passes through the intestines and takes serial images. Relevance in your case between stomach and colon, there is a long segment of intestine (known as small intestine). The role of PillCam is mainly to see this segment. This completes the evaluation of intestines. There is nothing wrong with doing this if we really have a suspicion of small intestine pathology. As I told you earlier, these may or may not be positive.
For more information consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist
Patient's Query
Thank you doctor,
I am uncertain if my GI doctor has really paid attention to these results. It concerns me that my platelets have dropped from 259 to 181 in just 11 days and my hematocrit has dropped from 38 % to 35.8 %. What are your thoughts?
Hi,
Welcome back to icliniq.com.
Nothing so alarming. Hematocrit varies depending on the hydration. Dehydration increases hematocrit and vice versa. Platelets normally vary between 151 and 400. So needs serial follow up.
For more information consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist
Patient's Query
Thank you doctor,
That is my concern about serial draws dropping. Is this not indicative of something autoimmune occurring? 292 to 181 within a month.
Hi,
Welcome back to icliniq.com.
Autoimmune is unlikely. Even now it is within the normal range. Can see a couple more values and consider a peripheral smear test then.
For more information consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist
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