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Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin

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Gastroenterologist
Practicing since : 1962
Answered : 693 Questions
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Dear Dr
Recently, I had a positive FOBT test.

In XXXXXXX 2013 , my Full Blood count in XXXXXXX is normal, liver function test is normal, alpha feto protein is normal, colonscopy all normal except for small XXXXXXX piles at anus. Allegic to penicillin. Endoscopy report done in Sept 2011 is normal except for -Antrum (Gastritis). Diagnosed Acute Gastritis. ESR done in February 2013 is normal.

I had on 3 occasions, dark stools.

Please advise .
Posted Thu, 8 Aug 2013 in Digestion and Bowels
 
 
Answered by Dr. Charles S Narasi 1 hour later
Hello, XXXXX,
Thank you for contacting XXXXXXX with your question.
Occult blood test can be positive from any source of
bleeding in the GI tract. That might include bleeding from
the gums, esophagus, stomach, small and large bowel.
You have small XXXXXXX hemorrhoids which could cause
intermittent bleeding, but usually the blood is bright red
not dark.
Dark stool usually indicates a high source such as esophagus,
stomach or small bowel.
In your case , endoscopy did show gastritis which is inflammation
of the lining of the lower part of the stomach. This can give rise to
a very slow bleed and the stool will turn dark or black. If you are
using any kind of NSAIDS (Non steroidal anti-inflammatory drugs)
this could make it happen. These include Aspirin, Ibuprofen, Naproxen
etc.
I would suggest that you stay on a PPI for 4-6 weeks and follow the
blood count and do occult blood test to see if this persists.
If no bleeding source is found on routine tests, you may need to
undergo capsule endoscopy which usually detects the source.
I wish you the very best.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 9 hours later
Thanks Doc
What is PPI ?

I have had done Full blood count 4 times since August 2012 to XXXXXXX 2013; all normal. 2 times Alpha feto protein/August 2012 & XXXXXXX 2013-both normal.

The endoscopy was done in Sept 2011. Is that relevant or should I do another one?

Since Sept 2012, I went on strict vegetarian and fish diet/Chicken breast and no fried or red meat where I lost 12 kg . The intention was to cure fatty liver. Latest XXXXXXX 2013 Ultra Sound did not mention anything about fatty liver. I do feel sometimes gastric sensation around solar plexus and chest area

 
 
Answered by Dr. Charles S Narasi 10 minutes later
Hello, XXXXX,
I am sorry I did not mention the complete words.
PPI stands for proton pump inhihibitors such as Omeprazole,
Pantaprazole, Rabeprazole , or Esomeprazole or Zegerid which
is a combination of esomeprazole and sodium bicarbonate.
These are all to control acidity and heal the inflammation or ulcer
in the lining of the stomach.
I am glad that you are following a diet to lose weight and it will
help your fatty liver.
No, not if you have any worsening of symptoms.
Wish you well.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 29 minutes later
Thanks Doc
If one continue to have specs of dark flakes in one's stools ocassionally, would it warrant endoscopy? The last endoscope was slightly less than 21 months ago; the only thing is that my full blood count 4 times since Aug 2012 - XXXXXXX 2013 is normal.
 
 
Answered by Dr. Charles S Narasi 9 hours later
Hello, XXXXX,
No, you don't need another endoscopy unless there are new
symptoms such as increasing abdominal pain , trouble swallowing
or black tarry stool etc.
Since your full blood count was normal , you don't have to worry.
Wish you the very best.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 3 hours later
Dear Doc, I did have dark stools as I mentioned but no remarkable episodes of abdominal pains or trouble swallowing. Seems that the dark stools alone doesn't warrant an endoscopy in your professional views?
 
 
Answered by Dr. Charles S Narasi 3 hours later
Hi !XXXXX,
Your blood count is normal and stable . At this pointyou do not need another scope exam.
Good luck.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 11 hours later
Dear Doc
Thanks for your endoscopy opinion.

My new question is on liver -cyst, fatty liver and common duct.

In XXXXXXX 2013 I did an Ultra Sound(US) and the comments is as follows:

The XXXXXXX US never mention any fatty liver whilst previous Sept 2012 CT and US August 2012 & Dec 2012 say fatty liver .

The XXXXXXX 2013 US report say(and was compared to US 28 Dec 2012):
Quote
The liver and spleen are normal in size and echo pattern. Two tiny subcentimer cysts in right hepatic lobe are stable. There is another septated cyst now seen in segment 5 measuring 08 X1.1X1.0 cm. The portal veins are patent.

There are few gallstones and tiny polyps in the gallbaldder. The gallbladder wall is not thickened. The ultrasonic XXXXXXX s sign is negative. No pericholecystic fluid is seen. The biliary tree is not dilated with the common duct mildly prominent measuring 7mm.

The visualised pancreatic head is unremarkable. The body and tail of the pancreas is obscured by bowel gas

Both kidneys are unremarkable.

CONCLUSION
1. Two stable subcentimeter hepatic cysts in right lobe. New septated cyst now seen in segment 5 measuring 1.1cm
2. Cholethiasis with tiny gallbladder polyps
3. Slightly prominent common duct likely related to age changes but correlation with liver function test advised.

May need further action
unquote

My question are:
1. What is your comments on the new septated cyst; prognosis? ie should I go for further imaging to define the septation properly

2.Does the gall bladder polyps require surgery?

3. The common duct was 3.5mm in Feb 2012 but was 3mm in August 2012 and now 7mm in XXXXXXX 2013. My Liver Function tests are normal since April 2012. Strange common duct can decrease in size? What is the prognosis?

4. Can one say that the latest US XXXXXXX 2013 does not say I have fatty liver and thus I don't have fatty liver now?

Thanks

 
 
Answered by Dr. Charles S Narasi 5 hours later
Dear XXXXX

Thank you for sending the detailed report. In my own opinion
some ultrasound interpreters read too much into it and fatty
liver is being mentioned more often when the realty is normal
architecture in most cases. I do not think you had fatty liver
since the liver tests were also normal.
As to the stones and polyps in the gallbladder , you have them.
Stones need to be addressed , I am not worried about tiny polyps.
Large gallbladder polyps in someone with advanced age (>75-80)
there is a chance of cancer.
Multiple gallstones can cause problem because one of them can get
caught in the bile duct and cause obstruction and jaundice with acute
attack. Currently , you have no symptoms related to those stones.
But should be watched.
As to the size of the duct , again it is a matter of who is doing the
actual measuring and the interpretation. I won't pay much attention
to that.
Little cysts in the liver also are benign and do not require treatment.
If the cyst is greater than 5 cm. in size , then there is chance of
infection , bleeding or rupture. All you need is a follow up sonogram
at a reputable place once in six months.
Right upper quadrant abdominal pain, severe, nausea, vomiting , fever,
chills may indicate acute gallbladder attack.
Hope this answers all your concerns.
Good luck and God bless.
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Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 3 hours later
Thanks Doc
My concern now is the Septation , the new segment 5 1.1mm cyst is not a simple cyst.

Do you think this 1.1mm septated cyst is benign because you think the XXXXXXX 2013 US did not show any vascular features or because the new cyst is too little(1.1mm) or it could be a false positive septation?

Last year Aug 2012, an US showed a subcentimeter Septated cyst in the right lobe. A follow up CT in Set 2012 did not show any septation in the cyst and also two subsequent US(Dec 2012 and XXXXXXX 2013) did show that cyst to be septated. It was thus a false positive.
 
 
Answered by Dr. Charles S Narasi 1 hour later
Dear XXXXX
I agree with you .Probably an error in interpretation or
technical glitch. Either case , I don't think you have to worry.
These are benign.
Good luck.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 6 hours later
Thanks Doc for opining that the new 1.1mm septated cyst is benign in the light of your professional experience.

Separately, what is the maximun number of Ct per year that is safe?

Had already done 2 already ; one in 2011 and one in 2012. Don't intend to do anymore

Sincerely
 
 
Answered by Dr. Charles S Narasi 2 hours later
Hi ! XXXXX,
We have to do three or four CT-Scans during a person's
hospitalization to follow an abscess's healing during 7-10
day period. So, I would say if you were to have two or three
during a year , with the present technological safeguards
that are in place , that is pretty safe.
Have a great day.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 15 minutes later
Thanks Doc
You have establised the basis of your opinion; that's good methodology.

I prefer future imaging modality thru MRI; tho' more expensive but most importantly no 'x-ray' and clearer. What do you think?

Sincerely
 
 
Answered by Dr. Charles S Narasi 9 hours later
Hi ! Again !
CT and MRI have different uses . For soft tissue structures MRI
may be better. For others CT may be preferable. I am not an
expert radiologist to make the assessment.
Thanks for your thoughts.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 18 hours later
Thanks Doc
I wonder why I keep getting cyst every 6 monthly; Ultra Sound identified the first one in Aug 2012, then a second one in Dec 2012 and now a third one in XXXXXXX 2013?

Another question, will the cysts dissolve by themselves ?

Finally, what should I do or take to increase my liver health to prevent cysts from appearing?

 
 
Answered by Dr. Charles S Narasi 4 hours later
Hello,XXXXX
There is no one answer why some people get cysts
and others don't. It could run in families. It may be associated
with cysts in Kidney or spleen. Really , no specific cause.
There is no medication that you can take to prevent the cyst
from forming.
The cysts do disappear spontaneously , yes !
Have a great day !
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 27 hours later
Dear Doc
Today I went for an endoscopy and the results are tabulated below :
10 July 2013 Sept 2011
Pre-Procedure Diagnosis : ? XXXXXXX GASTRITIS
Post -Procedure Diagnosis: ACUTE GASTRITIS Acute Gastritis

Oesophagus Normal Normal
Cardia Normal Normal
Fundus Normal Normal
Lesser Curve Gastritis(lesion site tissue for histology) Normal
Greater Curve Normal
Incisura Gastritis(lesion site tissue for histology) Normal
Body Gastritis Normal
Antrum Gastritis(lesion site tissue for histology) Gastritis
Pylorus Normal Normal
Duodenal Bulb Normal Normal
D2(2nd Part Duodenum) Normal Normal
Stoma Not applicable -

The Endoscopist told me that she can't find anything.

What is your opinion based on the the latest findings and the information you have so far?

Thank you
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 25 minutes later
Addendum
10 July 2013

Greater Curve Normal
 
 
Answered by Dr. Charles S Narasi 3 hours later
Dear XXXXX
All I can tell you is that you have "Gastritis" which means
inflammation of the lining of the stomach. What might be causing
this ? Acid and Bile damage could cause this. Medications such as aspirin,
ibuprofen, naproxen can cause this. Alcohol can also do this. One type
of gastritis just involving the lower part of the stomach called "Antrum"
can be associated with Vitamin B-!2 deficiency , that is autoimmune.
Those are some of my thoughts. Can this type of gastritis cause you to
have black stool ? Yes it could . There is a condition called "Watermelon
Stomach" and this can cause tarry or black stools.
You can talk to your doctor about all of these.
Good luck.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 7 hours later
Thanks Doc
When one has full blood count are normal, is the risk of auto /B12 deficiency there?

My XXXXXXX 2013 Full Blood count, Creatine Kinase, Liver Function , lipid are are all normal.
addendum
In particular the 21 XXXXXXX 2013 Full Blood Count are all normal , I have within normal values- haemoglobin, MCV, eosinophil etc etc

Do I have pernicious anaemia (which is associated with B-12 deficiency)?

The endoscopist says at the end of the scope' ...can't find anything...' and concluded Acute Gastritis instead of XXXXXXX

Awaiting biopsy results.
 
 
Answered by Dr. Charles S Narasi 9 hours later
Hello, XXXXX
Melena which means black stools is the reason for endoscopy.
Diagnosis was Acute Gastritis.
With normal blood count (Without anemia) it is unlikely that you
have Pernecious Anemia .
Have a nice day.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 1 hour later
Thanks Doc
Just posted some questions

Doc
Just to be clear, I should not have any issue with autoimmune/Vit B 12 deficiency/water melon stomach given that my blood profile etc etc for the last 10 months have been normal?

Have learnt a lot from this discussions
 
 
Answered by Dr. Charles S Narasi 30 minutes later
Yes, Dear XXXXX
You don't have to worry about these.
Thank you for your kind words and may God bless.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 23 hours later
Dear Doc
Will brief you next week when the biopsy results are out.

Thank you and God bless

 
 
Answered by Dr. Charles S Narasi 4 hours later
You are most welcome XXXXX
I will look forward to your reports next week.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 43 hours later
Dear Doc
1. Can you tell me what the biopsy would look for?

2. In the light of the information you have, what would you think the results would be?

Sincerely
 
 
Answered by Dr. Charles S Narasi 26 minutes later
Hello, XXXXX
Essentially , the biopsy would tell us about the degree of
inflammation (How severe ). It can also rule out any early
signs of cancer.
I have a feeling that the biopsy would show mild to moderate
gastritis or inflammation. It may or may not show H.Pylori
depending on if the pathologist does special stain to look for it.
Good luck.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 25 hours later
Dear Doc
Two days after the Endoscopy (last Wednesday where biopsies in 3 places were done), I had constipation for 2 days(Sat and Sun). Today Mon , I note there was a small dark flake floating in the toilet bowl from my bowel movements which are soft brownish stools today. The biopsy results are not out yet.

Could this could be due to the bleeding from last Wed biopsies?

The endoscopist said last Wed, '...can find anything...' My guess is that the endoscopist was referring to suspicious lesions eg obvious growth or water melon stomach (that you referred to ) or obvious bleeding sites.

For your information, my colonscopy results done 25 XXXXXXX '13 confirms small XXXXXXX piles at the Anus. Rest are normal- Rectum, Sigmoid colon , Descending colon, transverse colon, ascending colon, cecum and ileum.

I experience frequent constipation for a day and sometimes 2 days. Heard that anal fissures can give dark stools if one is constipated. Could this be my case as the obvious bleeding site is my piles?

My diet has a lot of green leafy veggies eg brocolli . Heard that green leafy veggies are XXXXXXX in iron and may also cause dark stools.

I have been having gastritis for many years .

Please comment.

Thank you.
 
 
Answered by Dr. Charles S Narasi 2 hours later
Hello, XXXXX
If you have fissure , usually it is very painful and burning
sensation is felt with difficult bowel movement. Blood is
usually bright red. Dark spots may indicate old blood.
You are correct , with lots of leafy vegetables your stool
could be dark as well but the color is not quite the same
as old blood.
You would have to wait for the biopsy results for further
comments.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 6 hours later
Tested negative for H.pylori
For your information.

Goodness, what could it be in the light of 10 -month quarterly normal Full blood count including alpha feto and esr in last Dec and XXXXXXX this yr?

angioplasia and metaplasia would show in blood tests at least
 
 
Answered by Dr. Charles S Narasi 39 minutes later
Hi !
I am glad H.Pylori was negative. I am not sure what
you are talking about Angioplasia and Metaplasia ?
That won't be in the blood. The biopsy may show angiodysplasia
or metaplasia.
Former , abnormal blood vessels and latter pre cancerous cells.
Relax.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 1 hour later
Still waiting for biopsy results
Read a bit about those stuff
Blood work markers do show abnormality that point to those things I hear
For the past 9 months , I had been on very strict diet of veggies , some brown rice, and some fish. Sometimes I missed meals. Lost 12 kg but happy to note no mention of fatty liver in last Ultra S.

I take pyslium husks daily for constipation.

Could above diet be the main cause of gastritis; latest 3 additions?
 
 
Answered by Dr. Charles S Narasi 8 hours later
Dear XXXXX
The diet that you are on is a healthy one and that should not
cause Gastritis. Glad you don't have fatty liver.
Try not reading too much into what any body might say.
Wait for the results of the biopsy.
Good luck.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 2 hours later
Thanks Doc for your kind words esp negative H.Pylori and no fatty liver. Used to have until diet change. Now getting back some weight as had lost too much.

The endoscopy report says CLO negative. Is that the same as H. pylori negative? Nurses told me yes.

 
 
Answered by Dr. Charles S Narasi 1 hour later
Hello,XXXXX,
At the time of endoscopy a biopsy is taken and the specimen
is put in a medium. CLO test is also called the Rapid Urease test.
The nurse is right , this is done to detect H.Pylori. Obviously , you
did not have this. Good !
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 9 hours later
Thanks Doc
What is helpful is to have an opinion before bio results:

In the light of information we have:
1. Endoscopy opines acute gastritis
2. Can't find anything
3. Normal blood count including alpha fetoprotein
4. No anaemia
5. H.pylori negative



 
 
Answered by Dr. Charles S Narasi 1 hour later
Hello, XXXXX
My answer would be

2, 3 , 4, 5 !

Good night !
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 7 hours later
Thanks Doc
Curious, you seem to disagree with No 1

Why?
 
 
Answered by Dr. Charles S Narasi 2 hours later
Hello,
Awaiting biopsy ?
That will show acute or chronic gastritis !
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 4 hours later
Thanks Doc
The main question I am asking now is what is causing the dark flakes/stools I have had?

My layman hypothesis is that the main- and only cause- of the dark flakes/stools is that my gastritis(and not something else) has never been treated since the first endoscopy in Sept 2011. Today, I visited a family physician and is commencing on Omeprazole and Magnesium Trisilicate. Because of non-treatment , the XXXXXXX 2013 endoscopy showed 3 new areas of gastritis on top of the first antrum gastritis.

To exclude other causes, I plan to continue Omeprazole and Magnesium Trisilicate and do stool analysis test monthly for the next 3 months. If there is no dark stools or flakes then , it is logical to assume the source of the XXXXXXX bleeding was due to gastritis and not something else.

What do you think of my explanation?

 
 
Answered by Dr. Charles S Narasi 2 hours later
Dear XXXXX
I agree with you that Gastritis, if severe enough can cause
slow bleed and stool can have black spots.
I still need to wait for the final pathology report to grade the
gastritis.
That's all I can say at this point.
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 38 hours later
Dear Doc
I have herpes simplex 1. Could this also trigger gastric inflammation?
Been on and off acyclovir for cold sores on my mouth when they flare up ; more so in 2012 and before.
 
 
Answered by Dr. Charles S Narasi 2 hours later
Hello,XXXXX
In my experience , the answer is No .
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 2 hours later
Thanks Doc
If the report says mild , what would you think?
 
 
Answered by Dr. Charles S Narasi 1 hour later
Hello,XXXXX
I will say "Good " and thank God .
Above answer was peer-reviewed by
 
Follow-up: Have piles and gastritis. Had positive FOBT test. Blood, liver and protein test normal. Allergic to penicillin 7 minutes later
Please explain
Mild
Moderate
Severe
 
 
Answered by Dr. Charles S Narasi 2 hours later
Hello, Dear XXXXX
Mild ,Moderate and Severe refers to the degree of changes
of inflammation seen under the microscope of the tissue
from the stomach lining obtained at the time of endoscopy.
Pathologist can see changes of various cells which can tell
him or her how extensive the inflammation is. Mild is minimal
changes. moderate is more changes and severe is extensive changes.
Complications are greater if the degree of inflammation is severe.
That would be the best way I can explain it to you.
Have a nice weekend.
Above answer was peer-reviewed by
 
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