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Suggest Treatment For Diverticular Colitis And Anemia
Question: Hi I am a 57 yr old female with SLE for about 25 years. Had GB removed in 2008/no stones. The last 10 months I have had GI symptoms of N/V, diarrhea, alternating with severe abd. pain. Went to ED 3 weeks ago with bloody diarrhea and N/V. Ct scan showed diverticulitis and colitis. Treated with medications but never felt well. Just this past week had another bout of severe N/V and stomach pain that was worse than renal stones or child birth. Admitted and was diagnosed with Bile salt gastritis and bile enteropathy ,acute chronic colitis, anemia, hypothyroidism. Started on Welchol and was wondering if this is all related to SLE?l
Brief Answer:
SLE with ? Abdominal Vasculitis
Detailed Answer:
Good evening
Thank you for writing on health care magic
Well, the sort of symptoms you are describing do look like related to SLE. The symptoms of constant abdominal pain with diarrhea and blood in stools, does point to inflammation of the intestine. I am sure you may have been treated with antibiotic course for the acute colitis. But since it is recurring, it is probably not due to infection.
What I would like to know is?
1. What medications are you taking for SLE?
2. Did they increase your SLE medications when the episode happened? If not, then what medications were you treated with
3. Was colonoscopy carried out??
4. Has your SLE been quiet in the recent past?? Did you ever have such abdomen symptoms since diagnosis??
I really dont feel it is gastritis. If it is colitis, it is essential to do a colonoscopy and Biopsy to determine what exactly is the cause for it. The sort of symptoms you are having can be due to vasculitis( vessel inflammation due to SLE) which needs to be treated with higher dose steroids.
Do let me know these queries. Will try to sort it out for you
REgards
Dr Naval
SLE with ? Abdominal Vasculitis
Detailed Answer:
Good evening
Thank you for writing on health care magic
Well, the sort of symptoms you are describing do look like related to SLE. The symptoms of constant abdominal pain with diarrhea and blood in stools, does point to inflammation of the intestine. I am sure you may have been treated with antibiotic course for the acute colitis. But since it is recurring, it is probably not due to infection.
What I would like to know is?
1. What medications are you taking for SLE?
2. Did they increase your SLE medications when the episode happened? If not, then what medications were you treated with
3. Was colonoscopy carried out??
4. Has your SLE been quiet in the recent past?? Did you ever have such abdomen symptoms since diagnosis??
I really dont feel it is gastritis. If it is colitis, it is essential to do a colonoscopy and Biopsy to determine what exactly is the cause for it. The sort of symptoms you are having can be due to vasculitis( vessel inflammation due to SLE) which needs to be treated with higher dose steroids.
Do let me know these queries. Will try to sort it out for you
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you! I have been on Plaquenil 400mg 1 tab qd. Tried Benlysta but SLE didnt respond. Now on Imuran 50mg 1 BID. Had colonoscopy last year and it was completely normal. Trying to get in to see GI for another colonoscopy ASAP. I have a MSN and have been in nursing for a long time. My SLE has been active for about 1 year and doesnt seem to want to cooperate. The newest thing is this:anti-dna (ds) ab qn is 28, (0-9 IU/mL ) It has stayed aroud 28-32 for over a year now. My CRP is always elevated as well. Here is my med list:MEDICATION LIST
Synthroid 25mg 1 po qd……………….HYPOTHYROIDISM
VASOTEC 10MG 1 PO QD---------------HTN-------STARTED 4-22-15
NYSTATIN SWISH AND SWALLOW-------FOR THRUSH AND BLISTERS ON ROOF OF MOUTH
BENTYL 10MG 1 PO QID AS NEEDED------IBS
PROTONIX 40MG 1 PO QD---------STOMACH
LIMBITROL DS 5/12.5MG 1 BID------------MIGRANEs
KLONOPIN 1 QD………………………………PAIN,HTN NERVES
SPIRALACTONE 25MG 1 QD-----------FLUID
HCTZ 25mg 1 QD---------------------------------HTN/FLUIS
COREG 12.5MG 1 PO BID---------------HTN
MIRAPEX O.25MG 2 TABS Q NIGHT FOR RLS
PLAQUENIL 200MG 1 PO BID--------------LUPUS
Phenergan 25mg 1 po as needed
PHENERGAN SUPP 25 MG ONCE VOMITING IS OVER 10 TIMES
ZOFRAN 4MG ODT PRN---------------------FOR SEVERE NAUSEA
TRIAMCINILONE CREAM FOR RASH ON FACE AND SORES IN NOSE
KENALOG IN ORABSE FOR SORES IN MOUTH
RESTASIS EYE DROPS FPR DRY EYES.
LUBRICATING EYE DROPS----------OTC
TRAMADOL 50 MG 1 BID FOR MODERATE PAIN
NAPROSYN 500MG EC 1 BID----------------PAIN AND INFLAMMATION
CYMBALTA 60MG 1 QHS……………………. FOR PAIN AND
FIBROMYALGIA
Thyroid dose was just changed to 88mcg this last week while in hospital.
Synthroid 25mg 1 po qd……………….HYPOTHYROIDISM
VASOTEC 10MG 1 PO QD---------------HTN-------STARTED 4-22-15
NYSTATIN SWISH AND SWALLOW-------FOR THRUSH AND BLISTERS ON ROOF OF MOUTH
BENTYL 10MG 1 PO QID AS NEEDED------IBS
PROTONIX 40MG 1 PO QD---------STOMACH
LIMBITROL DS 5/12.5MG 1 BID------------MIGRANEs
KLONOPIN 1 QD………………………………PAIN,HTN NERVES
SPIRALACTONE 25MG 1 QD-----------FLUID
HCTZ 25mg 1 QD---------------------------------HTN/FLUIS
COREG 12.5MG 1 PO BID---------------HTN
MIRAPEX O.25MG 2 TABS Q NIGHT FOR RLS
PLAQUENIL 200MG 1 PO BID--------------LUPUS
Phenergan 25mg 1 po as needed
PHENERGAN SUPP 25 MG ONCE VOMITING IS OVER 10 TIMES
ZOFRAN 4MG ODT PRN---------------------FOR SEVERE NAUSEA
TRIAMCINILONE CREAM FOR RASH ON FACE AND SORES IN NOSE
KENALOG IN ORABSE FOR SORES IN MOUTH
RESTASIS EYE DROPS FPR DRY EYES.
LUBRICATING EYE DROPS----------OTC
TRAMADOL 50 MG 1 BID FOR MODERATE PAIN
NAPROSYN 500MG EC 1 BID----------------PAIN AND INFLAMMATION
CYMBALTA 60MG 1 QHS……………………. FOR PAIN AND
FIBROMYALGIA
Thyroid dose was just changed to 88mcg this last week while in hospital.
Brief Answer:
Active SLE
Detailed Answer:
Good evening
Sorry for the delayed response. Had an emergency duty going on
Well, looking at your medications and history there is a possibility the lupus is still active and not enough medications are being given to control it. Raised DsDNA is an indication for the disease being active. It can be elevated with Vasculitis as well. My suspicion is still high on Vasculitis in the intestine due to SLE and which needs active treatment with Steroids.
I will suggest consult a Rheumatologist along with a Gastroenterologist. The definite diagnosis will be on Colonscopy with Biopsy but I wont suggest waiting for 3 weeks for it( Biopsy report will take a week at least. SO meanwhile you can start the treatment( steroids) and if it is normal, you can taper it later on. But yes another episode of rectal bleeding is not something we should wait for
Do let me know for more queries. Would be happy to help out
Regards
Dr Naval
Active SLE
Detailed Answer:
Good evening
Sorry for the delayed response. Had an emergency duty going on
Well, looking at your medications and history there is a possibility the lupus is still active and not enough medications are being given to control it. Raised DsDNA is an indication for the disease being active. It can be elevated with Vasculitis as well. My suspicion is still high on Vasculitis in the intestine due to SLE and which needs active treatment with Steroids.
I will suggest consult a Rheumatologist along with a Gastroenterologist. The definite diagnosis will be on Colonscopy with Biopsy but I wont suggest waiting for 3 weeks for it( Biopsy report will take a week at least. SO meanwhile you can start the treatment( steroids) and if it is normal, you can taper it later on. But yes another episode of rectal bleeding is not something we should wait for
Do let me know for more queries. Would be happy to help out
Regards
Dr Naval
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Above answer was peer-reviewed by :
Dr. Prasad
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