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What Causes Nausea And Fatigue For The Past Three Weeks Along With Intermittent Warm Sensation In The Lower Left Abdomen?
Question: Hi Doctor...I've been experiencing nausea, fatigue for the past 3 weeks. Initially also had an intermittent warm sensation in the lower left abdomen/upper groin which has subsided but nausea and fatigue continue.
Had blood work done and showed elevated liver enzymes...specifically ALT was fluctuating between 59 and122,
CT scan showed no diverticulitis or anything else remarkable. Microscopic hematuria in urine. Negative for Hep A B C
Also been experiencing nighr sweats
Normal CBC
Sedimentation rate 6 mm/h
C reactive protein 1.4mg/L
Normal bilirubin 0.7
Gammma glutamyl transpeptidase 20 UL
Smooth muscle antibody 20 units
Anti nuclear antibodies Positive
Ferritin 156 ug/L
Iron transferrin Saturation - normal
ANA Titer 40 Speckled Pattern
Immunoglobulin G Subclass 3 - elevated at 143
Subclass 1,2,4 normal range
My care team hasn't been able to discover anything...any thoughts appreciated
Had blood work done and showed elevated liver enzymes...specifically ALT was fluctuating between 59 and122,
CT scan showed no diverticulitis or anything else remarkable. Microscopic hematuria in urine. Negative for Hep A B C
Also been experiencing nighr sweats
Normal CBC
Sedimentation rate 6 mm/h
C reactive protein 1.4mg/L
Normal bilirubin 0.7
Gammma glutamyl transpeptidase 20 UL
Smooth muscle antibody 20 units
Anti nuclear antibodies Positive
Ferritin 156 ug/L
Iron transferrin Saturation - normal
ANA Titer 40 Speckled Pattern
Immunoglobulin G Subclass 3 - elevated at 143
Subclass 1,2,4 normal range
My care team hasn't been able to discover anything...any thoughts appreciated
Brief Answer:
Need few more details my dear patient.
Detailed Answer:
Hello,
Need some answers before I could give you a professional advice.
How are your bowel habits?
Any history of constipation or bowel inconsistency?
Any change in bowel pattern?
History of bloating belching excessive gas formation?
Is GERD in control now?
Smell of fart normal or pungent?
Any history of taking probiotics?
Food habits?
History of alcohol or smoking?
Was a colonoscopy ever done?
Intensity of pain on a scale of 1 to 10?
Any relieving factor?
Was a stool test done?
Can you pin point the site of pain by single finger or you need your palm?i.e localised or generalised?
Waiting for your reply.
Thank you.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
Need few more details my dear patient.
Detailed Answer:
Hello,
Need some answers before I could give you a professional advice.
How are your bowel habits?
Any history of constipation or bowel inconsistency?
Any change in bowel pattern?
History of bloating belching excessive gas formation?
Is GERD in control now?
Smell of fart normal or pungent?
Any history of taking probiotics?
Food habits?
History of alcohol or smoking?
Was a colonoscopy ever done?
Intensity of pain on a scale of 1 to 10?
Any relieving factor?
Was a stool test done?
Can you pin point the site of pain by single finger or you need your palm?i.e localised or generalised?
Waiting for your reply.
Thank you.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
Above answer was peer-reviewed by :
Dr. Remy Koshy
Bowel habits are slightly different...softer and narrower than typical
No history of constipation
GERD was in control but now I feel full with small meals with lots of belching
Smell of fart is pungent
I do take probiotic but nausea and fatigue predate the probiotic
average diet
no alcohol in over 4 months and before that maybe 1 drink every month
no smoking ever
No colonoscopy yet but am waiting for the referral to get one done
Nausea and fatigue are fairly constant with very breaks
Burning/warm sensation has subsuded in last 36 hours but replaced with marked increase in fatigue nausea and sore arms and legs - almost flu-like
No stool test done yet
Hope that helps narrow things down
No history of constipation
GERD was in control but now I feel full with small meals with lots of belching
Smell of fart is pungent
I do take probiotic but nausea and fatigue predate the probiotic
average diet
no alcohol in over 4 months and before that maybe 1 drink every month
no smoking ever
No colonoscopy yet but am waiting for the referral to get one done
Nausea and fatigue are fairly constant with very breaks
Burning/warm sensation has subsuded in last 36 hours but replaced with marked increase in fatigue nausea and sore arms and legs - almost flu-like
No stool test done yet
Hope that helps narrow things down
Brief Answer:
Follow up suggestions.
Detailed Answer:
Hello,
Firstly elevation of liver enzymes less then 3 times the maximum normal value has no clinical significance.So your raised liver enzyme has no clinical significance.Slight elevation was because of your alcohol drinking. Pungent fart is suggestive of fact that ammonia and hydrogen sulphide like gases are present.These gases are produced by incomplete fermentation and digestion of food.Smell is a very good indicator of act that digestion is not fine.I would suggest you to take a course of Rifaximin 400mg once daily for 14 days and change the probiotic to VSL#3 twice daily. Rifaximin would help to kill colonies of bad bacterias that have formed in intestines while a good probiotic would help in formation of good bacterial colonies.
I don't feel that there is some thing grossly wrong with you however what i feel is that there is problem with over all digestion (you have been tested extensively and all tests are fine).
Fatigue could be due to improper absorbtion of nutrients due to incomplete digestion of food.The gases formed inside compresses the intestines therefore pressure on intestine increases nerves running through them are compressed and may cause nausea and pain sensation.
Till the time colonoscopy is done i would suggest you to take a course of Rifaximin 400mg once daily for 14 days with VSL#3 twice daily add B complex supplement to it.For gas take omeprazole daily one tablet 40 mg before breakfast.
For nausea Zofran 4mg (otc) can be taken sos.
Tell me how you feel in 10 days.
Hope I have answered your query.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
Follow up suggestions.
Detailed Answer:
Hello,
Firstly elevation of liver enzymes less then 3 times the maximum normal value has no clinical significance.So your raised liver enzyme has no clinical significance.Slight elevation was because of your alcohol drinking. Pungent fart is suggestive of fact that ammonia and hydrogen sulphide like gases are present.These gases are produced by incomplete fermentation and digestion of food.Smell is a very good indicator of act that digestion is not fine.I would suggest you to take a course of Rifaximin 400mg once daily for 14 days and change the probiotic to VSL#3 twice daily. Rifaximin would help to kill colonies of bad bacterias that have formed in intestines while a good probiotic would help in formation of good bacterial colonies.
I don't feel that there is some thing grossly wrong with you however what i feel is that there is problem with over all digestion (you have been tested extensively and all tests are fine).
Fatigue could be due to improper absorbtion of nutrients due to incomplete digestion of food.The gases formed inside compresses the intestines therefore pressure on intestine increases nerves running through them are compressed and may cause nausea and pain sensation.
Till the time colonoscopy is done i would suggest you to take a course of Rifaximin 400mg once daily for 14 days with VSL#3 twice daily add B complex supplement to it.For gas take omeprazole daily one tablet 40 mg before breakfast.
For nausea Zofran 4mg (otc) can be taken sos.
Tell me how you feel in 10 days.
Hope I have answered your query.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
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Above answer was peer-reviewed by :
Dr. Nagamani Ng
Answered by
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