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Weight Loss, Swollen Lymph Node On Neck, Found Fat In Stool. Colonoscopy, Cat Scan Done. Lymphoma?
Question: Hi my name is XXXXXXX 26 year old female and nurse... and I am undergoing ALOT of health problems. . . I hope you can help; I am going to give you my results I have gotten thus far EVEN THOUGH most may not resemble my current health issue but in hopes that it may help you in your answer. I gave birth to a baby prematurely and since have gone down in health . Right now I have "Fat Malabsorption- and am losing a lot of weight, and i feel like im not getting the nutrition I need . I have lost 16 lbs since december without trying- but the doctor recently found fat in my stool. I am writing today because over a month period I have had a sore throat on and off , not VERY sore but sore enough to feel it. and on my left side of my neck; I have what I THINK is a swollen lymph node; its located on the middle of the left side of the neck almsot feels likes its on the muscle. It doesnt hurt, the top part is moveable but feels like its fixed down at the bottom like on a ligament or muscle. But it feels like its on the muscle. If I tighten the muscles in my neck i can no longer feel it. My worry right now is lymphoma, due to the weight loss and felt lymph node... ive been through a lot loss of my baby and this sickness (whatever I have) that I feel ive become a hypochondriac but at the same time don't want to dismiss my issues if their reall, I do not ever have a fevor, I dont have night sweats; though I did right after I gave birth, I ihave a sore throat, on and off very mild for the past month, no other swollen lymphnodes found.........Other symptoms are this - fat malabsorption (for an unknow nreason right now this started after the birth of my baby) I had Ketones in my urine (also I guess do to malabsorbtion right now) and the following are all the results I have recently had:
Colonoscopy- it came back normal with XXXXXXX hemmroids found only- biopsies done- normal no findings
EGD- -Found gastritis - otherwise normal also did biopsies
HIDA Scan- Normal it states "Normal Hepatobiliary scan with normal gallbladder ejection fraction of 47%
Abdominal Cat Scan with constrast- Normal it stated "The lung bases are clear. The Liver,spleen,
gallbladder,pancreas,kidneys, and adrenal glands are within Normal limits. A small splenule is noted anterior to the spleen. No mass or adenopathy is seen. No bowel wall thickening, edema, pneumoperitoneum or ascites is evident. The uterus and adnexa are unremarkable. No osseous is seen
Lipase- Low
Amylace- Normal range
Ultrasound of the right upper quandrant said "Liver is unremarkable in contour, shape and parenchmal echogenicity. There is no evidence of intra or extrahepatic bililary dilation with the CBD measuring 2mm. Gall bladder is unremarkable with no evidence of Cholelithiasis. The Visualized portion of the pancreas is unremarkable with the body and tail not well visualized due to overlying bowel gas. Screening images of the right kidney demonstrate no XXXXXXX hydronephrosis and unremarkable cortical echogenicity. The right Kidney measures 10.8cm in length Impression : Unremarkable rruq ultrasound
He did some kind of autoantibody for autoimmune pancreatitus- came back negetive
then he did stool samples for OvaParasites- negetive
stool sample blood- negetive
The only positive was stool sample for fat -Positive
Celiec disease- serum and biopsy -negetive
Hpylori Biopsy-negetive
Hemaglobin A1c -normal 5.6
CBC- Normal except very mild anemia Hemaglobin was 11.8 Hematocrit 36.2, wbc-5.9
BMP-normal last one bilirubin was 0.4, albumin 4.1 Sodium 143 Potassium 4.2 Calcium 9.6 Chloride 106 BUN 10 Creatinine 0.8 ,glucose 78, total protien 8.1 Alkaline Phos 50
Albumin that was in the BMP or CBC (forget which one thats in) was normal range
Carcinoid- was ruled out by a weird blood test.
All my thyroid levels were chcecked including TSH T4 T3 T7 and thyroid antibodies all normal.... (this was checked in depth due a nodule- which was benign ( I had a thyroid biopsy)
I have had many chest Xrays- all negetive
spine Xray-negetive
CRP 0.1
tryptase 3.3 XXXXXXX 1:80 -
I get a stiff back alot and stiff joints in my wrist , back , spine especially- they think I could have an autoimmune problem?
CT angioGram- negetive
I had an immunology panel that looked at IGG1 IGG2 IGG3 and IGG4 all within normal limits
As you can see I have had quite the work up. I know all of this wouldnt be reliable source for my current problem but wanted to give you all the information I had- I would hate to make ANOTHER doctor appt if unneccisary as I see doctors so much right now :-( do to the malabsorption issue they are trying to figure out. My main concern is lymphoma- I also have a concern to why the doctors cannot find my malabsorption issue (you may comment on that if you feel you could help me in that regards too) . If lymphoma is a concern , who do I talk to abotu it? as right now I have a Immunologist, Cardiologist, GI doc, GP, and I have a rheumology appt coming up soon
Colonoscopy- it came back normal with XXXXXXX hemmroids found only- biopsies done- normal no findings
EGD- -Found gastritis - otherwise normal also did biopsies
HIDA Scan- Normal it states "Normal Hepatobiliary scan with normal gallbladder ejection fraction of 47%
Abdominal Cat Scan with constrast- Normal it stated "The lung bases are clear. The Liver,spleen,
gallbladder,pancreas,kidneys, and adrenal glands are within Normal limits. A small splenule is noted anterior to the spleen. No mass or adenopathy is seen. No bowel wall thickening, edema, pneumoperitoneum or ascites is evident. The uterus and adnexa are unremarkable. No osseous is seen
Lipase- Low
Amylace- Normal range
Ultrasound of the right upper quandrant said "Liver is unremarkable in contour, shape and parenchmal echogenicity. There is no evidence of intra or extrahepatic bililary dilation with the CBD measuring 2mm. Gall bladder is unremarkable with no evidence of Cholelithiasis. The Visualized portion of the pancreas is unremarkable with the body and tail not well visualized due to overlying bowel gas. Screening images of the right kidney demonstrate no XXXXXXX hydronephrosis and unremarkable cortical echogenicity. The right Kidney measures 10.8cm in length Impression : Unremarkable rruq ultrasound
He did some kind of autoantibody for autoimmune pancreatitus- came back negetive
then he did stool samples for OvaParasites- negetive
stool sample blood- negetive
The only positive was stool sample for fat -Positive
Celiec disease- serum and biopsy -negetive
Hpylori Biopsy-negetive
Hemaglobin A1c -normal 5.6
CBC- Normal except very mild anemia Hemaglobin was 11.8 Hematocrit 36.2, wbc-5.9
BMP-normal last one bilirubin was 0.4, albumin 4.1 Sodium 143 Potassium 4.2 Calcium 9.6 Chloride 106 BUN 10 Creatinine 0.8 ,glucose 78, total protien 8.1 Alkaline Phos 50
Albumin that was in the BMP or CBC (forget which one thats in) was normal range
Carcinoid- was ruled out by a weird blood test.
All my thyroid levels were chcecked including TSH T4 T3 T7 and thyroid antibodies all normal.... (this was checked in depth due a nodule- which was benign ( I had a thyroid biopsy)
I have had many chest Xrays- all negetive
spine Xray-negetive
CRP 0.1
tryptase 3.3 XXXXXXX 1:80 -
I get a stiff back alot and stiff joints in my wrist , back , spine especially- they think I could have an autoimmune problem?
CT angioGram- negetive
I had an immunology panel that looked at IGG1 IGG2 IGG3 and IGG4 all within normal limits
As you can see I have had quite the work up. I know all of this wouldnt be reliable source for my current problem but wanted to give you all the information I had- I would hate to make ANOTHER doctor appt if unneccisary as I see doctors so much right now :-( do to the malabsorption issue they are trying to figure out. My main concern is lymphoma- I also have a concern to why the doctors cannot find my malabsorption issue (you may comment on that if you feel you could help me in that regards too) . If lymphoma is a concern , who do I talk to abotu it? as right now I have a Immunologist, Cardiologist, GI doc, GP, and I have a rheumology appt coming up soon
Hello and welcome to Health care Magic,
You have had had almost all the investigation done for your health problem.
The symptoms that you are having are suggestive of intestinal lymphoma.
You have undergone colonoscopy and biopsy, both of which are normal.
However, a small intestinal biopsy needs to be done to confirm or rule out a small intestinal lymphoma.
Mal-absorption is a feature of small intestinal lymphoma. If lymphoma is confirmed, you need to be under the treatment of an oncologist.
Secondly, the neck swelling also needs to be investigated by FNAC or biopsy.
If you have more concerns, I will be glad to answer.
Dr Shailja P Wahal
You have had had almost all the investigation done for your health problem.
The symptoms that you are having are suggestive of intestinal lymphoma.
You have undergone colonoscopy and biopsy, both of which are normal.
However, a small intestinal biopsy needs to be done to confirm or rule out a small intestinal lymphoma.
Mal-absorption is a feature of small intestinal lymphoma. If lymphoma is confirmed, you need to be under the treatment of an oncologist.
Secondly, the neck swelling also needs to be investigated by FNAC or biopsy.
If you have more concerns, I will be glad to answer.
Dr Shailja P Wahal
Above answer was peer-reviewed by :
Dr. Mohammed Kappan
I had an egd that also did biopsies which were normal. - my doctor stated he is looking at pancreatic insuffiency- so having the sore throat and cold over a month period does not lead to just a swollen lymph node? the size of the left neck area is like a kidney bean size so, your saying this is likely lymphoma both in my bowels and my neck?
Hello and welcome,
Nothing can be said without investigations. A lymph node in the neck can be secondary to throat infection as you have mentioned above or it can be due to lymphoma.
The malabsorption occurs due to pancreatic insufficiency commonly. However, all your tests and ultrasonography is coming out to be normal.
Other causes of malabsorption are due to pathology of the small intestine. So, the pathology has to be looked in the small intestine. It is not necessarily due to lymphoma. Other disease processes can also lead to these symptoms.
So, the best option is to repeat upper GI endoscopy and endoscopy.
If you have more queries, I will be glad to answer.
Dr Shailja P Wahal
Nothing can be said without investigations. A lymph node in the neck can be secondary to throat infection as you have mentioned above or it can be due to lymphoma.
The malabsorption occurs due to pancreatic insufficiency commonly. However, all your tests and ultrasonography is coming out to be normal.
Other causes of malabsorption are due to pathology of the small intestine. So, the pathology has to be looked in the small intestine. It is not necessarily due to lymphoma. Other disease processes can also lead to these symptoms.
So, the best option is to repeat upper GI endoscopy and endoscopy.
If you have more queries, I will be glad to answer.
Dr Shailja P Wahal
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Mohammed Kappan
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