Ask a Gastroenterologist: Dr Lee Keat Hong from Mount Elizabeth Novena Hospital Singapore

dr. Lee Keat Hong replied 2 years ago

The most common medical cause for sudden loose stools is acute gastroenteritis, usually as a result of exposure to gastrointestinal pathogens such as viruses and bacteria. Sometimes this may be accompanied by fever, vomiting, abdominal cramp and loss of appetite. These symptoms usually will resolve with adequate rest and hydration (drinking enough fluids).

In your case, I will recommend at least a GP consult as you are complaining of fatigue (feeling weak). It could be a sign of inadequate hydration or even loss of body electrolyte (due to loose stools) for which more targeted treatment is indicated.

dr. Lee Keat Hong replied 2 years ago

Your symptoms (cold and weak, neck ache) are non specific and may occur in many other medical situations (such as spine issue, muscle strain etc). In any case I recommend that you see a doctor to get a complete history and physical evaluation then decide what investigations or treatment is required further. As for your gastric pain, have you seen a doctor before? Since it has been there for a long time you should also consider visiting a doctor if you have not seen one.

dr. Lee Keat Hong replied 2 years ago

There are many digestive conditions that can give rise to gastro problems. For example, gastro-esophageal reflux disease (GERD) results in symptoms such as abdominal pain, bloating and burning sensation and is usually treated with antacid and acid suppressants (H2RA or PPI medications). Therefore it is recommended that patients with digestive issue / gastric problems to be assessed and diagnosed correctly before being prescribed 'medicine for gastric problems'.

dr. Lee Keat Hong replied 2 years ago

Gallstones and 'gastric acid' conditions may co-exist, i.e both may be present in the same patient. Gastro-esophageal reflux disease (GERD), or sometimes known as 'gastric acid' to a layperson, typically presents as a burning sensation at the stomach, heartburn and acid brash. Pain from gallstones commonly starts at the upper right part of the abdomen radiating to the back and often described as being sharp and 'colicky'.

Diagnosis of gallstone disease can be achieved by ultrasound imaging of the gallbladder. It is advisable to have gallbladder surgery if the pain is recurrent (rather than taking painkillers only) as it may progress to complications such as gallbladder infection and jaundice.

dr. Lee Keat Hong replied 2 years ago

Burping and 'gastric acid' symptoms are most commonly related to a medical condition called dyspepsia and gastro-esophageal reflux disease (GERD). Patients are usually advised to have a combination of lifestyle changes and medical therapy to help with the symptoms. Examples of lifestyle changes include dietary (less spicy, less heavy meal, reduced caffeine), avoidance of smoking, alcohol and keeping ideal body weight. If life-style changes doesn't help much, medications such as antacids, H2RA (e.g. ranitidine) or PPI (e.g. omeprazole) is a reasonable 'add-on' to help achieve symptom control.

In your case, especially with your age (49 years old), I will recommend a full medical evaluation and endoscopy if it hasn't been done before.

dr. Lee Keat Hong replied 2 years ago

SGPT is an enzyme that is found in many organs (such as liver, heart and muscle), hence a raised ALT on blood test may not necessarily mean it is a liver problem. The next step for you would be to obtain a medical consult and determine the cause of the high ALT, only then can a doctor advise on the next management step.

dr. Lee Keat Hong replied 2 years ago

The few symptoms that you have been experiencing are non specific in nature and do not all point to one particular medical diagnosis. For example, shortness of breath may be related to a lung (asthma) or heart (heart failure) condition. Similarly, dizziness may be related to ENT (vestibular condition), neurological (stroke) etc.

Have you seen a doctor already? I recommend a complete history and physical examination by a qualified doctor as your symptoms may not be properly assessed through an online forum alone. Frequently your doctor may also order investigations such as blood tests to further arrive at a diagnosis.

dr. Lee Keat Hong replied 2 years ago

Clopidogrel sometimes may cause stomach discomfort and worsening of existing gastric reflux condition. In this case, gastric medication may be prescribed to help ease the symptom. However, you do experience quite a significant weight loss – in this intentional (from eating less, exercises)? If the weight loss is non intentional, I will recommend a full body check-up to make sure that you do not have a medical cause for the sudden weight loss (such as thyroid problem, stomach problem etc).

dr. Lee Keat Hong replied 2 years ago

Since your USG showed normal liver fat, you do not need to take any medication. In addition to regular exercises, I will recommend a healthy diet as well (more fruits and vegetables, less oily / fatty food).

dr. Lee Keat Hong replied 2 years ago

Common medications for gastric acid reflux include antacid, histamine receptor blocker (such as Ranitidine) and proton pump inhibitor (such as Omeprazole).

dr. Lee Keat Hong replied 2 years ago

Spicy food is not known to be a cause of stomach ulcer. There are various reasons for getting stomach ulcers, common ones being infection with a bacteria (Helicobacter Pylori) and medications (painkillers such as NSAIDs). More importantly though, what was the cause of her stomach ulcer previously (what did the doctor tell her)? Was it caused by bacteria, and has it been treated? If she has been treated, is there a repeat endoscopy (Gastroscopy) to be sure that the gastric ulcer has healed?

dr. Lee Keat Hong replied 2 years ago

Pain above the belly button (upper part of the abdomen) may be caused by problems with the stomach, small intestine or even pancreas. When you mentioned that it is 'hard', do you mean that you can feel a mass above your belly button? I suggest you visit a doctor to have yourself checked, most likely your doctor will offer some investigations such as blood tests and scans since you are losing your appetite also.

dr. Lee Keat Hong replied 2 years ago

Medications for liver cirrhosis are targeted at the actual cause of the liver cirrhosis itself (e.g. if the cirrhosis is related to Hepatitis B then antiviral treatment is needed) and complications related to liver cirrhosis (e.g if patient has ascites there is medication to reduce water retention in the body). I am not familiar with both Hepamax and AHFC biolife. Looking at the product information (from the Internet), both of these are liver supplements though evidence on its actual benefit in liver cirrhosis is lacking.

Since your mother has liver cirrhosis, she should also undergo screening for varices if it has not been done. Equally important, she will need to be followed up regularly by a doctor trained in managing liver cirrhosis (Gastroenterologist) as she is at higher risk of developing liver cancer and decompensation.

dr. Lee Keat Hong replied 2 years ago

How long have you been taking your medications? Medications such as Prosogan (Lansoprazole) may take up to 2 months sometimes for symptoms to completely subside. I generally do not prescribe Vometa and Dogmatil for long term use due to potential medical side effects. If your reflux symptoms persist, what I recommend is for you to consider getting a pH study done (e.g. 24-H pH impedance study) to look for the degree of 'acidity' and response to treatment.

dr. Lee Keat Hong replied 2 years ago

I recommend endoscopy in your case as you have been taking your medications for 3 months already. Usually I would expect at least some response to treatment especially after 3 months of taking PPI medications.

dr. Lee Keat Hong replied 2 years ago

Pain in the epigastric region can be due to stomach, pancreas, gallbladder and even intestinal problems. Sometimes, it may also relate to underlying heart disease. I recommend that you get a full medical evaluation (history, examination) to understand more about your problem before getting proper medication.

dr. Lee Keat Hong replied 2 years ago

Pain at the lower left abdominal region may originate from the intestines, kidney / ureters and even female reproductive organ. Is there any mention in your USG about the kidney stones which may be the cause of the pain? You should also consider getting a colonoscopy to exclude intestinal condition.

dr. Lee Keat Hong replied 2 years ago

The recommended daily vitamin C dose is around 65 mg to 90 mg a day, and the upper limit is around 2000 mg. Your current dose of 500 mg daily is still within this range so I do not think that it is the cause of your symptoms.

The symptoms you described seem to indicate neurological (cold hands and feet, trouble sleeping) and digestive (nausea) issues. Before taking any new medication, I recommend seeing a doctor to get a proper physical examination (neurological, abdominal) to get a diagnosis and subsequently getting treatment.