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Abdominal pain, blood in stool, fatigue, lump below rib cage, elevated liver enzymes. Digestive issues and lump related?

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Practicing since : 2004
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My husband will be 30 years old next month. He has been serving as a Navy Corpsman for 11 years including one tour to Iraq and one to Afganistan. While in Iraq in 2003, he was hospitalized with severe abdominal pain. The cause for this was never determined but ever since then, he has had issues with abdominal cramping, urgent diarrhea, explosive diarrhea, and just generally an upset stomach. These symptoms came along maybe once or twice a month and I wasn't able to determine a specific trigger for it. More recently (within the past month), the abdominal pain is worse, he has blood in his stool, he's fatigued, and he has abdominal cramping. These symptoms now occur everyday. In addition to these symptoms, a hard lump has developed on the right side of his back, just below his rib cage. We noticed this lump about 2 months ago and it is getting bigger. I finally convinced him to speak with his doctor because I had been telling him for years that he caught something, possibly H. pylori, in Iraq and it's getting worse. He had blood drawn and they sent a sample out to test for H. pylori. I know his liver enzymes were elevated (I don't know the exact levels), his platelet counts were up, and his white count was abnormal (though he neglected to expand on that statement). The H. pylori test is not back yet. He was referred to general surgery for the lump but has not yet been to that appointment. My question is whether these two events, disgestive issues and this hard lump, could be connected? It's possible he just has an ulcer and this lump is something totally unrelated. However, I think it's possible that these issues are connected. I even read some information about MALT Lymphoma and thought that was a possibility, but it's pretty rare. I believe his is not getting the attention for this issue that he needs from his doctors so I want to send him to the doctor with specific questions to speed the investigation up a bit. That seemed to help when I told him about H. pylori. What do you think are some explanations for these issues and what should the doctor be checking at this point?
Posted Wed, 12 Sep 2012 in Digestion and Bowels
Answered by Dr. Om Lakhani 24 minutes later

Thanks for writing in.

There are two issues here :

1. A lump in the back
2. Symptoms of pain , diarrhea and blood in stools

Lets tackle issue 2 first . The symptoms you have described are symptoms of colitis. Could be infective or non infective colitis. Since you husband caught something while abroad, it is could be infective. However infections tend to subside with time and chronic infections causing such symptoms since 2003 is less likely. Sometimes a minor infection can trigger an underlying inflammatory bowel disease.

Either ways there are some test I would advise for the same:

1. A Sigmoidoscopy / Colonoscopy- the symptoms you have described are suggestive of a lower large intestine pathology and sigmoidoscopy or a colonoscopy would give us the answer
2. A stool examination for parasites and atypical organisms.
3. fecal calprotectin- would help us establish colitis.

As far as H. pylori goes , H.pylori commonly infects the stomach or duodenum- commonly causes an ulcer or gastritis and rarely a MALToma . Either ways symptoms you have describe fit into more of large intestinal symptoms rather than stomach of duodenum symptoms.

The second issue is the lump. It may or may not be associated with above, however since the lump is in the back it is less likely to be associated with above. Before you see a surgeon for the lump, get him examined by a general physician. In most cases your doctor can make a clinical diagnosis or atleast an impression on physical examination. The fact that he has referred you to a surgeon means he/she has made some clinical impression. Talk to your doctor about what is the clinical impression. Based on that, we can discuss what is the possible diagnosis

Hope I have answered your query. If you have any further questions I will be happy to help

Dr. Om Lakhani
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