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    What causes persistent diarrhea along with abdominal cramps and nausea?

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Posted on Mon, 28 Aug 2017 in Digestion and Bowels
Question: I just had my annual physical last week and I have an ast level of 53 and normal alt level. I have elevated bilirubin, had it all my life it fluctuates between 2.1-2.5. I also was just diagnosed with mild anemia. My Hgb is 12.1. I had high RDW around 19 and my MSV was normal. I am fairly healthy, I work out four days a week three days with weights and one for cardio and maintain a decent diet.

At the end of XXXXXXX i came down with some type of sickness which caused fever, joint, pain, coughing, chills etc. I had that twice in one week. The week of my routine physical I had diarrhea for three days along with stomach cramps and nausea. I have two questions.

1. How concerned should I be with my AST level?
2. How concerning is the mild anemia and is there a correlation between the two.

My doctor told me not to drink for a month, which I rarely do probably about 4-8 beers a month and they would recheck my levels in a month. He is also having me perform fecal tests at home to check for blood in my stool.
The original question did not have all of my details this one below does.

I just had my annual physical last week and I have some values that concerned me. I have an AST level of 53 which is above the normal of 40 or 45 and normal AlT of 26 level. I have elevated bilirubin, it fluctuates between 2.1-2.5. For my past physicals it was 2.0, 2.1, 2.4, and now 2.5. This is over a four year period and all of my other results were normal till now. I also was just diagnosed with mild anemia. My Hgb is 12.1. I had high RDW around 19 and my MSV was normal. Of course hemocorit was low and my platelet count was below normal at 121. I am usually at 150. I also had a low rbc around 3.65.



I also had two or three viral infections this summer. I had one or two infections a month before my physical, they were both within two weeks within each other and the other was the week of my physical. The first infections a month before my physical caused massive headaches, bodyaches, fever, chills, and sweating. My wife had it as well.

The second one; the week of my physical caused stomach cramping with frequent diarrhea. My wife had this as well as so did my daughter. I am fairly healthy, I work out four days a week three days with weights and one for cardio and maintain a decent diet.



I have three questions.


1. How concerned should I be with my results? I have spoken with some people who said its not a concern at all and others said I need to be checked for chronic liver disease despite the fact I rarely drink.

2. My bilirubin has been high for four years and as increased a little each year. My DR thinks I have XXXXXXX Syndrome. And at this last physical he said I have a fatty liver. Would a fatty liver cause these types of lab values to be abnormal?

3. Also I know chronic liver disease can be caused by an obstruction, since I have had elevated bilirubin for four years possibly more would I bee experiencing symptoms from an obstruction? My urine is normal color, as is my stool. No yellowing of the eyes or skin and no stomach or upper chest pain.



My doctor told me not to drink for a month, which I rarely do probably about 4-8 beers a month and they would recheck my levels in a month. He is also having me perform fecal tests at home to check for blood in my stool. I did an at home kit to check for blood in my stool and so far 2 of the 3 tests have came back negative.
doctor
Answered by Dr. Ramesh Kumar 15 hours later
Brief Answer:
Very likely its XXXXXXX

Detailed Answer:
Hello,
Thanks for choosing HealthcareMagic for your query
I am a Gastroenterologist and would be answering your query.
Answers to your queries are as follow-

As per your query it would take almost 3 months to bring back the liver enzymes to normal..

Frankly speaking you should go for two tests-
1)ultrasound abdomen-Any pathological problem with hepato-biliary system would be reflected for e.g cirrhosis fibrosis etc.
As per standard text a minimum of 3 times of ALT and AST more then normal is required to be clinically significant.
i would take your case as mild rise in liver enzymes idiopathically(cause unknown).Chances of it being chronic liver disease is very rare as you are totally asymptomatic and secondly your bilirubin level is not elevated to a level which are clinically significant.A total bilirubin level less then 3 has no clinical value.
However you can Start taking Sylmarin(Milk of thistle) once daily along with Liv 52 DS(herbal preperation).Its a potent liver rejenuvator and help to rejenuvate the liver cells and would help to replete mildly deranged Liver functions.

Follow a proper diet as suggested below-
-Whole grains are very beneficial to consume.These can be in the form of XXXXXXX whole wheat bread or cereal, brown rice, whole grain pasta,grains such as whole oats, wild rice, rye, oatmeal and corn are also beneficial and can be taken if suits your fooding pattern.
-Fruits and vegetables should be a significant part of any diet to help in recovering from a liver disease. They are full of essential nutrients and are easy to digest.When on recovery diet follow a high carbohydrate diet,Fat contents of diet should be very low.However Olive oil, canola oil and flaxseed oil are all healthy fats that are recommended as part of a diet for patients.
-Healthy proteins in the form of low-fat milk and dairy products along with lean meats, beans, eggs and soy products can also be a part of a healthy liver diet.


2)Any patient with constant mild elevation in levels of bilirubin with almost normal LFT can be considered as having XXXXXXX syndrome.The combination of normal blood and liver function tests and elevated bilirubin levels is an indicator of Gilbert's syndrome. No other testing usually is needed, although genetic testing can confirm the diagnosis.Some fat in your liver is normal. But if it makes up more than 5%-10% of the organ's weight, you may have fatty liver disease.There are many grades of fatty liver disease in which grade 1 and 2 are normal in patients above age of 35.So mild fatty liver has nothing to do with your problems.

3)There are two forms of bilirubin
1)Conjugated
2)Non conjugated
Un-conjucated bilirubin reaches liver where its converted into conjugated bilirubin. So in case of obstruction this bilirubin can't be conjugated normally leading to rise in levels of non-conjugated or indirect bilirubin in blood.



Advice-
Go for
An ultrasound abdomen and serum direct and indirect bilirubin. If these tests are normal you have Gilbert's.

Warm regards.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar 1 hour later
No concern for my mild anemia and low rbc. Wbc was normal but lower than usual I'm usually around 7 but was 4.5 this time. But could be due to multiple viral infections in a month.
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Follow up answer.

Detailed Answer:
Hello there,
See firstly anemia are of many types from hemolytic,thalessemia minor to iron deficiency.So firstly we have to rule out that from what type of anemia are you suffering from.For this apart from your blood profile; Peripheral smear of blood is required.In a peripheral smear we can differenciate the type of anemia.
Apart from that few tests like serum transferrin saturation.Serum ferritin,Total iron binding capacity should be done.Exact pathology and nature of anemia can be known only after that.
(Though personally i don't feel that you should worry about mild anemia.)
4000-11000/mm3 is normal WBC count so 4.5 is normal.
Yes lower wbc are seen in some types of infections but they have no sIgnificance in your case.
In few days these parameters would come back to normal.
Unless you are symptomatic only issue to take care of is bilirubin.

Feel free to follow up.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar 38 minutes later
Thank you I was concerned about aplastic anemia or possibly leukemia since rbc and platelets were low and my wbc was lower than usual.
doctor
Answered by Dr. Ramesh Kumar 1 minute later
Brief Answer:
Follow up answer.

Detailed Answer:
Hello again,
Very basic tests have been done on you so don't worry leukemia and aplastic anemia usually are associated with a number of symptoms and gross derangements.
Don't worry you are normal.
You look very concerned about fatty liver but fatty liver grade 1 and 2 are very common in adults and apart from prohibition and sylimarin nothing else is usually done.
Regards.

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ramesh Kumar 28 hours later
Thank you for your advice. I did a direct and indirect test today and I am seeing a gastrointestinal Dr this week. One last question why would my platelets be low? Due to anemia?
doctor
Answered by Dr. Ramesh Kumar 14 hours later
Brief Answer:
Follow up.

Detailed Answer:

Hi again,
No dear anemia has nothing to do with platelets but in some viral infection's platelet's are severely lowered.As per your history you have suffered from recurrent viral infections.
Platelets 121 are definitely on lower side and needs monitoring.Repeat platelet test after 4 days if trend is on rising side then you need not to worry however if you see that further decrement in platelet count is there further tests would be done.

Please attach reports of Direct and Indirect bilirubin.

Thanks.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar 7 hours later
My bilirubin test came back I was 2.3 total 0.48 direct Ast down from 53 to 20 and Alt down from 26 to 14. How should I interpret those results?
doctor
Answered by Dr. Ramesh Kumar 21 minutes later
Brief Answer:
Its XXXXXXX syndrome.

Detailed Answer:
Hey again,
Your direct bilirubin is almost normal.
Indirect and total bilirubin are on higher side.

As per the definition a patient with constantly elevated levels of bilirubin and elevated unconjugated bilirubin with normal LFT is Gilberts syndrome and no further testings are required.

Unfortunately its Gilberts.
Thanks!
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ramesh Kumar 54 minutes later
I have an appointment with a gastrointestinal Dr tmrw still a good idea to go? And I still don't understand the anemia and low platelets. Unless it was a byproduct of my multiple viral infections.
doctor
Answered by Dr. Ramesh Kumar 15 hours later
Brief Answer:
Follow up answer.

Detailed Answer:
Hi again,
Yes dear you should visit your gastroenterologist.
A diagnosis can't be given online so you have to consult a doctor physically. XXXXXXX is a genetic disorder and is characterized by intermittent episodes of jaundice in the absence of hepatocellular disease or hemolysis. The patients have variable degrees of ANEMIA, jaundice, and splenomegaly.

As per standard text variable degree (mild to moderate) anemia can be seen in patients with XXXXXXX syndrome.There could be a possibility of the coexistence of Gillbert with Heriditary spherocytosis.

However as explained earlier you have to go for peripheral smear of blood and transferrin,ferritin TIBC tests to rule out the exact nature of your anemia.
Viral infection supresses the bone marrow functions platelets and red blood cells are produced in bone marrow so it may be a reason behind mildly deranged figures.

Regards.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Answered by
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2438 Questions

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