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Suggest Treatment For Upper Abdominal Pain, Lupus And Blood In Urine

Posted on Fri, 12 Jun 2015

Question: My husband has lupus and has had it for at least 20 years recently he's been having pain in his upper abdomen when he swallows he recently just saw his rhemetoligist to get his results from routine blood work his platelet levels was high he's slightly anemic and there is blood in his urine and also bight red blood present with bowel movements we are waiting to see his regular pcp next week but this waiting is killing me what can it be

Answered by Dr. Naval Mendiratta (27 minutes later)

Brief Answer:
SLE Activity

Detailed Answer:
Good evening

Thank you for writing on health care magic

I have gone through your history. I would like to clarify on a few things as it all needs to be treated aggressively if the disease is getting active.

1. The blood in stools, is it like fresh blood or he passes Dark colored Stools?

2. Does the blood come in the beginning or at the end like few drops?

3. As for Anemia, has the hemoglobin dropped from the last reading or has been the same?

4. Did he have kidney involvement previously considering there is blood in urine??or is it a new finding

5. Currently what medications is he taking for lupus

We need to figure out firstly if the disease is active or the fall in Hb and Blood in stools is due to Hemorrhoids( which is a more common cause). The exact level of activity can only be made by comparison with the last results to see if the findings are fresh or the old ones...

DO let me know. Would try to guide you further

Await your reply

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Naval Mendiratta (3 hours later)

The blood in stool is fresh bright red and more then a few drops anemia and platelets are new fidings pain in his upper abdomen when he swallows started 3 weeks ago medications are leflunomide escitaloprama amittriptyline zolpidemh hydroxy chlorine omeprazole Dr lisinopril atrovastatin simponi injection once monthly rhumetologist just stopped his celecoxib

Answered by Dr. Naval Mendiratta (4 hours later)

Brief Answer:
Management of Lupus

Detailed Answer:
Good evening

Thanks for your response.

1. Firstly, I would suggest you consult your GP and ask him if you could stop Leflunomide and Simponi injection. I suppose these medications were added for his arthritis part in Lupus, but one has to be very careful using Anti TNF in SLE. Considering the pain abdomen, Leflunomide will cause more of stomach upset. Same goes with Celecoxib, even though it is a COX 2 Selective blocker, it can still cause Gastritis or peptic ulcer.

2. Anemia is probably due to the blood he is losing in stool. I would suggest you take him to ER. It may be just haemorroids but Considering SLE as the background , and bleeding in stools along with pain abdomen, one needs to rule out any ischemia in the intestines which will need aggressive treatment and one cant ignore it.

3. I am not sure why he is not on any Steroids for Lupus. It is the best drug till date we have for arthritis or for the other manifestations.

I would suggest you take him to ER and get it sorted out, cause if the Lupus is active one cant wait for that one week either. He will need a PR examination to see if the blood is due to hemorrhoids, and if not the next line would be CT Abdomen. If anything comes positive, he will need treatment with steroids.

I understand getting immediate medical help is tough there, so you can tell them he has been passing fresh blood and you want to be sure his SLE is not active. That should prompt them to investigate him

Do let me know for more queries

Regards
Dr Naval

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Above answer was peer-reviewed by : Dr. Shanthi.E