Trying to interpret symptoms and test results

[jbtrichel]

I am currently seeking a good Gastroenterologist in the Dallas area... so please be patient with my questions as my primary care doctor seems to have very few answers for me at this time.

I am a 31 yr old male, 5'11, 195 pounds.

I know that I have a hiatal hernia and reflux esophagitis from an EGD that was performed in 2000.  I take 40mg Nexium daily. Other than that, relatively healthy.

However, over the last 6 months, I have developed symptoms that do not appear to be related to my hiatal hernia/reflux.  I have experience persistent dull aching in my chest and upper abdomen, swelling of my abdomen, belching, cramping, and mild nausea.  I have had no diarrea (diarrhea) and no fever.  My stool has remained pretty firm but has become lighter in color I have noticed.  

I have had stress echo testing performed to rule out cardiac causes, and a lung CT scan performed... both came back normal. Typical general blood tests came back normal.  My primary care doctor ordered an abdominal ultrasound...which came back normal.  

I recently had an abdominal CT scan performed at presentation to the ER based on pretty severe cramping, pale skin color and weakness with the following results:  
"Two subcentimeter low desnities are demonstrated within the dome of the liver too small to characterize but likely represent simple cysts.  The liver is otherwise normal in appearance.  The gallbladder, pancreas, spleen, adrenal glands and kidneys are normal.  No free air or free fluid is demonstrated within the abdomen.  Multiple prominent lymph nodes are demonstrated within the small bowel mesentery, and in particular in the ileocecal region.  This is most likely secondary to chronic inflammation.  The large and small bowel are normal in appearance.  There is subtle apperance of bowel wall thickening at the terminal ileum, but this is likely within the limits of normal.  The appendix is well seen and is normal.  Osseous structures and soft tissues are normal".

1.  Should these findings from the CT abdomen concern me?  The ER doctor seemed to dismiss the findings as within normal limits, but I am not completely comfortable with that yet.  Could there be anything ominous going on that has not been detected?

2.  Would do you recommend should be my next steps - would an additional endoscopy be in order?

3.  If you were to guess at some POSSIBLE scenarios given my history and symptoms, what would they be - only asking for possibilities and I realize that I need to see a physician for a definitive diagnosis.  

Bottom line, I am scared and without answers.  I am doing my best to find a good Gastroenterologist, but until then, any input you can provide will be very helpful.  Thank you.

[Kevin Pho, MD]

1) Your CT shows simply liver cysts and lymph nodes along with bowel wall thickening in the ileum.  Simple cysts normally do not require treatment, but large ones (> 4cm) should be periodically monitored.  Lymph nodes and the thickening is suspicious for inflammatory bowel disease.

2) I would consider a colonoscopy to further evaluate the thickening.  

3) As was mentioned, inflammatory bowel disease (either Crohn's disease or ulcerative colitis) are possible.  

A list of gastroenterologists can be found here:
http://www.abim.org/dp/apps/physdir1.htm

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.

Thanks,
Kevin, M.D.

[surgeon]

a common explanation for enlarged nodes and inflammatory changes in the ileocecal region (where the small intestine joins the large intestine) is Crohn's disease, which is a chronic inflammatory process that can involve any part of the intestinal tract, but classically is at the ileocecal location. It can certain cause the symptoms you describe. It shouldn't be hard to find a gastroenterologist in the Dallas area -- if your own doc isn't making a referral for some reason, you could start at one of the major medical centers there. Once you find a gastroenterologist, likely colonoscopy will be recommended: usually they can reach the ileocecal area and visualize and/or biopsy it directly

[GI.PA]

I am in a large group in Fort Worth (your neighbor).  Check your insurance.  I would reconmend Mark Dalton, MD and he can usually see you in 3-4 weeks.  I can see you with him in 1-2 weeks.  We are at 1201 Summit Ave #300 and our number is 817-335-2487.  Wherever you go, get personal copies or your studies to date, get the films from your CT scan and bring that all with you to your GI appointment.  This will save you and your doc a lot of time and energy.

Erin Dettrey, PA-C
Gastro Physician Assistant
Gastro Associates of North Texas

[jbtrichel]

Thanks for all the information.  One follow-up question:  Should I be concerned about cancer given the enlarged lymph nodes?  Or does the lack of any masses and normal blood results eliminate any major concern of cancer?  Is it at all possible that there is NOTHING wrong with me and this is just a normal CT scan with a couple of minor abnormalities?  In other words, does the slight thickening of bowel wall and enlarged lymph nodes mean there is DEFINITELY something going on?  Or just a possibility that needs to be evaluated by the gastro doctor...

[kkg]

Regarding your symptoms,try these few simple rules and then let me know how do you feel:
1. Do not eat too much of purines i.e meat products for some time.
2. If you have to eat meat products do not mix starch and meats,
its very important, e.g do not have bread and meat together!
3.Try and be on fruits  for a couple of days and then be a vegetarian for a week.
4.Eat a lot of fresh spearmint leaves with every meal.

hope you get some relief.

Krishna Gulliya
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