Prior abdominal surgeries and causes of diarrhea and malabsorption

I developed an inability to absorb fats, and probably other nutrients. It is critical that I absorb some fat because I have to take a high dose of vitamin D due to parathyroid failure. Basically, my problem started in 2001 after my nissan fundoplication due to reflux. After the surgey when I ate a meal, I would immediately swell up, bloat, feel nauseated, release gas, and have one or two bowel movements. I had to lay down to relieve the nausea (stretch out while laying down since after the fundoplication I could not vomit.)  Prior to the surgery, I had one bowel movement per day in the morning, could eat with minimal to no bloating and rarely had farting problems. Over the last 4 years, these problems increased. I went back to the gastro surgeon and he told me that the air I swallowed would now be released the other way and that I should expect some bloating. So I resolved that I had to adjust to this. Then over the last two years, it just got worse and worse until, I could not eat without farting, sometimes ate and felt like I was going to faint at the table, felt the urgency to have a BM after eating, and developed continual diarrhea. Then early Feb 2005, I developed tremors and learned I was having latent tetany because I was not absorbing my vitamin D. My endo doctor put me on calcitriol which relieved the cramping, tremors, etc.  Then the gastro doctor put me on enzymes and I still did not form a normal stool after 6 weeks of it. Instead in the morning, when I first get up, it is a struggle to eat, no appetite, feel nauseated, and I have 4-5 watery BMs, with fat floating, all even though I take enzymes. Once the BMs cease my bowel is generally quiet during the day, except for maybe one BM. Now I am on immodium once a day to prevent dehydration, etc.  During the last few weeks, I experienced pain in the high right area (gall bladder), shaking or quivering deep right area.  My stools are generally very light colored with a few grey (cement) color.  My vegetables often go undigested.  My gastro doctor did an endoscopy, found that my duodenum tissue was normal, no stomach or eshophagus problems. He had me checked for bacteria -all negative. He is ordering a sonagram of my gall bladder and some procedure to check the latter part of my small intestine. He did a fatty stool test but I don't have the results. I had a past gall bladder attack due to an infection 30 years ago and my gyn doc noted adhesians in that area. Question is: my gastro doc thinks I have Crohn's disease but I wonder if adhesians or a bad gall bladder could cause all this? Or if the fundoplication resulted in repositioning my gall bladder so that I get little bile to break up the fat? My sister had a gall bladder removed which was diseased and it had upset her electrolytes.  What do you think I have?

[Kevin Pho, MD]

The fatty stool tests would check for fat malabsorption, and would be helpful in the workup.

Crohn's disease is certainly possible.  A colonoscopy as well as an upper GI series with small bowel follow-through can be helpful in the diagnosis.  

It is possible that the fundoplication is related.  However, I am not a surgeon and you may want to discus this question with your personal surgeon.  

Another consideration would be celiac disease - which can also cause symptoms of malabsorption.  A blood test looking for endomysial antibodies would be the proper test to evaluate for this condition.

You can discuss these options with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com

[astros18]

You indicated you are taking enzymes. Are you taking a hi lipase enzyme. That's what you need to digest fats. Chickweed is also good. If your bowel movements are with out color, it sounds like you are not producing enough bile to help digest your food.