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History of bilateral inguinal hernias. Have celiac. Getting back pain, constipation and losing weight. Treatment?

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Gastroenterologist, Surgical
Practicing since : 1989
Answered : 883 Questions
My boyfriend,46 years old, was diagnosed with celiac in April. He also has a history of bilateral inguinal hernias (repaired as a child). He has periodic mid back pain, which radiates to his stomach area. He has fluttering in his right upper abdomen, with rigidity occasionally. He feels some relief after bowel movements or farting, but the fluttering is new. We are strict with diet. He still has occasional bouts of constipation, especially if glutened accidentally. He is now lethargic (could be a touch of the flu, but no flu symptoms), his stomach is a constant source of irritation for him. I think its retrocecal appendicitis (from reading), but what tests should we be asking for? He has no health insurance, so we are looking for the least invasive, inexpensive solution. He only weight 110 pounds. He has lost 6 pounds in the last two weeks. It is getting to be desparate. Suggestions? His doctor (whom we pay cash to) only treats his hypodthyrodism, he checked for hernias about two months ago, an said he was fine (manual exam). But, we feel there is something else going on. Help.
Posted Tue, 19 Feb 2013 in Digestion and Bowels
Answered by Dr. Ketan Vagholkar 44 minutes later
thanks for writing in.
From the description which you have given it appears that your friend requires proper nutritional assessment both with biochemical as well as anthropometric markers. This will help detect all deficiencies thereby allowing correction. As he already has malaborption syndrome due to celiac disease he will require parentral nutritional supplements and perhaps even diets. This will correct most of his problems.
Regarding the querry on appendicitis, a barium study or a contrast enhanced CT will be diagnostic.
All the above will incur a significant cost but that is inevitable if he is to treated properly.
I hope this answers your querry.
Above answer was peer-reviewed by
Follow-up: History of bilateral inguinal hernias. Have celiac. Getting back pain, constipation and losing weight. Treatment? 5 minutes later
What about diagnostic blood work? Anything we should be asking for specifically? Would a stool sample be of any benefit? A 24 hour urine?
Answered by Dr. Ketan Vagholkar 11 hours later
thanks for the feedback.
The lab tests needed would dependupon the physical state of the patient. However I would suggest afew general investigations.
1. CBC
2. Serum Proteins
3. Serum B12 levels(schilling index)
4. Serum calcium and vitamin D levels.
5. Stool routine examination.
6..Renal parameters (BUN, creatinine and electrolytes)
7. Urine routine and microscopic examination.
8. Ultrasound of the abdomen.
The results of the above help to quantify the severity of the problem and will also provide ayard stick to plan the treatment including the dietary plan.
I hope this answers your querry.
Above answer was peer-reviewed by
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