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Losing Weight. Found Fat In Stool. Felt Swollen Lymph Node On Neck. Clonoscopy Done. Lymphoma
Question: Hi my name is XXXXXXX 26 year old female and nurse I am 5'3 133lbs... and I am undergoing ALOT of health problems. . . I hope you can help; I am going to give you my results I have gotten thus far EVEN THOUGH most may not resemble my current health issue but in hopes that it may help you in your answer. I gave birth to a baby prematurely and since have gone down in health . Right now I have "Fat Malabsorption- and am losing a lot of weight, and i feel like im not getting the nutrition I need . I have lost 16 lbs since december without trying- but the doctor recently found fat in my stool. I am writing today because over a month period I have had a sore throat on and off , not VERY sore but sore enough to feel it. and on my left side of my neck; I have what I THINK is a swollen lymph node; its located on the middle of the left side of the neck almsot feels likes its on the muscle. It doesnt hurt, the top part is moveable but feels like its fixed down at the bottom like on a ligament or muscle, when i move it it "flaps over" like it can flap back and forth. But it feels like its on the muscle. If I tighten the muscles in my neck i can no longer feel it. My worry right now is lymphoma, due to the weight loss and felt lymph node... ive been through a lot loss of my baby and this sickness (whatever I have) that I feel ive become a hypochondriac but at the same time don't want to dismiss my issues if their reall, I do not ever have a fevor, I dont have night sweats; though I did right after I gave birth, I ihave a sore throat, on and off very mild for the past month, no other swollen lymphnodes found.........Other symptoms are this - fat malabsorption (for an unknow nreason right now this started after the birth of my baby) I had Ketones in my urine (also I guess do to malabsorbtion right now) and the following are all the results I have recently had:
Colonoscopy- it came back normal with XXXXXXX hemmroids found only- biopsies done- normal - other than redness was found
EGD- -Found gastritis - otherwise normal also did biopsies which were normal
redness was found in the stomach
HIDA Scan- Normal it states "Normal Hepatobiliary scan with normal gallbladder ejection fraction of 47%
Abdominal Cat Scan with constrast- Normal it stated "The lung bases are clear. The Liver,spleen,
gallbladder,pancreas,kidneys, and adrenal glands are within Normal limits. A small splenule is noted anterior to the spleen. No mass or adenopathy is seen. No bowel wall thickening, edema, pneumoperitoneum or ascites is evident. The uterus and adnexa are unremarkable. No osseous is seen
Lipase- Low
Amylace- Normal range
Ultrasound of the right upper quandrant said "Liver is unremarkable in contour, shape and parenchmal echogenicity. There is no evidence of intra or extrahepatic bililary dilation with the CBD measuring 2mm. Gall bladder is unremarkable with no evidence of Cholelithiasis. The Visualized portion of the pancreas is unremarkable with the body and tail not well visualized due to overlying bowel gas. Screening images of the right kidney demonstrate no XXXXXXX hydronephrosis and unremarkable cortical echogenicity. The right Kidney measures 10.8cm in length Impression : Unremarkable rruq ultrasound
He did some kind of autoantibody for autoimmune pancreatitus- came back negetive
then he did stool samples for OvaParasites- negetive
stool sample blood- negetive
The only positive was stool sample for fat -Positive at 1+
Celiec disease- serum and biopsy -negetive
Hpylori Biopsy-negetive
Hemaglobin A1c -normal 5.6
CBC- Normal except very mild anemia Hemaglobin was 11.8 Hematocrit 36.2, wbc-5.9
BMP-normal last one bilirubin was 0.4, albumin 4.1 Sodium 143 Potassium 4.2 Calcium 9.6 Chloride 106 BUN 10 Creatinine 0.8 ,glucose 78, total protien 8.1 Alkaline Phos 50
Albumin that was in the BMP or CBC (forget which one thats in) was normal range
Carcinoid- was ruled out by a weird blood test.
All my thyroid levels were chcecked including TSH T4 T3 T7 and thyroid antibodies all normal.... (this was checked in depth due a nodule- which was benign ( I had a thyroid biopsy)
I have had many chest Xrays- all negetive
spine Xray-negetive
CRP 0.1
tryptase 3.3 XXXXXXX 1:80 - speckeled
they also did a paraneoplastic autoantibody panel- negetive in all areas
I get a stiff back alot and stiff joints in my wrist , back , spine especially- they think I could have an autoimmune problem? so im seeing a rheumotologist soon- could the lump also be due to autoimmune? they are thinking autoimmune due to the pain i have at times, and how i got POTS (postural orthostatic tachycardia syndrome) after giving birth
CT angioGram- negetive
I had an immunology panel that looked at IGG1 IGG2 IGG3 and IGG4 all within normal limits
As you can see I have had quite the work up. I know all of this wouldnt be reliable source for my current problem but wanted to give you all the information I had- I would hate to make ANOTHER doctor appt if unneccisary as I see doctors so much right now :-( do to the malabsorption issue they are trying to figure out. My main concern is lymphoma- I also have a concern to why the doctors cannot find my malabsorption issue (you may comment on that if you feel you could help me in that regards too) . If lymphoma is a concern , who do I talk to abotu it? as right now I have a Immunologist, Cardiologist, GI doc, GP, and I have a rheumology appt coming up soon
ps. Not many are aware of POTS- pots is a dysfuction of the autonomic nervous system so im wondering if my belly problems could be do to dismobility of my bowels due to autonominc nervous system. Also prior to giving birth- they gave me vancomycin , zyvox, and zosyn due to they thought i had a uterine infection which i never did so i recieved 2 days worth of those IV antibiotics, also wondering if that plays a role in my stomach issues. I was healthy 26 year old prior to pregnancy and I gained wait fine in pregnancy- during pregnancy i had a placental abruption and bled the whole time - and after that is when all these health problems arised all at once
so 3 questions in the end
1. is the left neck lump concerning
2. my losing weight "fat malabsorption" could be do to something like autonomic dismobility,, or small bowel overgrowth- the doctors cant figure it out I go from constipation to diarrhea
3. Can all this be due to autoimmune. 1, I had an XXXXXXX 1:80 speckeled, stiff neck/pain ALOT and it hurts and i mean the whole back- Xrays negetive they havent done MRI, pain in wrists and arms at times.
Colonoscopy- it came back normal with XXXXXXX hemmroids found only- biopsies done- normal - other than redness was found
EGD- -Found gastritis - otherwise normal also did biopsies which were normal
redness was found in the stomach
HIDA Scan- Normal it states "Normal Hepatobiliary scan with normal gallbladder ejection fraction of 47%
Abdominal Cat Scan with constrast- Normal it stated "The lung bases are clear. The Liver,spleen,
gallbladder,pancreas,kidneys, and adrenal glands are within Normal limits. A small splenule is noted anterior to the spleen. No mass or adenopathy is seen. No bowel wall thickening, edema, pneumoperitoneum or ascites is evident. The uterus and adnexa are unremarkable. No osseous is seen
Lipase- Low
Amylace- Normal range
Ultrasound of the right upper quandrant said "Liver is unremarkable in contour, shape and parenchmal echogenicity. There is no evidence of intra or extrahepatic bililary dilation with the CBD measuring 2mm. Gall bladder is unremarkable with no evidence of Cholelithiasis. The Visualized portion of the pancreas is unremarkable with the body and tail not well visualized due to overlying bowel gas. Screening images of the right kidney demonstrate no XXXXXXX hydronephrosis and unremarkable cortical echogenicity. The right Kidney measures 10.8cm in length Impression : Unremarkable rruq ultrasound
He did some kind of autoantibody for autoimmune pancreatitus- came back negetive
then he did stool samples for OvaParasites- negetive
stool sample blood- negetive
The only positive was stool sample for fat -Positive at 1+
Celiec disease- serum and biopsy -negetive
Hpylori Biopsy-negetive
Hemaglobin A1c -normal 5.6
CBC- Normal except very mild anemia Hemaglobin was 11.8 Hematocrit 36.2, wbc-5.9
BMP-normal last one bilirubin was 0.4, albumin 4.1 Sodium 143 Potassium 4.2 Calcium 9.6 Chloride 106 BUN 10 Creatinine 0.8 ,glucose 78, total protien 8.1 Alkaline Phos 50
Albumin that was in the BMP or CBC (forget which one thats in) was normal range
Carcinoid- was ruled out by a weird blood test.
All my thyroid levels were chcecked including TSH T4 T3 T7 and thyroid antibodies all normal.... (this was checked in depth due a nodule- which was benign ( I had a thyroid biopsy)
I have had many chest Xrays- all negetive
spine Xray-negetive
CRP 0.1
tryptase 3.3 XXXXXXX 1:80 - speckeled
they also did a paraneoplastic autoantibody panel- negetive in all areas
I get a stiff back alot and stiff joints in my wrist , back , spine especially- they think I could have an autoimmune problem? so im seeing a rheumotologist soon- could the lump also be due to autoimmune? they are thinking autoimmune due to the pain i have at times, and how i got POTS (postural orthostatic tachycardia syndrome) after giving birth
CT angioGram- negetive
I had an immunology panel that looked at IGG1 IGG2 IGG3 and IGG4 all within normal limits
As you can see I have had quite the work up. I know all of this wouldnt be reliable source for my current problem but wanted to give you all the information I had- I would hate to make ANOTHER doctor appt if unneccisary as I see doctors so much right now :-( do to the malabsorption issue they are trying to figure out. My main concern is lymphoma- I also have a concern to why the doctors cannot find my malabsorption issue (you may comment on that if you feel you could help me in that regards too) . If lymphoma is a concern , who do I talk to abotu it? as right now I have a Immunologist, Cardiologist, GI doc, GP, and I have a rheumology appt coming up soon
ps. Not many are aware of POTS- pots is a dysfuction of the autonomic nervous system so im wondering if my belly problems could be do to dismobility of my bowels due to autonominc nervous system. Also prior to giving birth- they gave me vancomycin , zyvox, and zosyn due to they thought i had a uterine infection which i never did so i recieved 2 days worth of those IV antibiotics, also wondering if that plays a role in my stomach issues. I was healthy 26 year old prior to pregnancy and I gained wait fine in pregnancy- during pregnancy i had a placental abruption and bled the whole time - and after that is when all these health problems arised all at once
so 3 questions in the end
1. is the left neck lump concerning
2. my losing weight "fat malabsorption" could be do to something like autonomic dismobility,, or small bowel overgrowth- the doctors cant figure it out I go from constipation to diarrhea
3. Can all this be due to autoimmune. 1, I had an XXXXXXX 1:80 speckeled, stiff neck/pain ALOT and it hurts and i mean the whole back- Xrays negetive they havent done MRI, pain in wrists and arms at times.
Hi,
Thanks for your query.
A single lymphnode or a single lymph node group involvement does not indicate Lymphoma. Lymphoma can be considered a possibility when there is involvement of atleast 3 or more groups of nodes with fever of rising intensity.
A single node involvement is a common presentation in infectious conditions like Tuberculosis, other bacterial or viral infections. A FNAC (Fine needle aspiration cytology) of the node will surely find out the exact cause for the same.
It’s well evident that the weight loss you have is due to fat malabsorption and is confirmed by low lipase levels. I would consider it wise to assess the pancreas health by repeating tests to rule out inflammations in the pancreas like USG scan, auto antibodies, C-peptide levels and observation on lipase and amylase levels. Treating the underlying condition or taking enzyme supplements may treat your weight concern.
Let me answer your questions now:
1) Yes, you have to rule out the possibilities I mentioned above which may cause such node swelling. A FNAC would be the best tool.
2) No, I do not think the fat malabsorption is something related to autonomic function. With Lipase (enzyme needed to digest fat) low I would consider it wise to ascertain health in pancreas.
3) No, I would consider the autoimmunity as the last possibility. Though you have multiple problems the pattern does not follow any autoimmune disease. Each symptom has to be evaluated individually first.
Do go ahead for your appointment with the Rheumatologist. His opinion would be essential to rule out autoimmunity.
You will need an integrated approach by a Gastroentrologist and an XXXXXXX medicine specialist.
Hope I answered your query.
Please let me know if there are any other concerns.
Regards,
Thanks for your query.
A single lymphnode or a single lymph node group involvement does not indicate Lymphoma. Lymphoma can be considered a possibility when there is involvement of atleast 3 or more groups of nodes with fever of rising intensity.
A single node involvement is a common presentation in infectious conditions like Tuberculosis, other bacterial or viral infections. A FNAC (Fine needle aspiration cytology) of the node will surely find out the exact cause for the same.
It’s well evident that the weight loss you have is due to fat malabsorption and is confirmed by low lipase levels. I would consider it wise to assess the pancreas health by repeating tests to rule out inflammations in the pancreas like USG scan, auto antibodies, C-peptide levels and observation on lipase and amylase levels. Treating the underlying condition or taking enzyme supplements may treat your weight concern.
Let me answer your questions now:
1) Yes, you have to rule out the possibilities I mentioned above which may cause such node swelling. A FNAC would be the best tool.
2) No, I do not think the fat malabsorption is something related to autonomic function. With Lipase (enzyme needed to digest fat) low I would consider it wise to ascertain health in pancreas.
3) No, I would consider the autoimmunity as the last possibility. Though you have multiple problems the pattern does not follow any autoimmune disease. Each symptom has to be evaluated individually first.
Do go ahead for your appointment with the Rheumatologist. His opinion would be essential to rule out autoimmunity.
You will need an integrated approach by a Gastroentrologist and an XXXXXXX medicine specialist.
Hope I answered your query.
Please let me know if there are any other concerns.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you- The doctor did autoantibodies for the pancreas and I guess that was also negetive (no antibodies found) . Which is why he is so baffeled by my problem. As we cannot find the answer. My lipase was 19 Amylace was 59 , so not sure if Lipase was really low? it just seemed low to me; i had another lipase done before and it was 24. So is that low? Right now im on Creon. If my pancreas is not working wouldnt that mean I would have diabetes? My hemaglobinA1C was normal. But I am just going off of my own knowledge that I know of. I just find it weird that all of this just so happened after the birth/death of my baby. Not only my left neck Node is swollen but so is my Left tonsil (just on the left side) as well as my throat is getting more sore... im trying to hold out on another doc appt as I already have so many. And yes I am seeing a GI doc :-) just trying to understand and figure all this out. IF my left node/left tonsil area is swollen with sore throat, that could be a run of a viral/bacterial infection or abcess right? but I do not have a fevor
Hi,
Thanks for writing back.
Lipase is an enzyme released due to stimulation by food present in the stomach hence, its levels has to be studied with pre test meals.
It is not necessary for the pancreatic ill-health to always be associated with low insulin levels. Disturbance in lipase levels can present alone.
Yes, you are right in suspecting the lymph node swelling to be due to viral or bacterial infection due its association with sore throat and tonsillar swelling. Absence of fever indicates more of viral etiology than bacterial.
Hope I cleared your doubts.
Wish you good health.
Regards,
Thanks for writing back.
Lipase is an enzyme released due to stimulation by food present in the stomach hence, its levels has to be studied with pre test meals.
It is not necessary for the pancreatic ill-health to always be associated with low insulin levels. Disturbance in lipase levels can present alone.
Yes, you are right in suspecting the lymph node swelling to be due to viral or bacterial infection due its association with sore throat and tonsillar swelling. Absence of fever indicates more of viral etiology than bacterial.
Hope I cleared your doubts.
Wish you good health.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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