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Suffering from abdominal pain, lymphnodes on shoulders. Medical test done. What are the findings?

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Dr. Charles S Narasi

Gastroenterologist

Practicing since :1962

Answered : 693 Questions

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Posted on Mon, 11 Feb 2013 in Abdominal Pain
Question: Hello Doctor,
good Day!
I was suffering from severe Pain in my Abdomen for quite 4years, whenever i check with the local doctors, they confirmed its due to weakness and prescribed me medicines accordingly. i will be ok for some months and again i start getting a pain.

Now for the last 20days i had acute pain along with loose motion and with Vomiting / vomiting sensation.

i was asked to take CT scan were we could identify problem as below

1. Multiple Mesentric Lymphnodes noted predominant in the right lower quadrant largest measuring to 1.2 x 0.9cm.
2. Mild Circumferential Wall Thickening in the terminal Ileum.
3. Heterogeneously enhancing soft tissue density lesion in the uterine Myometrium - Fibroid.

Based on the report, i was asked to consult Gastroenterologist.

I had some Lymphnodes on my shoulders (both right & left side) i was diagnosed Tuberculosis in 10yrs back. i was completely cured with the medicine (thoughi had break in continuing medicine)

My gastroenterologist advised me to take blood test details as below

TC / DC/.HB/ ESR/ CRP / Peripheral Smear/ S.IGE.
LFT / S. Amylax / S.Lipids

Digital X- XXXXXXX
CXR - Pa / X-Ray PNS

Ultrasound of whole abdomen - Proved normal
Urine Routien / Motion Routine.

My X- XXXXXXX report says:
Soft Tissue Shadows appear unremarkable
Mild Deviation of Nasal septum to Right Side

My weight has increased by 2kgs in the last 4months

as per Blood test Report:
My Hemoglobin has been increased from 10.8% to 12% in the last 4months.
WBC was increased to 7100 cells/ cu.mm from 4000 cells / cu.mm in the last 4months

Polymorphs -70%
Lymphocytes - 26%
Eosinophils - 04%
Monocytes -0%
ESR - 4mm in Half an hour
ESR - 10mm in 1hour
Sr. Amylase 54 U/L
Sr. Lipase 29 U/L
CRP - Positive

Liver Function Test
SGOT - 36 iu/l
SGPT - 29 IU/l
ALP 142 iu/l
Bilirubin - 0.7 mg/dl (direct 0.4mg/dl) and indirect 0.3mg/dl
Total Protein - 5.6gms%
Albumin - 3.4grams%
Globulin - 2.2grams%
A/G Ratio 1.54
SR. IGE - 53.83 IU/ML

Urine routine:

Sugar (R) - NIL
Albumin - NIL
Deposits|:

EPi Cells - 2-3 cells / hef
Pus Cells - 1-2 cells / hef


Motion complete examination

color - Brownish
Consistency - Semi Solid
Reaction - alkaline
Mucous - Nil
OVA - Nil
Cyst - Nil
Others - Nil
Pus Cells 4-6cells/ hpf
Bacteria - Positive
FOBT - Negative

I was asked to take Medicine
pantodac 40 -1 before breakfast
Capusule Nutrolin B -1-0-1
B-activ - 1 in the morning after food

i am having this medicine since last night fortunately i dint had pain in my abdomen, my Gastroenterologist told me; there might be possibilities Colonel Tuberculosis and if the test given doesnt show any cause of the pain, i was told to do colonoscopy.

People arround me scares me not to go for colonoscopy.since i am not married and 30yrs old. please guide me what could be the reason for the pain,
Will this lymphnode become Tuberculosis / Cancer cell
or its just a infection that can be cured once for all through Medicine.

Please suggest me what should i do further to get rid of this pain.
regards,
XXXXXXX
doctor
Answered by Dr. Charles S Narasi 54 minutes later
Hello, XXXXXXX,
You state that you have been treated for TB 4 years ago.
I am assuming that was the pulmonary(Lung) variety.
Most important findings from your CT-Scan are the
enlarged lymph glands around the intestne and the
thickening of the lower small bowel at the junction
of the large intestine. These type of findings are seen
in Crohn's disease and also tuberculosis involving that
part of the intestine.
I agree with your gastroenterologist that a colonoscopy
would be very helpful in ruling out Crohn's.
CT -guided biopsy of the lymph node may be helpful
to rule out TB.But, if there is strong suspicion of Crohn's
biopsy could cause problems.
You should get blood tests -IBD Panel.If positive,further
tests can be ordered and there are effective drugs to
achieve remission, since we still don't have a cure.
Right now all your blood, urine and stool tests all look
normal except for CRP which is mildly elevated and this
is non-specific.
There is no reason to fear colonoscopy procedure.
This is done even in children.
Procedure is life saving.
I wish you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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