OpenHealth Q&A

Seeking Clarity on Ongoing Abdominal Discomfort and Confusing Test Results

Hello everyone! I'm a long-time observer of this forum, but sadly, I'm now in need of assistance. To give you a clear picture of my situation, here are my details: I’m a 30-year-old male, standing at 6 feet 3 inches tall and weighing 245 pounds. My medical history includes ADHD, hypertension (with a family history), gastroesophageal reflux disease (GERD), and microcystic adnexal carcinoma, a form of sweat gland cancer treated in a manner similar to skin cancer. I am currently on a proton pump inhibitor for my GERD symptoms. For over five years, I have been grappling with persistent bowel issues characterized by diarrhea. My stools are frequently yellow and oily, and often stick to the toilet bowl. This happens with almost every bowel movement, regardless of diet changes. Comprehensive tests for celiac disease and other intolerances have returned negative results. In 2023, I underwent a colonoscopy, which, while it remained largely benign, revealed “increased vascular congestion” across nearly all samples, and was negative for microscopic colitis. There were no clear indicators of inflammatory bowel disease during the procedure. Due to a change in employment from traveling nurse to a staff position, I did not follow up with a gastroenterologist between 2023 and 2025. However, approximately 12 weeks ago, I consulted with my primary care physician regarding my ongoing concerns about the oily and greasy diarrhea occurring multiple times a day—only rarely do I experience formed stools. In addition, I have been feeling a cold, uncomfortable sensation in my extremities—my feet, hands, nose, and ears—which might suggest neuropathy or a problem with nutrient absorption, persisting as long as my diarrhea. About six weeks prior, I began noticing a persistent gnawing pain in my left upper quadrant, which sometimes radiates to my back. While it’s not overly intense, it is a constant presence. Three weeks ago, while working, the discomfort intensified to the point where I sought immediate care in the emergency department, fearing that I might have pancreatic cancer or pancreatitis. For context, I do not consume alcohol, not even socially, nor do I smoke, making it particularly alarming. My CT scan revealed: 1. No evidence of kidney stones, hydronephrosis, or distal obstructions. 2. A nonspecific bowel pattern with fluid-filled loops suggestive of potential enteritis. 3. Hepatic steatosis was observed without any focal lesions or ductal dilation. 4. The spleen was measured at 14 cm, slightly elongated, accompanied by several borderline mesenteric lymph nodes, with the cause remaining uncertain but possibly related to a reactive or post-inflammatory condition. Despite unremarkable lab results, I noted that my mean corpuscular volume (MCV) was low, indicating potential microcytic anemia, fluctuating between 75 and 78. Other blood tests appeared normal, including lipase and lactic acid testing. Afterward, I experienced nausea and diarrhea, presumably due to a gastrointestinal bug, but my testing was limited to standard assessments for COVID, flu, and RSV, which yielded normal results. Exactly one week later, I experienced another episode of debilitating pain, during which I was sweaty, vomited, and had to leave work. This prompted a repeat CT scan with contrast, which revealed similar findings as before, although my liver enzymes were elevated, and my white blood cell count, as well as neutrophils, had increased. Notably, my lymphocyte count decreased, and the MCV remained low. A request for a C-reactive protein (CRP) test also came back normal. I insisted on a referral back to gastroenterology. In my recent visit with the gastroenterologist, there was no immediate cause for alarm attributed to inflammatory bowel disease, and I was scheduled for further procedures: a repeat colonoscopy and an EGD. It's now been three weeks since my last visit to the ED, and I continue to endure abdominal pain, which sometimes intensifies but remains inconsistent regardless of my eating habits. I’m left questioning whether my spleen could be involved, though I struggle to accept that this prolonged pain might originate from it. I do agree some enteritis signs were apparent during my second visit. Following the last ED encounter, I faced severe gastrointestinal upset that led to extensive diarrhea and vomiting. I’ve grown increasingly worried about the significance of my CT results, notably the presence of mesenteric lymph nodes and splenomegaly. While I conducted a self-check, I found a swollen lymph node beneath my right armpit, which is firm, about the size of a pea, and detectable. No healthcare provider has yet examined this area thoroughly. It's notable that three weeks post-ED visit, I still have a visible bruise from a missed IV attempt at the hospital, which raises my concern about its prolonged healing time. Though I may be overthinking this, it weighs on my mind. My main query is whether there is a possibility that this situation could be related to lymphoma. What additional tests can I request from my healthcare providers to help eliminate this concern? I have been diligent in reviewing relevant literature and peer-reviewed studies, yet the gastroenterologist did not seem overly worried. I have also noticed a lack of evidence indicating that Crohn's disease can cause steatorrhea, which has been my primary gastrointestinal symptom. Some of my other symptoms do not correlate as well, either. Considering it’s flu season—with various abdominal complaints affecting many in the ED—I am at a loss. The ongoing abdominal pain combined with lymph node involvement is concerning. What further investigations can I discuss with my provider, or is it wiser to await the endoscopic procedures? I’m a parent to two young daughters, and if there’s any potential for serious illness, I want to address it promptly. Any guidance or insights would be greatly valued. I am more than willing to provide further information if needed. Thank you in advance for your support!

Answers (1)

3/22/2025, 4:50:55 AM

OpenHealth AI

I understand that you've been dealing with persistent abdominal discomfort and a complex medical history, which can understandably lead to significant concern, especially given your family responsibilities. Let's break down your situation and discuss what steps might help clarify things further.

Key Points:

1. You experience ongoing abdominal pain, diarrhea (often oily), and other concerning symptoms like extreme fatigue and visible lymph nodes.
2. Recent imaging showed liver steatosis, splenomegaly, and mesenteric lymph nodes, but no clear indication of a serious underlying condition was identified so far.
3. You have upcoming endoscopic procedures (colonoscopy and EGD) for further investigation.

Explanation:

Your symptoms—steatorrhea (fatty, oily stools), abdominal pain, and the swollen lymph node—are indeed worrying and point towards possible malabsorption issues or a more complex condition. The findings of splenomegaly and mesenteric lymphadenopathy can sometimes be linked to infections, inflammatory processes, or malignancies, though this isn’t necessarily indicative of lymphoma. It's good to hear that your gastroenterologist has scheduled follow-up procedures, as these can provide essential information.

Lymphoma typically doesn't present purely with gastrointestinal symptoms but may affect the spleen and lymph nodes. Your history of low MCV indicates possible anemia, which can also accompany various conditions, including chronic disease processes.

Next Steps:

1. Prepare for Endoscopy: Given that additional procedures are already planned, it's beneficial to wait for those results. They will provide more direct insight into your gastrointestinal health. Make sure your gastroenterologist is aware of all your symptoms, including the swollen lymph node and any changes in your condition since your last appointment.

2. Request Specific Tests:

   • Complete Blood Count (CBC): Regular monitoring of your blood counts can help track potential changes related to lymph nodes or signs of infection.
   • Peripheral Blood Smear: This can help provide more detail about abnormal cells in your blood and rule out hematological concerns, including lymphoma.
   • PET Scan: If there's continued concern over lymphadenopathy after your procedures, this can help assess metabolic activity in lymph nodes.
   • Nutritional Assessment: Given your diarrhea and potential malabsorption, a referral to a dietitian might help address any deficiencies.

3. Monitor Symptoms: Keep a detailed symptom diary, noting any changes in pain, bowel habits, and general well-being. Report these details to your healthcare provider.

4. Follow-up on Lymphadenopathy: Bring up your concerns about the swollen lymph node during your upcoming visit. It’s important for your provider to assess it physically.

5. Support System: Since you are a parent, consider seeking support from family or friends as you navigate this health concern. Mental well-being is equally important.

Remember, your healthcare providers are your best resource for understanding these complex symptoms, so keep the lines of communication open. Stay hopeful, and I wish you clarity and improved health in the upcoming evaluations.