Questions in the Gastroenterology and Liver Diseases Forum have been answered by Dr. Kevin Pho who is board certified in Internal Medicine and by doctors from Henry Ford Health System.

Question Title: GI Problem or Nervous Breakdown?

Forum: The Gastroenterology and Liver Diseases Forum
Topic: Digestive


I am a 32 year old female, and have been in good health (I think), but with the advent of some GI problem a month ago, I am beginning to think that I am losing my mind! My only prior health problems have been a bout with erythema nodosum four years ago and a positive skin test for tuburculosis 1 1/2 years ago. No systemic cause
for the erythema nodosum was found and since I did not have active TB, I did 6 months of isoniazid as a prophylactic. Then, a month ago, I begain having watery diarrhea between 2-5 times per day for a two week period, sometimes it would wake me at night. My only other symptoms were extreme fatigue, loss of appetite, and a nervous stomach (no vomiting or abdominal pain). My doctor checked for the four most common bacteria, blood, and parasites in my stool, but all came up negative. I then had a colonoscopy, and everything looked fine. Following the colonoscopy, the diarrhea subsided for about 10 days, although I continued having more bowel movements than normal for me (2-3 times per day), floating stool, a temperature from 99-99.6 degrees, a persistent but nonproductive cough, weight loss (I'm down 6 pounds total), continued fatigue, and anxiety. I know that I have been stressed due to my symptoms and worried that I may have a serious illness, but I have been feeling anxious at strange times, such as when I am trying to get to sleep. Meanwhile, a complete blood count looked fine, but I had diarrhea again three days ago. My GI guy put me on metronidazole and Immodium AD two days ago because he thought that I may have a toxin or parasite that the tests did not pick up. I know that all the negative tests are a good sign, so why is it that I am not gaining back weight, still feel fatigued, lacking an appetite, and anxious? Is there a way I can tell organic disease from a psychologial problem? Are there any more tests that you would suggest? I just want to get to the bottom of this so that I can do whatever I need to in order to feel well again.

______

Dear Stephanie,
Thank you for your recent letter. As you wrote to Jean, there is a similarity between your symptoms and hers. Several pieces of information are needed. Do you take medications at this time? Do you suffer from other medical problems? Have you taken antibiotics recently? What is your source of water? With regard to the diarrhea the physician should know the stool consistency and the stool volume (large or small bowel movements).

One of the diseases that must be considered when someone develops chronic diarrhea is AIDS. If you have risk factors for this condition (drug use, multiple sexual partners etc) you should be tested for HIV infection. AIDS can be associated with a number
of intestinal infections. Special tests are required to exclude all the different possible infections. Another possible cause of your diarrhea and weight loss is hyperthyroidism. This disease can be easily evaluated by a blood test.

Malabsorption must be excluded in view of your weight loss. Pancreatic diseases as well as duodenal mucosal disease must be excluded. In addition, your doctor should exclude Crohn's disease of the small intestine. Finally, if you have diarrhea despite not eating, it is possible that you have a SECRETORY DIARRHEA. There are a number of
conditions that can cause this problem. Evaluation by a gastroenterologist with expertise in this field is required.

You should have a 24 hour stool collection weighed to determine how much stool you are actually passing. Second, the stool sodium and potassium concentrations should be measured. These two pieces of information may help your physician direct your investigation.

If you want Dr. Fogel of the Division of Gastroenterology at Henry Ford Hospital, one of our experts in the evaluation of patients with diarrhea, would be happy to see you. He would review your outside records and arrange for the necessary tests to complete the evaluation of your diarrhea. You can arrange for an appointment by calling the Henry Ford Physician Referral Line at (313) 876-2393.

This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
HFHSM.D.-rf
*keywords: diarrhea, Crohn's disease. Malaborption
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