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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What does my lab test report indicate?

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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 1924 Questions

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Posted on Thu, 14 Jun 2018 in Digestion and Bowels
Question: Hello, I am a 61 year old female, with pain in my right side just below rib cage beginning in July, 2017. It went away in Augst 2017 and returned in late September 2017 and has been bothering me since. I am a current smoker, I have gastroparesis and rapid gastric emptying for 11 years. I have copied my most recent ct scan and capsule endoscopy below and questions below the tests. Thank you for any advice.
DECEMBER 1, 2017- CT of the Abdomen and Pelvis- History: RUQ, LUQ pain radiating into right flank. Nausea, diarrhea, increased flatulence x 3 months. Pt hx of gastroparesis. Pt sx hx includes hernia repair, hysterectomy, cholesystectomy. IV Contrast: 125 ml Isovue-300- Oral Contrast: YES
Bowel: The bowel is nondilated. There is no evidence for obstruction. The appendix is not visualized but there are no inflammatory changes in the region. The terminal ileum is normal.

There is a section of proximal jejunum beginning just beyond the ligament of Treitz extending for approximately 10 cm which shows abnormal wall and fold thickening. The appearance is somewhat suggestive of the "fat halo sign" or submucosal edema.
The remainder of the bowel is unremarkable.
IMPRESSION:
1. Abnormal focus of bowel wall thickening involving the proximal jejunum as noted above. This could represent a focus of inflammatory bowel disease versus infectious enteritis or other intrinsic bowel disease. Consider capsule endoscopy.
PROCEDURE: Video capsule endoscopy.

JANUARY 5, 2018- DESCRIPTION OF PROCEDURE: Video capsule endoscopy was performed
per protocol. The first gastric image was at 17 seconds. The
first duodenal image was at 11 minutes and 43 seconds. No
gastric pathology was visualized. The first ileocecal image was
at 1 hour 49 minutes and 22 seconds. There was no small bowel
mucosal abnormality visualized. The remainder of the
examination was viewed and showed only glimpses of normal colon
mucosa and stool.
1) Could thickening in bowel on ct scan be a spasm rather than inflammation?
2) Is the transit time on capsule endoscopy fast?
3) Could the capsule endoscopy missed the inflammation seen in the ct scan?
4) With these two tests what would your thoughts be on a diagnosis and/or further tests?
5) Could the pain in my right side just below ribs be caused by the inflammation seen on ct scan?
Any other insight you can give me would be appreciated. Thank you
doctor
Answered by Dr. Ramesh Kumar 13 hours later
Brief Answer:
Please see detailed answer.

Detailed Answer:
Hello,
Thanks for query,
Answers are-
1)No spasm cant be seen as thickening on CT scan.
2)No transit time is a bit on high side but average transit time always has a range and slighly higher or lower side of it does not alters the result.
3)Yes in case intestinal
mucosa is not cleared up or there are lots of residual stools etc on surface of intestine it can miss it.
4)I would suggest you to take a course of Ifaximin 400 mg once daily for 7 days.This wouod clear up any inflammation caused due to bacteria or protozoa.
If not relieved in 7 days then a Fecal calprotectin test has to be done.
Start taking a probiotic VSL#3 twice daily.

If still not relieved an upper gi endoscopy has to be done to rule out Gerd and acid peptic disorder as cause of pain around ribs(very common cause).
and colonosvopy would help to confirm the inflammation.
Regards!
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Ramesh Kumar 27 hours later
Thank you! Your answer makes total sense. My doctor said that since there was no inflammation in the capsule endoscopy the abnormality that was in the ct scan was just a spasm. He is going to do an upper endoscopy and colonoscopy the first of february to look for an explanation for the pain. I'm afraid if he finds nothing in the scopes I will either have to find another doctor or simply live with the pain. There are supplements that claim to reduce gut inflammation such as tumeric and I can get a probiotic over the counter and try to treat it myself.
What would your advice be for my situation?

Again, thank you so much!
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
follow up.

Detailed Answer:
Hello again my dear patient,
Over the counter suggestions are as follows-
1)Probiotic VSL# 3 twice daily.
2)B complex capsule once daily.
3)A potent enzyme supplement twice daily.
4)A antacid like omeprazole once daily.
5)Anti inflammatory Ibuprofen 400 mg twice daily.

If possible get a prescription for Rifaxamin 400 mg once daily for 7 days.

I can’t understand why would he say that thickened area is due to spasm in intestine.It does not make sense.CT is a very sensitive test.

Thanks!
Above answer was peer-reviewed by : Dr. Prasad
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