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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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How can depleted intestinal flora be treated?

Answered by
Dr. Ramesh Kumar


Practicing since :1986

Answered : 2349 Questions

Posted on Thu, 9 Feb 2017 in Digestion and Bowels
Question: I have a history of diverticulitis. Had a successful resection in 07.. Seems tho that I have an irritable bowel. My internist says I have chronic diverticulitis, but he is guessing. I had a colonoscopy last spring. The doc who did the surgery said it was time. No polyps or evidence of more than some diverticuli . I have a lot od diahrrea. Just have black stools. My bottom (anus) hurts.( I do have a hemorhoid) Burns actually. I have a creme but the Hemmorhoid cream works best. I have bowel movements lately that are not watery but often, and black. No pain in gut. I have a specialist but I don't seem to fit the criteria or something. I don't know why. Nothing gets solved really. I have had a CT scan which dr. ordered...Just nodules here and there. Lung nodules, a few in kidney, in gall bladder. I feel great other than this bowel thing. I am not sick ever except for this.

The thing is, I don't want to be negligent, and I don't want to ignore this as I take my kaopectate and my diahrrea pill.. But there has to be a reason. I don't see any correlation between fiber and diahrrea unless I really ,really overdo it.
Two weeks ago, the bowel was acting normal again. It is a confusing situation all right. My specialist had me do so many bowel submissions to the lab that it was getting embarrassing, truly. But they were devoid of bacteria
I cannot send you my file because it is HTML and I have no idea how to change it. I will try.

This is my document. Sorry. It was a photograph and I am learning how to change it. So I am copying and pasting. Sorry
Print Page Logo
01/16/17 XXXXXXX's Report Details
Chest CT, Abdomen/Pelvis CT
Pt Name: XXXXX
DOB: 00/00/0000
Order #: 11-0010; 11-01
Ordering Provider: XXXX
CPT Code: 0000; 0000
Exam Date: 00/00/00
Location Performed: XXXX
Procedure: CT Abdomen and Pelvis W; CT Chest W



Reason: Lung nodule. Hepatic mass..



Axial images are obtained through the thorax following the uneventful intravenous bolus of 75 mL Omnipaque-300 contrast material.


No previous CT chest.

Heart size is normal. No pericardial effusion. Aorta, pulmonary arteries, and branch vessels appear grossly normal.

Thyroid is normal. Mediastinal configuration appears unremarkable. Calcified hilar and mediastinal granulomas. There is no suspicious hilar or mediastinal lymphadenopathy. The airways are clear. No hiatal hernia.

Nodular scarring in the lung apices. Calcified granulomas bilaterally. 4 mm pleural-based noncalcified nodule right upper lobe anteriorly on image #4/66. Reticular opacity in the middle lobe on image #4/81 through image #4/82, tiny subpleural nodule image #4/86. 3 mm subpleural nodule right lower lobe image #4/92. The nodule along the minor fissure shows calcification. Tiny subpleural nodule left upper lobe image #4/32. Subpleural left upper lobe nodule on image #4/54 measures 5 mm. Localized pleural thickening laterally in the left upper lobe. Small pleural-based nodule left lower lobe image #4/84 and image #4/92. Small pleural-based nodule left lower lobe image #4/104. Peripheral nodule left lower lobe image #4/108 measures 5 mm. Nodule just above the diaphragm image #4/107. No pulmonary mass. No consolidated parenchymal opacities, no pleural effusion or pneumothorax.

Osseous structures in the thorax are grossly normal. No destructive osseous lesions are seen.



Multidetector axial images are obtained through the abdomen and pelvis following the uneventful intravenous bolus of Omnipaque-300, and oral ingestion of Redicat.


Comparison: 00/00/0000

Liver is normal in size. The small low attenuating right liver hepatic lesions are again seen, show no interval change, probably represent simple cysts. Largest measures just under 4 mm in size. No suspicious solid or cystic hepatic mass. No intrahepatic bile the dilatation.

Gallbladder is normal in diameter. There is some high density debris within the dependent gallbladder, probably represent very small stones. No evidence of acute cholecystitis or choledocholithiasis. Spleen is normal in size, there are calcified granulomas. No solid or cystic splenic mass. Thickening of the apex left adrenal gland is again seen. No discrete underlying mass. Right adrenal gland is normal. Kidneys are normal in size. There are renal cortical cysts, no solid mass. No urinary tract stones, no evidence of urinary tract obstruction. Urinary bladder is normal, ovaries are normal. Previous hysterectomy.

Visualized bowel is normal in caliber. No sign of bowel obstruction. Minimal distal colon diverticulosis. No evidence of acute diverticulitis. Previous appendectomy. Essentially unremarkable GI tract..

There is no adenopathy, no ascites or free intraperitoneal air. The vascular structures are patent. Extraperitoneal soft tissue structures are normal.

Degenerative changes in the spine. Severe degenerative disc at L2-L3, and L4-L5. No aggressive appearing osseous lesions.


1. Multiple small pulmonary nodules, largest measures 5 mm in size. Follow-up per Fleischner Society recommendations.
2. No thoracic lymphadenopathy. No pulmonary mass. No acute cardiopulmonary abnormality.

1. Stable low attenuating right hepatic lesions, probably simple hepatic cysts.
2. Renal cortical cysts.
3. Minimal colonic diverticulosis. No evidence of diverticulitis. No bowel obstruction.
4. Probable cholelithiasis. No evidence of acute cholecystitis or choledocholithiasis.
5. Otherwise unremarkable CT of the abdomen and pelvis. No abdominal lymphadenopathy or evidence of malignant process


Low risk patient: (minimal or absent history of smoking and of other known risk factors)
< 4 mm No followup needed
4-6 mm Followup CT at 12 months; if unchanged, no further followup needed
6-8 mm Initial followup CT 6-12 months then at 18-24 months if no change
> 8 mm Followup CT at around 3, 9, and 24 months.

High risk patient:(history of smoking or of other known risk factors)
< 4 mm Followup CT at 12 months; if unchanged, no further followup
4-6 mm Initial followup CT at 6-12 months then at 18-24 months if no change
6-8 mm Initial followup CT at 3-6 months then at 9-12 months and 24 months if no change
> 8 mm Followup CT at around 3, 9, and 24 months. Nuclear medicine PET scan and/or biopsy

~~~Electronically Signed By: XXXXXX

Dictated by: XXXXXX
D: 1001/0016/1600014
T: 0110/1600/1600101004/
Answered by Dr. Ramesh Kumar 4 hours later
Brief Answer:
Deplenished intestinal flora!

Detailed Answer:
Thanks for choosing health care magic for your query!

Our gut has its own enviroment called gut flora.Because of age and a number of factors like medication ,prior surgeries etc the gastric flora is deplenished.Gut flora is the complex community of microorganisms that live in the digestive tracts of humans,The intestinal microflora is a complex ecosystem containing over 400 bacterial species. Anaerobes outnumber facultative anaerobes. The flora is sparse in the stomach and upper intestine, but luxuriant in the lower bowel.Destruction of this flora can cause loose stools or constipation,iregular bowel.
I would recommend you to take a course of probiotics so that the destroyed flora can be replenished ,once the intestinal flora will become normal,Gut mobility and digestion will improve and your problems will settle down.
Apart from probiotics following should be done-

-Take two tea spoon isphagula husk with 200 to 300 mL water once while going to bed every day.
- Increase XXXXXXX warm water intake
- Eat small meals ,Avoid eating outside for few days ,Try to eat vegetable,Take a lot of curd along with food.
- Eat plentiful "fresh oranges" and "pear "
- Avoid COLD milk and and AVOID junk food(NO burger , pizza-even if its veg.)
- avoid beverages / alcohol/ soft drinks
- do some exercise (push-ups / squats etc) early in the morning
- avoid carbonated drinks
- take 2-3 spoon edible virgin olive oil in the morning

Apart from that most of the nodules reported in Ct and other reports are small and need not to be worried of,All ssri's causes diarrhea so if you are having
escitalopam then you should follow the advice given by me above.
As other stool reports are normal,There is no need to worry you will be fine soon.

Thank you!

Above answer was peer-reviewed by : Dr. Raju A.T

The User accepted the expert's answer

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