How Can Depleted Intestinal Flora Be Treated?

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
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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

Signs and Symptoms: LUNG NODULE, HEPATIC MASS


CT CHEST , ABDOMEN AND PELVIS WITH IV CONTRAST 11/16/2016

Reason: Lung nodule. Hepatic mass..


CT CHEST:

Technique:

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

Findings:

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.





CT ABDOMEN AND PELVIS:

Technique:

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

Findings:

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.

IMPRESSION:

CT CHEST:
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.

CT ABDOMEN:
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




FLEISCHNER SOCIETY RECOMMENDATIONS

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/
000011/1006/1600001035