Significance of Chem-24 Panel and CBC for Diagnosing GI disorder

[Christine__0__0]

  I've posted here several times in the past few weeks and thank you for input and guidance.  If I could get this from my physicians, maybe I wouldn't need to post so much!!
  I am a 34 y/o female who abruptly presented in early July with nausea/loss of appetite/early satiety; followed the next day by diarrhea.  This same pattern happened intermittently over a period of approx. 4 weeks.  Diarrhea progressed to mucous diarrhea.  Lost 10 lbs.  After visiting my family physician and my endocrinologist who labelled me as having IBS or a virus, I made it to a GI doc.  He suspected giardia.  O&P tests were negative.  There was a lab mix up and the giardia antigen was NOT run.  Elected to do the antigen test anyway, even though I had taken two doses of Flagyl--result was negative.  Treated with Flagyl, felt 80% better, put 3 lbs on while on vacation.  Upper stomach problems still persisted though.  Food intake has been reduced because of early satiety.  Weight leveled off at 139 (10 lb weight loss).  Regained appetite; however, still could not eat my usual portion--nor can I tolerate sweets on most occasions, although sometimes I can.  Then, I had a routine follow up scheduled with my endocrinologist.  He was not happy that I still had ongoing problems with my stomach.  He decided to run a CBC and Chem-24, along with the routine TSH.  (I previously had thyroid cancer).  This made me very upset.  I quickly lost my appetite again but tried to eat well in spite of it.  I went out to dinner on Saturday (ate fish/baked potato/salad) and did okay.  Then a few hours later, against my better judgement, I decided to eat a piece of pecan pie.  Could only eat half of it.   Two hours after eating it, I felt so FULL I thought I would die, I was miserable.  When I awoke I still felt uncomfortable.  No pain, just fullness/belching, etc.  I ate very mildly on Monday.  On Tuesday morning I awoke with nausea, more severe than before (by the way, endo had me taking Pepcid since my visit with him).  Two hours after I took a Pepcid in the a.m. nausea decreased.  Breakfast did not seem to alleviate or aggravate nausea.  Ate lunch, no nausea.  Ate a yogurt for snack- nausea returned along with a mild ache in my upper abdomen (a bit left of center--rib cage area).  Maalox and Pepcid seemed to help a bit.  Stomach was sensitive to pressure.  Today, still nausea in the a.m.  Took Pepcid and a few hours later it begins to lessen.  Ate lunch (peanut butter/jelly) with no problem.  Also, I had that endo appt. on Friday--by the next day I had noticed I had lost another 2 lbs.  Part of me thinks this is my nerves that are exacerbating maybe a minor problem because I can't get any answers.
  My doctor's nurse called today and my Chem-24 and CBC are both normal.  What do normal results signify to the doctor when he is trying to rule out causes for GI disturbance.  I know he wanted to check my liver and kidney function along with blood sugar levels.  Obviously the CBC would indicate if I am losing blood?  Does this test show any indications of gall bladder or pancreatic disease?  My endo then recommended I take 20mg Pepcid twice per day (instead of 10mg), and to make another appt. with my GI doc. which I have done.  Of course this all takes so much time.  Can the Pepcid AC aggravate a stomach condition?
  Thanks,
  Christine
Dear Christine,
Particular foods seem to aggravate your symptoms. It may be helpful to avoid such foods.  In terms of the blood tests, as you mentioned a CBC (complete blood count) will measure the hemoglobin and hematocrit which will indicate whether bleeding is present. The white blood cell count can be elevated with infection. The Chem 24 probably includes electrolytes such as sodium or potassium which can be low with vomiting or diarrhea. It may also include some liver enzymes which could help to determine whether a hepatitis or biliary disorder (such as gallstones) is present. Liver enzyme abnormalities can occur with acute pancreatitis (inflammation of the pancreas), but usually an amylase and lipase (pancreatic enzymes) level are sent to exclude this disorder. An assessment of kidney function (blood urea nitrogen and creatinine) are also usually included as part of the Chem 24 as well as a blood sugar (glucose) level. Famotidine (Pepcid) is a medication which works by decreasing stomach acid production. It is useful in a number of gastrointestinal conditions such as gastroesophageal reflux disease and  peptic ulcer disease. It does not usually cause stomach upset and is often well tolerated.
Good luck with your follow-up appointment.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568 our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
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*Keywords: complete blood count, biochemical profile, famotidine