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Suggest Treatment For Symptoms Of IBS
Question: Hi I am 53 yr female I had my gall bladder removed 17 yrs ago ,over the past 18 months have been suffering with right sided abdominal pain pain was initially intermittent ,sometimes pain in the back often going into sweats with the pain .Gp referred for ultrasound showed dilated bile duct 10mm, MRI can showed bile duct at 15mm also had biopsy of bowels calprotectin 350 repeated tests resulted in 290 .? Coeliacs disease ,chrohns disease .Recently started having pain on the left side of stomach sometimes pain with or without food .Pain can be worse at night lying down .I take medication for the pain which only masks for a short period occassional stomach bloating .I suffer with loose bowel motions they are very smelly and float .Blood results okay .No weight loss just suffering with fatigue ?Had camera into stomach okay awaiting to see consultant .What do you advise .I have requested that they give me laparoscopy to check pancreas and bile duct this has need refused.My concern is that having pain for the period is not normal and my body is telling me something is wrong .I need answers ??
Brief Answer:
Evaluation of loose stool + dilated bile duct
Detailed Answer:
Hello,
1) First of all, you do not need laparoscopy just to check status of pancreas and bile duct as they give information about structural changes of these organs (outside part)
2) Symptoms of abdominal pain + loose stool, smelly, floating + mucus in stool + high calpoprotein value suggest possibility of inflammatory bowel disease (Crohn's disease) or irritable bowel syndrome (Coeliac disease).
3) But if you have Coeliac disease then it generally affects first portion of small intestine and it can be visualized in upper GI endoscopy. Absence of these findings reduces possibility of Celiac disease.
4) If USG abdomen and MRI, both showed dilated bile duct (15mm) then it is rudimentary to check liver function test, status of gall bladder. Also it is essential to find reason for bile duct obstruction.
5) Bile can not reach to small intestine in proper amount and this affect metabolism of fat due to which fat would not be absorbed by intestine and will be present in stool (smelly, floating, sticky stool).
6) Inflammatory bowel disease generally affect large intestine and for this colonoscopy is recommended.
7) But in your case loose stool + bile duct obstruction require evaluation in detail first rather than to proceed for Crohn's evaluation and for this either CT scan abdomen or ERCP is recommended. If these did not reveal anything then it is suggestible to proceed for colonoscopy.
8) Yes, you must continue medications for pain relief during process of evaluation.
Evaluation of loose stool + dilated bile duct
Detailed Answer:
Hello,
1) First of all, you do not need laparoscopy just to check status of pancreas and bile duct as they give information about structural changes of these organs (outside part)
2) Symptoms of abdominal pain + loose stool, smelly, floating + mucus in stool + high calpoprotein value suggest possibility of inflammatory bowel disease (Crohn's disease) or irritable bowel syndrome (Coeliac disease).
3) But if you have Coeliac disease then it generally affects first portion of small intestine and it can be visualized in upper GI endoscopy. Absence of these findings reduces possibility of Celiac disease.
4) If USG abdomen and MRI, both showed dilated bile duct (15mm) then it is rudimentary to check liver function test, status of gall bladder. Also it is essential to find reason for bile duct obstruction.
5) Bile can not reach to small intestine in proper amount and this affect metabolism of fat due to which fat would not be absorbed by intestine and will be present in stool (smelly, floating, sticky stool).
6) Inflammatory bowel disease generally affect large intestine and for this colonoscopy is recommended.
7) But in your case loose stool + bile duct obstruction require evaluation in detail first rather than to proceed for Crohn's evaluation and for this either CT scan abdomen or ERCP is recommended. If these did not reveal anything then it is suggestible to proceed for colonoscopy.
8) Yes, you must continue medications for pain relief during process of evaluation.
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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