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What causes elevated CRP level? - Online Doctor Chats

Date : 19-Apr-2014
User rating for this question
Very Good Posted in: X-ray, Lab tests and Scans
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
I am generally fit & healthy, I have IBS. I have been having problems for the past four weeks: I have RLQ pain, intermittant RUQ pain, Paraesthesia RLQ, Loss of balance on right side, relative weakness on right leg (75%), Fasiculations (intermittant), Abdominal distenstion, raised ALT. A contrast CT and pelvic and abdominal ultrasound have shown no pathology, CRP is
Let me read your query for few minutes to be able to have a good discussion here.
User:Ok, thanks.
Doctor:all right, I have read your query
Doctor:Sorry about your health concerns
Doctor:Since your CT and ultrasound reports are normal, I do agree with your GP about relating it to stress
Doctor:Since, no organic causes are noted on CT or scan, I would like to look at other possibilities here
User:If I do not feel stressed, is there an evidence-based way of determining whether it is stress?
Doctor:You could watch over the symptoms yourself
Doctor:There are no objective ways to check the same
User:What is the DD if stress is removed?
Doctor:Yes, I am coming to that point
Doctor:The abdominal pain symptoms along with stress can be due to pre-existing IBS itself
User:IBS is intermittant and moves around the abdomen.
User:It does not stay in the same place for 4 weeks
User:It is a different type of pain from IBS
Doctor:Like Vitamin B12 deficiency
Doctor:apart from this, the loss of balance on right side, relative weakness on right leg (75%), Fasiculations (intermittant)- these symptoms could be neurological
Doctor:or even calcium deficiency
Doctor:The second DD for it is non-specific colitis in which again the radiology reports are normal
User:As far as I know blood tests are normal although I do have folic acid deficiency
Doctor:This improves with a course of intestinal antibiotics and probiotics followed
Doctor:Folic acid deficiency can cause Paraesthesia and weakness in the legs, along with fasciculations
Doctor:How about the Vitamin D level
Doctor:what is your B12 levels along with Calcium?
User:Everything normal except folic acid (low), ALT (raised), TSH (raised, but T4 is normal).
Doctor:May I know the TSH level in number, also the ALT
User:The GP did not tell me TSH though T4 is 19 (range 10-24). ALT is around 80.
Doctor:Please do get that checked, the TSH number
Doctor:The raised ALT at 80 is still fine
Doctor:It may be caused by the strong pain killers that you are taking
User:My GP said TSH is irrelevant if T4 is normal
Doctor:I would suggest you to not take much pain killers
Doctor:No, that is not right
User:Apparently ALT is supposed to be 34
Doctor:The value of TSH is more important
Doctor:Also when T4 is normal
User:If I do not take painkillers I cannot function at all, but i can stop the one that I know can cause raised ALT.
Doctor:Because, in subclinical hypothyroidism TSH is elevated while T4 is normal
Doctor:This needs medication
Doctor:Yes, the normal value of ALT is to be at 34
Doctor:However a value of 80 is acceptable as well
Doctor:The value is significant only when it runs in hundreds like 200 or 300
Doctor:good, stop that medicine
User:What else is in the DD for severe continuous abdominal pain, RLQ, made worse by sitting upright, relieved slightly by lying flat (supine)?
Doctor:Appendicitis is a classical DD
Doctor:Right ureteric colic or stone is one other DD
Doctor:Salpingitis is a DD too
Doctor:Along with ectopic gestation if you are sexually active
User:Is appendicitis definitely ruled out by CRP
User:Pregnancy has been ruled out
User:Pelvic USS rules out uteric stone
Doctor:No, appendicitis cannot be ruled out that way
User:My GP thinks it can
User:What should I tell him?
Doctor:It is mostly clinical diagnosis and if the symptoms are consistent, one can go ahead with the surgery of removal of appendix
Doctor:You did not mention about your bowel state
Doctor:Or you constipated or having loose stools now?
User:Bowel state has returned to normal following constipation treated by laxatives
Doctor:Please ask him to re-evaluate you
User:Do you have any other ideas about what this could be?
User:Are there any auto-immune disorders that could present like this?
Doctor:I mostly suspect non-specific colitis as I told you initially
Doctor:auto-immune disorders do not present solely with abdominal symptoms
User:Wouldn't colitis cause fever, bowel problems and raised CRP or ESR or WBC?
Doctor:not really, when it is non-specific and sub clinical infection
User:How can I get my GP to consider the possibility of sub-clinical infection?
Doctor:Going by your symptoms, and perhaps a simple stool routine test
Doctor:like I said, subtle changes need not show up on radiological investigations
User:Can subtle changes cause severe pain lasting for four weeks?
Doctor:yes, pain can last for four weeks but not severe
Doctor:It is usually mild to moderate in intensity
User:Thank you for chatting with me, I will ask my GP to re-evaluate the situation.
Doctor:Wish you quick recovery and good health
Doctor:It's my pleasure
User:Thanks, bye.
Doctor:Thank you too
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