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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29791
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I am a 55 year old male who is having alot of stomach problems

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I am a 55 year old male who is having alot of stomach problems who can't get a doctor do believe me. In the past six months I have lost approximately 50 lbs. I am unable to keep any food in me I pass it out mostly in the form of diahrea even though i get dry heaves nothing comes out, I am thirsty most of the time no matter how much I drink dehydrated quite a bit. Everything I eat usually tastes funny, I have no appetitem force myself to eat it is like what I eat goes in and pushes out what I ate without getting the benefit of what I have eaten. I have a history of stomach problems since I was around 3 years old I had my first stomach surgery, I have my appendix, gaul bladder, spleen, 1/3 of my pancreas out over the years.
I hope you may be able to help me. Thank You
Submitted: 2 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 2 years ago.
Hello,

I am sorry about your persistent significant symptoms.

Why were your spleen and 1/3 pancreas removed?
Apart from diarrhea, weight loss and dry heaves, what are your other symptoms?
What are the investigations done?

Dr. Arun
Customer: replied 2 years ago.

The reason why I had my spleen removed. In November 2002,I started having pancreatitis attacks, the first few years of the attacks I was having I would end up having them 2 times a year wher I ended up in the hospital for 12 to 14 days on strictly ivs and antibiotics. Over the years I began having more attacks tight out of the blue any time of day or night I had to go to the hospital I had a few false alarms over the years but mostly they were the real thing. Over the period of time I spent they done various test on putting me to sleep light down in me for different tests on me they discovered a aneriusm or the artery going into spleen first they tried burning it did not work so they removed the spleen, moving forward about 3 years of having pancreatitus the family doctor I had at the time sent me for a specialized test that checked all aroud the stomach area that is when they discovered a blockage in the head of the pancreas. When they operated they didn't know going in if I was going to lose part of the pancreas or all of it, but I was lucky they had to only to take a third, and I didn't become a diabetic as a result of the surgery. Since the surgery I have only had 1 pancreatitis and I was only in the hospital for 24 hours and they got the white cell count back to normal.


The doctor that I have now do not believe that there is nothing wrong so he don't do anything, I also have been passing blood this he has scheduled a test where they put a light my anus, to see what is going on but that is not scheduled till october and the rate I am going I will proably down by 10 or more pounds by than and the way I feel like I can't keep going on and it will be to late to do anything.


Thank You for your time. Randell

Expert:  Dr. Arun Phophalia replied 2 years ago.
Thanks Randell for the details.

Is this diarrhea new thing or has been there since you had been having abdominal pains?
Are your abdominal pain persisting in the same severity?
Do you have bloating, gas, heartburn, urinary symptoms?
Are you passing blood in every motion or occasionally?
What did your stool exam show?
Can you tell me about your previous investigations / CT scans and other medical imagings?

Dr. Arun
Customer: replied 2 years ago.

I will go back to the early after I had my first surgery I was never normal wen it came to bowl movements. For me normal was to go a few days without going to the washroom then I would have one or 2 days of either diahrea or normal, this was the way all my life till 2 or 3 years ago where I started going everyday nostly diahrea or small pieces once in awhile it looks normal I have seen days where I have gone l upwards of 7 or 8 times a day once in awhile I go a day without having to go at all, the smell is somthing that smells that I died, whn I pass alot of time it smells a bad as in the washroom, The last stool sample I had done was awhile ago and it was normal, I have some bloating. Over the years I have passed some blood but not much, it was only tis year I stated passing alot of bloodone day I wentto the wahroom 8 times andpassed blood times, luckily I hven't passed any blood in the last couple of months. Once in awhile I will get a sharp pain in mystomach in the upper right quadrant which is my trigger point for any problems to do with my stomach.There isn't no urinary problems tha I know off I go normally without any pain,


 


Randell

Expert:  Dr. Arun Phophalia replied 2 years ago.
Thanks Randell for the further information. I appreciate it.

Your main symptom is diarrhea with the abdominal pain and I wonder if somebody suggested about either Crohn's disease or ulcerative colitis. The other possibility to look for may be either food allergies or celiac disease. The initial evaluation of diarrhea with abdominal pain is on these characteristic;

 

a) stool volume,

b) frequency,

c) consistency, and

d) gross appearance.

 

This description to use the term "diarrhea" to describe urgency and the frequent passage of small-volume stools suggests a functional disorder such as IBS.

 

Stool volume can give an idea of disease location and underlying mechanism.

 

a) Large-volume stools (more than one liter per day) would point to small bowel disease and secretory diarrhea.

b) Small-volume stools (less than 300 ml per day) suggest large intestine diseases and functional gastrointestinal disorders like IBS.

 

Stool consistency can be varied ranging from formed to watery, and correlates with the rate of intestinal transit.

 

a) Secretory diarrheas are liquid.

b) Functional diarrheas are soft or semi-solid.

c) Stool floating will be indicative of if being filled with gas from fermentation of mal absorbed carbohydrates.

d) Mucus can point to both inflammatory and noninflammatory diarrheas, such as ulcerative colitis and IBS.

 

Stool appearance helps to classify diarrhea as;

 

a) Watery diarrhea is caused by carbohydrate malabsorption, medications, bile acid malabsorption, Crohn's disease, microscopic colitis, chronic mesenteric ischemia, post surgical diarrhea, hyperthyroidism, colonic adenomas and carcinomas, alcohol induced diarrhea, laxative abuse, and hormone-secreting tumors.

b) Steatorrhea or fatty diarrhea is greasy, oily, foul smelling, bulky, or voluminous stools that are often difficult to flush, might contain undigested food particles, and sometimes leaves an oily stain in the toilet bowl. These characteristics suggest pancreatic disease, short bowel syndrome, celiac disease, giardiasis, and small bowel bacterial overgrowth (SBBO).

c) Bloody diarrhea suggests Ulcerative colitis, Crohn's colitis, cancer and chronic infections.

Chronic diarrhea, is defined as the production of loose stools with or without increased stool frequency for more than 4 weeks. The main causes of the chronic diarrhea are following;

 

1) Irritable bowel syndrome; it is a sort of functional diarrhea in which no abnormality is found. This is unlikely the diagnosis in your case.

 

2) Inflammatory bowel disease (IBD); this is auto immune mediated type of diarrhea and it can involve other organs in the body. The biopsy of colon and small intestines need to be taken to establish the diagnosis with investigations like CRP, ANA, HLA B 27 etc. There are two type of IBD;

 

a) Crohn's disease

b) Ulcerative colitis

 

3) Microscopic colitis; Microscopic colitis is characterized by chronic watery (secretory) diarrhea without bleeding. It usually occurs in middle-aged patients. Two different types of microscopic colitis have been generally recognized:

 

a) Lymphocytic colitis

b) Collagenous colitis without lymphocytic infiltration of the surface epithelium

 

Collagenous and lymphocytic colitis produce a similar clinical picture characterized by non bloody chronic watery (secretory) diarrhea of up to two liters daily. So total amount of stools per day has to ascertained.

 

4) Malabsorption syndromes; The classic manifestations of malabsorption are pale, greasy, voluminous, foul-smelling stools and weight loss despite adequate food intake.

 

5) Chronic infections; Some persisting infections (C. difficile, Aeromonas, Plesiomonas, Camyplobacter, Giardia, Amebae, etc.) can be associated with chronic diarrhea.

 

You should be investigated for IBD, chronic infections or for secretory diarrhea (by estimating total amount of stools per 24 hours). Looking for the carcinoid tumor also may be considered. Gastrinoma and VIPoma also should be considered for prolonged secretory diarrhea and an high index of suspicion is required. Secretory diarrhea characteristically continues despite fasting, is associated with stool volumes more than 1 liter/day. Selective testing for plasma peptides such as gastrin, calcitonin, vasoactive intestinal polypeptide, and somatostatin, as well as urine excretion of 5-hydroxyindole acetic acid, metanephrine, or histamine and other tests of endocrine function, such as measurement of thyroid-stimulating hormone and serum thyroxine levels or an adrenocorticotropin-stimulation test for adrenal insufficiency, can be considered by your physician. An aspirate of small bowel contents for quantitative culture or breath tests with glucose or isotopically labeled xylose can be used to establish the presence of small bowel bacterial overgrowth.

 

Meanwhile an empirical trial of bile acid-binding resins, such as cholestyramine, may be started, which is the least expensive way to diagnose bile acid-induced diarrhea. Opiates are the most effective nonspecific antidiarrheal agents and can also be considered as a therapy in your case with Octreotide.

 

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

 

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Customer: replied 2 years ago.

Sorry I have to go to work now thak you for your information, I don't hve time to read and digest it all right now, I will read it when I get home from work and I will let you knowyou should get your reply tomorrow.


Thank You Randell

Expert:  Dr. Arun Phophalia replied 2 years ago.
You are very welcome, Randell.

Have a great day.
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29791
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 4 other Health Specialists are ready to help you
Customer: replied 2 years ago.

Hello Dr Phopalia,


Thank you for the informatin you have provided, I like to give you some more information to maybe help with the problem,


I mentioned earlier that I had my first stomach surgery when I was 31/2 years old. The symptons I had leading up to the surgery was dizzyness throwing up nausea, I don't know if I had diarahea or not alot of pain I couldn't go out into direct sunlight without getting sick, The doctors didn't know what was going on. So they sent to to a general surgeon. During the surgery he discovered a blockage in my food pipe, so they took out where the blockage was, so instead of my food pipe going going down straight down and accross, it comes down and curves, they also removed my appendix at the same time. I was in the hospital for 3 weeks after the surgery. One of the problems in getting doctors to believe what happened the official medical files were changed to show was all they did was a exploratory surgery and removed the appendix. Unfortunately anybody that knew what really happened has died. The only thing that I know is that I had to go to the surgeon for followup every year till I was 12 years old. On my last visit I remember the Dr saying to watch out for changes in the way I went to the washroom, wha was normal for me even if it wasn't normal for anyone else, if it changed I was to get it checked by a doctor. So up to about 3 years ago I what was normal for me than I changed, the problem is nobody believes me to do anything. One other thing about this I was always told I wasn't going to live to see 12 birthday the why and the reason I don't know.


When I had my pancreas surgery 2 years ago after the sugery while in recovery they discovered that I was bleeding out, So they had to operate and patch a hole in the bile duct. One of the concerns going into the surgery was that there was a chance that the blockage in the pancreas was cancer which it wasn't, Which causes a person to wonder if all these stomach problems over the years are related or if they are totally unconnected.


Thank You Randell

Expert:  Dr. Arun Phophalia replied 2 years ago.
You are very welcome, Randell.

These problems are likely to be not connected. Though a small connection can be that these seem to be various birth defects.

Your symptoms presently need a through work up, as we discussed and various work for the plasma peptides such as gastrin, calcitonin, vasoactive intestinal polypeptide, and somatostatin are likely to give the clue to the cause. Capsule endoscopy, mesenteric angiography, virtual colonoscopy, stool culture, should be able to give diagnostic clue.

It is privilege assisting you.
Customer: replied 2 years ago.

Thank You Dr Phophalia::


You have ben very informative, At Least i have someone that will listen thatr has been the whole proble my doctor will not listen, but that is my problem and I have to find a doctor that will do the tests that you said needs to be done. My last question to you is is the problems life threatening and ifso how much time do I have before my time is up because I feel That I donot have much time left,


Thank you Randell

Expert:  Dr. Arun Phophalia replied 2 years ago.
Randell,

I am quite sure that this is not life threatening. This is all likelihood to be treatable disorder (autoimmune disease is most likely cause).

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