Brief Answer:
Fecal fat analysis, CTscan abdomen and colonoscopy

Detailed Answer:
Hi XXXX
Thanks for writing in to us.

I have read through your query in detail.
Being a doctor specializing in scans, I would like to help you out with your choice of investigation.

1. You might have the clay colored stools after fat intake due to a condition termed as fat malabsorption.

(i)Current medical literature says the following on fat malabsorption.

(ii) Fecal fat analysis provides a simple, rapid, inexpensive screening test for malabsorption.

(iii) Measurement includes fecal fat quantification for 48 to 72 hours while patient is on a defined intake of fat, typically 100 g/day.

(iv)Normally, >95% of dietary fat is absorbed; consequently >5 g/day of fecal fat is diagnostic of steatorrhea.

(v) Fecal fat analysis does not distinguish among intestinal, hepatobiliary, and pancreatic causes of malabsorption, although the level of steatorrhea associated with pancreatic insufficiency (∼50 g) tends to be higher than the level for intestinal disease (∼20 g).





2. For lower left side discomfort and bowel disturbances, any one or more of the following might be required.

(i) Upper GI barium study with small bowel follow-through.

(ii) Double-contrast barium enema.

(iii) Abdomen and pelvis CT scan.

The requirement for above examinations can vary with exact clinical symptoms.

As you are having a history of bowel disturbances with diverticulitis, a CT scan of abdomen and pelvis is the most desired standard investigation. It will also help know causes of malabsorption if associated to liver, pancreas and bowel.

After having done CT scan, a virtual or endoscopic colonoscopy can be done depending on the findings at CT scan.




3. For constant pressure feeling under left rib,

Since you have not written in details about the thoracic surgery you had for lesions in stomach and esophagus, it is not possible to comment on the pressure feeling under ribs on the left side.

Should it be a felt more in the ribs, a chest X ray might help.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Taking probiotics and enzymes can help.

Detailed Answer:
Hi XXXX
Thanks for writing back with an update.

The acid reflux disease which has occurred is under control and not a hazard at present. That condition can cause any heart burn if you are experiencing such symptoms. I think you earlier had a problem with lower esophageal sphincter.

Hysterectomy and gall bladder surgery will have reduced chances of any conditions to do with these organs.

My only concerns in you will remain with the diverticuli and any changes around that. A CT scan will help rule out any serious causes causing any of your symptoms and assess organs like pancreas which can show sigs of inflammation. Since colonoscopy has been done recently, doing a CT scan if not done earlier can also help in knowing the cause of malabsorption in your pancreas, if present.

Continuing with probiotics and enzymes can give you a relief should you have malabsorption.

Significant research focus and several teams of investigators have confirmed that the inflammatory response to gliadins (formed from gluten) is inhibited by healthy intestinal probiotics. So if you have such a condition or anything related to it then probiotics will help.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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