Not feeling well - nausea, right back pain, weight loss

Digestive health
1

Hello.  Ive been a lurker on this site for the past few months in my quest to find answers to issues I've been dealing with since July of this year.  I'm currently going through the medical system here in the US trying to find answers to what aisles me but have yet to find relief of my symptoms.  Sorry for the lengthy post.

Male, late 40s, not overweight

It all began with a sudden change to bowel movements (loose stool, diarrhea) and onset of illness and general lack of energy.  The only significant event around the time this started was a sports related back injury which I successfully treated with a few days worth of rest and NSAIDs.

Since that time, I've been dealing with the following list of symptoms -

Unintentional weight loss of 20lbs (I'm 72" and went from 204lbs to 182lbs)

Loose stool - yellowish brown (usually 1-2 BM/day, mornings mostly), sometimes float, mostly 'sticky' and dry

Daily nausea - usually worse in the mornings, then tends to subside in the evenings (my worst symptom right now)

Lack of appetite - I eat now mostly just to sustain/gain weight (fear of losing more wieght)

Right back pain, at base of rib cage (fullness/dull ache feeling in this general area) 

Right shoulder pain (trapezius muscle inflammation)

Left upper quadrant pain - i can pinpoint a nerve/muscle just left of my sternum just below the last rib that's painful

Anxiety and depression

Headache/dizziness

Bloating/gas/indigestion

Just feel run-down

My brief medical history -

2011 - Gall bladder removed in 2011 (no stones but diseased; diagnosed via HIDA scan).  Went through several months of hell leading up to a diagnosis.  Even after the removal I experienced frequent diarrhea and was finally prescribed Cholestyramine which managed my symptoms.  Right shoulder blade pain persisted but eventually went away.

Sept 2017 (when my symptoms started)

Blood work - all normal except ALT = 71 IU/L (9-44), Albumin = 4.8 g/dL (3.1-4.7)

Abdominal US - all normal, except mildly dilated bile duct 9mm (liver/pancreas partially obstructed due to bowl gas)

CT abdomen w/constrast - Liver enlarged, 20 centimeters craniocaudal, without evident cause. There are 2 too small to characterize low density lesions 1 each left and right hepatic lobes of doubtful significance.  Everything else unremarkable.

Aug 2017

Blood work - hepatic values all back to normal, tested for Hepatitis (neg) among other related things liver related (all neg)

Sept 2017

Hydrogen breath test - abnormal (diagnosed with SIBO)

Colonoscopy/Endoscopy - normal

Oct 2017

Fibroscan of liver - 5.6 kPa (normal)

Nov 2017

Vit D = low (28 ng/mL) - prescribed Vit D supplements to take daily

Stool - pancreatic elastase (normal), fecal lactoferrin (normal)

MRI/MRCP w/wo contrast - waiting on results

My blood work appears to be relatively normal from what I can tell, and it appears Ive had a pretty extensive work up (lots of other blood tests I haven't listed above all came back negative).

Lately, I find myself going crazy.  The nausea is completely ruining my life.  I've become an emotional mess and its taken a toll on my family.  It's hard to give them my all when I just dont feel well.  I worry a lot about the big C since its been months of this going on with no clear end in site.  Could a stone or sludge be stuck in my bile duct somewhere that would cause my pain/symptoms and the my liver to get inflamed?  Could there be an issue with my pancreas?  My hepatic and pancreatic enzymes are within normal ranges right now (although, my Albumin is always right on the edge of normal a 4.7g/dL, and my last lipase test came back slightly below normal at 19IU/L).  Could all this be stemming from the SIBO I have?  Back in Aug, I was put on 2wks of antibiotics for this (Flagyl & Keflex), which seemed to help a little, but I don't think cured me of it.

I'm not sure what I'm looking for really, maybe just to talk to some folks that may be going through some of the same things as me.  I'm scared, I wont lie.  This is the first time I'm posting anywhere about what I'm going through.  Folks on here seem very sincere and supportive.  While I don't wish what I'm going through on anyone, it does comfort me to know in some way that I'm not alone.  Thanks for taking the time to read through this.  God Bless.

 

2

Your symptoms sounds awfully familiar to mine except mine is all left sided pain.. im only 22 yrs old though. 

Have had extensive blood work and testing, heart testing and ct scans and xrays, colonoscopy and all and still have no diagnosis everything has come back normal. 

Sounds to me like you have a problem with your liver or pancreas though.. do you drink alot of alcohol? 

3

Hi Losinj70, your anxiety is understandable and very normal however worrying can increase symptoms so the quicker you're sorted the better.  

You don't say who you're seeing, a GP or a specialist.  Hopefully you're doc is a gastroenterologist, and I agree with Kurt that it sounds like your pancreas or liver, therefore I hope your doc specialises in the pancreas, they know way more than gastroenterologists.  Seek one out via one of your local teaching hospitals and get a referral.   

You do have symptoms of SIBO and whilst I have no clue about the antibiotics, I do know that I've been on them for 3 prescriptions at times (not for SIBO) as the first and second rounds didn't do the job so perhaps you need to be tested again and the anti's reintroduced for longer.  That said it can take months for SIBO to go away completely.

Try eating a low fat diet, small meals often rather than 3pd, no alcohol, or cigarettes, keep hydrated.  You can buy pancreatic enzymes or be prescribed them, they help digestion if your malabsorption issues relate to your pancreas.  It will cut down the nausea and diarrhea.  Your tests may be fine but the pancreas is a weird beast, try the enzymes and see how you go, they won't cause any harm.  Good luck, sorry I can't provide the answers you want. Keep us informed of your progress.  Cheers

 

4

Hi Kurt, thanks for the reply.  I don't drink.  Back in my college days, yeah, plenty.      Only on rare occasions since.  Last drink I had was probably 10 mo. ago.  I do admit to indulging in a lot of bad food though on a regular basis (pizza, chocolate, chips, were some of my biggest vices).  Ever since my issues started however I've cut all that stuff out.  I was also a pretty active guy before, doing cardio 3-4x per week.  Haven't worked out in a long time as I feel like I can't afford to burn the calories now.  I miss the old me.

Is your ULQ pain in front as well as the back?  How would you describe it?

My only pain in the front is more like muscle tendon pain, just left of center, where the last rib meets the sternum.  I can pretty much put my finger right on it.   I asked my PCP about it once and he mentioned it may be costochondritus pain, but I'm not sure.  I wouldn't describe any of my pains as debilitating, just sort of nagging.

5

Could be the fatty foods doing it to you than.. sounds like your not getting enough nutrients, like your body isnt absorbing enough.. 

Its so hard to describe the pain, its just constantly there.. sometimes its sharp but majority of the time its a dull ache and crampy feeling..

I know what you mean about the pain just left of centre on the chest i have that to its like between my nipple and centre chest but at the last rib there

6

Hi Reefsider, 

I'm currently seeing a GI doctor who's part of a group that specialize in GI and liver.  I was recently referred to him through a friend who's a surgeon.  Back in Oct I went to a liver specialist at a larger metropolitan medical campus, but after reviewing my case they pretty much said I didn't have anything serious based on my normal labs.  They performed a quick fibroscan of my liver to test for signs of cirrhosis and it came back normal.  The Dr performed the scan himself (nearing close of business hours I guess, and they were 'fitting me in' as it wasn't a regularly scheduled apt), which I thought was weird, and it seemed like he only tested one point on my right side.  The whole experience however felt a little odd, as if they were just placating me since I didn't have any obvious signs of liver damage, looked healthy, and all my recent blood work was normal.  They told me to come back if my liver enzymes change.

To be honest, early on I was never really concerned about my pancreas as being a cause to my symptoms.  I was more concerned about my liver as that was only thing that was called out on the CT scan as being 'abnormal'.  But I could not find much information linking my digestive issues to the liver, other than issues stemming from major liver damage which i don't seem to have.

Ive been reading a bit on exocrine pancreatic insufficiency and pancreatitis and while both appear to have some correlation with my digestive symptoms I don't seem to have a lot of the 'classic' pain symptoms.  I'm anxiously waiting for the results of my most recent MRI/MRCP (performed this past Fri).  To be honest, I'm kinda hoping they don't find an issue with my pancreas as its one of the thing that's most concerning me right now.

Also wondering if SIBO may be the major reason for my current condition (its been known to cause malabsorption as well), though I've read that its often viewed as more of a condition from some other underlying cause.

I'll try and keep you all posted.

 

7

Thanks for  responding.  Be aware that if you have chronic pancreatitis, and I hope you don't, that you may not experience much pain.  A lot of people do especially during the acute stage but as the disease progresses it's not uncommon for the pain to decrease or go away altogether.  Sounds bizarre I know.  I seem to get a generalised stomach ache when my (chronic) pancreatitis is playing up, sometimes sharpish pain in stomach area but generally I'm pain free just uncomfortable with constant diarrhea/constipation/bloating.  So don't assume your pancreas is tickety boo because you're not in excrutiating pain, follow through, your weight loss is a bit of a worry methinks and your symptoms should be investigated more methinks.  I agree your symptoms could still be as a result of SIBO. Push on.

BTW many of us with chronic pancreatitis have never been drinkers or fatty food fans, sometimes it just happens.  I have another weird disease and my diagnosis was Chronic Auto Immune Pancreatitis.  I have malabsorption issues, malnutrition, vitamin deficiencies etc etc.  It's a bummer and I hope you don't have it but do push for answers.

8

I just got back the results of my MRI/MRCP.

Impression:

1. Choledocholithiasis.  A small 2 mm ampullary ductal stone is demonstrated

2. No intrahepatic ductal dilation

3. The liver and pancreas are normal

4. Prior cholecystectomy

So, it appears I have a small stone stuck just inside my SOD.  I'm hoping its small enough to remove (ERCP perhaps?).  I have a follow up with my GI doc next week to discuss the findings and next steps.

I'm at least a little relieved that there doesn't appear to be any major anomalies in my pancreas or liver.  Could this really be the reason for all my digestive issues?  God I hope so.

 

9

Hello again.  Thought I'd provide some more information since my last post.  So, after consulting with my GI doc, it was determined that the next best thing was to undergo a endoscopic ultrasound (EUS).  I had this procedure on Dec 12, and results were -

1. Non-specific, benign-appearing bile duct dilation reaching a 8.5mm diameter, but which was compressible.

2. No stones or ampullary mass

3. Possible hepatic hemangioma

Some notes regarding the pancreas -

'Focal parenchymal lesions of the pancreas head beyond echogenic foci without acoustic shadowing were not noted.  Transgastric views of the pancreas showed normal parenchyma and no pancreatic duct dilation.'  After reading this several times, it seems to me this translates to - not much going on with the pancreas.

So, no stone as previously identified in my MRCP.  I surmise that if I did have a small stone I must have passed it sometime since then.

Right around the time of my MRCP, I do admit I was probably feeling my lowest in terms of health, with nausea being my main issue.  Things started taking a turn for the better though at the end of Nov, around the time I started taking some herbal antibiotics to treat SIBO.  Thankfully, for the whole month of Dec my symptoms seemed to improve - not 100% - but the nausea dissipated, my head and aches seemed to subside, and my digestion seemed to calm down.  I even began gaining weight!  So much so, that I thought I had finally turned the corner and rid myself of all this crap.

Then, about two weeks ago, I decided to stop my herbal antibiotics course (I had been on it for 5wks), and my symptoms started to slowly come back.  Ugh!

So now, I've made another appointment to see my GI doc to see what's next.  Not sure what that is, but I need to keep pushing for answers as I still dont feel right.  Maybe ERCP, but I'm a little scared of the procedure though.

One recurring theme in a lot of my tests seem to be this common bile duct dilation.  I've read that certain people post-gall bladder removal, have mildly enlarged CBD.  Have any of you been diagnosed with this before?  I wonder if i have a wonky working sphincter of oddi?  Would the antibiotics have such an effect on my symptoms if the issue stemmed from some bile duct obstruction as opposed to SIBO?  Have any of you found relief while on antibiotics?

RIght now, I'm taking some grapefruit seed extract (drops) with water 2x day and some ginger root (capsule) 1x day (mostly because I've heard its good for SIBO) and it seems to help some.

So, back to the drawing board for me...  feeling a bit depressed to be honest.  As always, thanks for reading.

 

10

Thanks for the update.  I'm sorry that not all of your symptoms have resolved yet but it's good news that your pancreas appears fine at this point. Seeing the GI again will perhaps put your mind at rest especially if he thinks it might be the SIBO taking it's time to settle.  I hope you have a resolution soon. Take care

11

What were your symptoms in terms of pain? How long and where? Pain aggravated by moving the body?

That's what I feel, and it's in the LUQ, plus nausea and change in bowels.

12

I would do blood in stools tests ( you can even find this online in the UK), and barium x-ray to see small bowel. The loss of weight might be also just to malabsorption but one needs to exclude other causes.

I haven't lost much weight but I share similar symptoms, but nausea is just occasionally. Pain in LUQ since 6 months.

13

Hi there pcbessa.  I'm weird medically so not sure my signs were at all typical.  My doc's thought it was another 'thing' I have and put me in hospital periodically for strong pain relief.  That went on for a couple of years on and off.  Didn't do a thing and I kept saying the pain was different but it fell on deaf ears.  

My pain was like a high stomach ache which went through to my back mostly, interspersed with sharp pain at about where my ribs start on left.  Movement did exacerbate the pain, I'd basically have to sleep where I landed many times and woke myself up if I turned in my sleep, it was awful and I was hunched over like I'd just had abdo surgery when walking around. 

Sometimes I felt I was having a heart attack, would perspire, get dizzy feel nauseous and was even monitored in the ER with suspected heart attack one time.  I'd also get an incredible thirst sometimes so then I started thinking I might have diabetes because my bsl was all over the place too.  My guesses were wrong but at least I was thinking about it unlike my doctors'.

The telling symptoms for me were my bowel movements, my malabsorption issues, food went through within 15 mins max of eating.  My doc's didn't hear me at all, they all get so obsessed with my other thing.  I moved  to the city, found a decent GP who doesn't blame everything on that.  I requested an abdo CT which showed my calcifying pancreas, was referred to the best gastro guy who specialises in the pancreas hereabouts had the endoscopy etc and here I am.  I hardly get pain now btw, sometimes but more the stomach ache than the sharp pains, a chronic thing apparently.

We're all different and throw different symptoms depending on which bit's dodgy.  Whenever something doesn't fit a precise format doc's pass the buck these days (I've found, but I'm getting old and remember more thorough times).  

The problem is that once gall bladder, liver, pancreas are ruled out the doc's feel great, tell the patient to feel great and drop the ball entirely or often, start on the mental health route which isn't always appropriate.  Meanwhile there are still numerous ills which can be overlooked and the patient's symptoms remain or get worse. It requires persistence if one is to get answers sometimes.  

Sorry for long response your question got me thinking about the process on my way to diagnosis which brought up all my memories of frustration back then.  Besides I've always been a short story long sort of gal. Hope there's a helpful word or two in there for you.