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Abdominal Stiffness. Taking Medicine For TB Of Uterus Although Negative. How Can We Identify The Problem?
Question: Hello Doctor,
The patient is my younger sister. Details are as below.
Name : XXXXXXX
Age: 26 yrs
Gender : female
She is suffering from an unidentified sickness from past 1.5 year.
Her stomach area feels rigid , stiff , tight all the time. She doesnt feel healthy and hence becomes dull and feels low.
We tried all possible tests to identify the cause of the problem but none of the doctors could identify anythings.
List of tests tried.
1) Antibiotics for a few weeks thinking it was realted to digestion and stomach ache.
2) Ultrasounds
which showed some lymph nodes and were tested for being cancerous , the output of the test was negative.
2) Colonoscopy -> All clear
3) Hormone tests -> All normal
4) Blood tests such as CBC, IGA
5) Thyroid tests -> no problem noticed
6) CT scan of pelvis and chest which shows
Multiple small subcentimetric sesentric nodes noted.
Liver is normal in shape and size. No focal lesion seen IHBR are not dilated.
Gallbladder is normally distended and shows no radio opacity inside. CBD is not dilated.
SPleen and pancreas are normal in size,thickness and enhancement pattern.
Both kidneys and normal in location,shape,size and axis,Renal function are adequate
The adrenals are normal.
Urinary bladder is normal.
The stomach is normal in wall thickness. Rest of the gut loops up to the normal. The rectum is normal. Surrounding fat planes are maintained.
Aorta and illac vessels are normal.Other vessels are normal in course and diameter. There is no aneurysm or thrombosis.
No ascites is seen.
Uterus is normal.
Both ovaries shows multiple peripherally arranged follicles.
The spine is normal. No lysis is seen.
The plevic bones are normal.
She had a history of cysts 2 years back and she took homoepathy treatment for that and the cyst problem got solved hence it did not list in ultrasound
In CT scan however polyscistic cysts were cited and then we consulted a gynaecologist.
She suggested laproscopy.
8) Laproscopy
The gyane who did laproscopy was confident that my sister has Tuberculosis of Uterus, She noticed the fluid in pouch of XXXXXXX
Uterus was red with infection (she said)
She ordered a TB test to confirm the same from a special lab which came out negative.
She still was confident that my sister is suffering from TB of uterus and since then she started TB medicine course . It has been 3 months since
then but there is no improvement in the tightness and rigidity around the stomach area.
We are clueless what to do now . Please show us some way to identify the problem.
The patient is my younger sister. Details are as below.
Name : XXXXXXX
Age: 26 yrs
Gender : female
She is suffering from an unidentified sickness from past 1.5 year.
Her stomach area feels rigid , stiff , tight all the time. She doesnt feel healthy and hence becomes dull and feels low.
We tried all possible tests to identify the cause of the problem but none of the doctors could identify anythings.
List of tests tried.
1) Antibiotics for a few weeks thinking it was realted to digestion and stomach ache.
2) Ultrasounds
which showed some lymph nodes and were tested for being cancerous , the output of the test was negative.
2) Colonoscopy -> All clear
3) Hormone tests -> All normal
4) Blood tests such as CBC, IGA
5) Thyroid tests -> no problem noticed
6) CT scan of pelvis and chest which shows
Multiple small subcentimetric sesentric nodes noted.
Liver is normal in shape and size. No focal lesion seen IHBR are not dilated.
Gallbladder is normally distended and shows no radio opacity inside. CBD is not dilated.
SPleen and pancreas are normal in size,thickness and enhancement pattern.
Both kidneys and normal in location,shape,size and axis,Renal function are adequate
The adrenals are normal.
Urinary bladder is normal.
The stomach is normal in wall thickness. Rest of the gut loops up to the normal. The rectum is normal. Surrounding fat planes are maintained.
Aorta and illac vessels are normal.Other vessels are normal in course and diameter. There is no aneurysm or thrombosis.
No ascites is seen.
Uterus is normal.
Both ovaries shows multiple peripherally arranged follicles.
The spine is normal. No lysis is seen.
The plevic bones are normal.
She had a history of cysts 2 years back and she took homoepathy treatment for that and the cyst problem got solved hence it did not list in ultrasound
In CT scan however polyscistic cysts were cited and then we consulted a gynaecologist.
She suggested laproscopy.
8) Laproscopy
The gyane who did laproscopy was confident that my sister has Tuberculosis of Uterus, She noticed the fluid in pouch of XXXXXXX
Uterus was red with infection (she said)
She ordered a TB test to confirm the same from a special lab which came out negative.
She still was confident that my sister is suffering from TB of uterus and since then she started TB medicine course . It has been 3 months since
then but there is no improvement in the tightness and rigidity around the stomach area.
We are clueless what to do now . Please show us some way to identify the problem.
Detailed treatment given
it started1.5 yrs back when she FELT TIGHTNESS IN RIGHT ABDOMEN had a constipation for few days and than there was little blood in stool.we went for a gastroentrentologist
note:-.tightnes and tenderness(right abdomen) was less in the biggening and then it spreaded and became huge
treatment given was as follows
A) Antibiotics for a few weeks thinking it was related to digestion and stomach ache.
B) Colonoscopy -> All clear
C) Ultrasounds...(REPORT ATESTED)
few lymph nodes seen in right inguinal region
it was than treated by the gynaec with the antibiotics but there was no relief than she adviced for F.N.A.C->REPORT ATTESTED
D) Hormone tests -> like fh, fsh, glucose(all nrml)
E) Blood tests such as CBC,ESR IGA
F) Thyroid tests -> no problem noticed
G) CT scan of pelvis and chest(REPORT ATTESTED):- MESENTRIC LYMPHADENOPATHY.POLYCYSTIC OVARIES
h) vitamin d3 ->14 counts(insuffceincy)treted with 3 dose in 15 days gaps via injectable vitamin D suppliments
note:-every thing was normal but ESR was always high 55 counts,2mnth later 60, 2 mnth later 58, after 52
She had a history of cysts 2 years back and she took homoepathy treatment for that and the cyst problem got solved hence it did not list in ultrasound
In CT scan however polyscistic cysts were cited and then we consulted the gynaecologist.
She suggested laproscopy.
I) Laproscopy:-REPORT ATTESTED
ࠠ The gyane who did laproscopy diagnosed Uterus was red with infection and told that there is a lot of inflammation in that region
DOC COLLECTED SAMPLE OF FLUID FROM (POD) AND TESTED IT FOR TB_PCR WHICH WAS FOUND NEGATIVE then She started treatment for (PID) WITH SOME HEAVY
ANTIBIOTIC INJECTIONS AND TABLETS BUT THERE WAS NO RELIEF AT ALL.THEN THE GYNEC SAID THAT I M
confident that SHE has Tuberculosis of Uterus,
ࠠ Uterus was red with infection (she said)
ࠠ She ordered a TB test to confirm the same from a special lab which came out negative.
ࠠ She still was confident that my sister is suffering from TB of uterus and since then she started TB medicine course . It has been 3 months since
ࠠ then but there is no improvement in the tightness and rigidity around the stomach area.
it started1.5 yrs back when she FELT TIGHTNESS IN RIGHT ABDOMEN had a constipation for few days and than there was little blood in stool.we went for a gastroentrentologist
note:-.tightnes and tenderness(right abdomen) was less in the biggening and then it spreaded and became huge
treatment given was as follows
A) Antibiotics for a few weeks thinking it was related to digestion and stomach ache.
B) Colonoscopy -> All clear
C) Ultrasounds...(REPORT ATESTED)
few lymph nodes seen in right inguinal region
it was than treated by the gynaec with the antibiotics but there was no relief than she adviced for F.N.A.C->REPORT ATTESTED
D) Hormone tests -> like fh, fsh, glucose(all nrml)
E) Blood tests such as CBC,ESR IGA
F) Thyroid tests -> no problem noticed
G) CT scan of pelvis and chest(REPORT ATTESTED):- MESENTRIC LYMPHADENOPATHY.POLYCYSTIC OVARIES
h) vitamin d3 ->14 counts(insuffceincy)treted with 3 dose in 15 days gaps via injectable vitamin D suppliments
note:-every thing was normal but ESR was always high 55 counts,2mnth later 60, 2 mnth later 58, after 52
She had a history of cysts 2 years back and she took homoepathy treatment for that and the cyst problem got solved hence it did not list in ultrasound
In CT scan however polyscistic cysts were cited and then we consulted the gynaecologist.
She suggested laproscopy.
I) Laproscopy:-REPORT ATTESTED
ࠠ The gyane who did laproscopy diagnosed Uterus was red with infection and told that there is a lot of inflammation in that region
DOC COLLECTED SAMPLE OF FLUID FROM (POD) AND TESTED IT FOR TB_PCR WHICH WAS FOUND NEGATIVE then She started treatment for (PID) WITH SOME HEAVY
ANTIBIOTIC INJECTIONS AND TABLETS BUT THERE WAS NO RELIEF AT ALL.THEN THE GYNEC SAID THAT I M
confident that SHE has Tuberculosis of Uterus,
ࠠ Uterus was red with infection (she said)
ࠠ She ordered a TB test to confirm the same from a special lab which came out negative.
ࠠ She still was confident that my sister is suffering from TB of uterus and since then she started TB medicine course . It has been 3 months since
ࠠ then but there is no improvement in the tightness and rigidity around the stomach area.
Hi
Thanks for posting your query.
Persistent pain and stiffness and rigidity with tenderness in right side of upper abdomen indicates some underlying inflammation in the underlying organs. It may be within the stomach in the form of peptic ulcer /gastritis/hepatitis etc. Gall bladder disease also needs to be excluded.
If there are associated dysentery like features like diarrhoea, fever; stool examination is to be done and amoebic hepatitis should be excluded
As opined by gynaecologist of having tuberculosis, immunological test for tuberculosis should be done. Upper gastrointestinal endoscopy should be done also to rule out gastritis and peptic ulcer syndrome
Dorsal spine should be examined also for any lesion that may cause referred pain and other features in the area by pressure on nerve roots
If nothing helps, persistent pain, rigidity, tenderness if associated with loss of weight and continuous running down, laparotomy to be considered
Hope she becomes all right soon
Thanks for posting your query.
Persistent pain and stiffness and rigidity with tenderness in right side of upper abdomen indicates some underlying inflammation in the underlying organs. It may be within the stomach in the form of peptic ulcer /gastritis/hepatitis etc. Gall bladder disease also needs to be excluded.
If there are associated dysentery like features like diarrhoea, fever; stool examination is to be done and amoebic hepatitis should be excluded
As opined by gynaecologist of having tuberculosis, immunological test for tuberculosis should be done. Upper gastrointestinal endoscopy should be done also to rule out gastritis and peptic ulcer syndrome
Dorsal spine should be examined also for any lesion that may cause referred pain and other features in the area by pressure on nerve roots
If nothing helps, persistent pain, rigidity, tenderness if associated with loss of weight and continuous running down, laparotomy to be considered
Hope she becomes all right soon
Above answer was peer-reviewed by :
Dr. Aparna Kohli
There is no dysentry/fever assosciated , loss of weight is also not significantly noticed.
Stool examination was also done and nothing came out .
Also we had taken advice from a gastroentrentologist in Bombay Hospital before. He said its not related to any gas/stomach infection.
As you say that it cud be peptic ulcer/hepatitis , Would CT scan /colonoscopy not show that ?
What is the specific test which can find the problem? Please narrate the process in brief if possible?
What is immunological test for tuberculosis?
She has already started medicines of Uterus TB from past 3 months. Is this immunological test possible now?
Please advice.
Stool examination was also done and nothing came out .
Also we had taken advice from a gastroentrentologist in Bombay Hospital before. He said its not related to any gas/stomach infection.
As you say that it cud be peptic ulcer/hepatitis , Would CT scan /colonoscopy not show that ?
What is the specific test which can find the problem? Please narrate the process in brief if possible?
What is immunological test for tuberculosis?
She has already started medicines of Uterus TB from past 3 months. Is this immunological test possible now?
Please advice.
Hi,
Thanks again,
Peptic ulcer / gastritis can be missed on regular CT scan and colonoscopy. It can be excluded by gastroduodenal endoscopic examination performed by a gastroenterologist. It is an endoscopic procedure in which an endoscope is passed through the mouth and the upper gastrointestinal structures are visualized internally. You can discuss with your gastroenterologist further regarding this.
Immunological tests for tuberculosis may be in the form of 'Mantoux test'(tuberculin skin test). Further serological testing such as M. tuberculosis antibodies IgG / IgM /IgA may be performed. This will be more specific and indicate active / chronic / old cases. Current antitubercular drugs may have little effects on these tests. You may discuss about it with your doctor.
Hope i have answered all your queries. Please accept the answer if you do not have any other queries.
I wish an early recovery of your sister.
Regards
Thanks again,
Peptic ulcer / gastritis can be missed on regular CT scan and colonoscopy. It can be excluded by gastroduodenal endoscopic examination performed by a gastroenterologist. It is an endoscopic procedure in which an endoscope is passed through the mouth and the upper gastrointestinal structures are visualized internally. You can discuss with your gastroenterologist further regarding this.
Immunological tests for tuberculosis may be in the form of 'Mantoux test'(tuberculin skin test). Further serological testing such as M. tuberculosis antibodies IgG / IgM /IgA may be performed. This will be more specific and indicate active / chronic / old cases. Current antitubercular drugs may have little effects on these tests. You may discuss about it with your doctor.
Hope i have answered all your queries. Please accept the answer if you do not have any other queries.
I wish an early recovery of your sister.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Thanks for your reply doctor ,just one last question
If immunological test comes negative (for TB) , should we stop the medications she is currently taking for TB?
Pl advise
If immunological test comes negative (for TB) , should we stop the medications she is currently taking for TB?
Pl advise
Hi,
Thanks for reverting.
Starting or stopping the treatment for tuberculosis on the basis of immunological tests would depend upon the clinical picture and the sensitivity and specificity of the test. Generally, the sensitivity (ability to detect a true case of tuberculosis) varies from 1%-60% and the specificity (ability to detect who truly does not have tuberculosis) varies from 53% to 99%. Thus, if a test is positive, one may reasonably start treatment, but if the test is negative, it does not mean that the person does not have tuberculosis.
Since the CT scan revealed lymphadenopathy, a biopsy is needed to establish the pathology. An endometrial biopsy may be helpful in this condition and you may want to discuss this with your gynaecologist. For proper treatment a proper diagnosis is needed and biopsy will be helpful
Please get the tests done and I will like to know the report
Even with 3 months treatment for tuberculosis, her condition is expected to improve sufficiently.
Hope your sister recovers soon.
I hope I have answered your question. Please accept my query if you have no further questions.
Thanks for reverting.
Starting or stopping the treatment for tuberculosis on the basis of immunological tests would depend upon the clinical picture and the sensitivity and specificity of the test. Generally, the sensitivity (ability to detect a true case of tuberculosis) varies from 1%-60% and the specificity (ability to detect who truly does not have tuberculosis) varies from 53% to 99%. Thus, if a test is positive, one may reasonably start treatment, but if the test is negative, it does not mean that the person does not have tuberculosis.
Since the CT scan revealed lymphadenopathy, a biopsy is needed to establish the pathology. An endometrial biopsy may be helpful in this condition and you may want to discuss this with your gynaecologist. For proper treatment a proper diagnosis is needed and biopsy will be helpful
Please get the tests done and I will like to know the report
Even with 3 months treatment for tuberculosis, her condition is expected to improve sufficiently.
Hope your sister recovers soon.
I hope I have answered your question. Please accept my query if you have no further questions.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Aparna Kohli
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