Need some peace of mind: Stool symptoms

[caoimhinn]

23 year old male

In May, I returned from stay in Ireland with a fever, moderate diarrhea, and abdominal pains, vaguely located on my far right side, slightly above the line of my belly button. My urine also appeared a bit more concentrated--not dark, but it looked like it wasn't mixing uniformly with the water in the toilet. Doctor did bloodwork for liver functions Hepatitis, and ordered a CT scan (looking for appendicitis). He also collected a urine sample, and ordered a few stool samples--if I remember, he was looking for Shigella and Giardia. All tests were negative, but my AST/ALT counts were slightly elevated. He said that the whole thing might have been viral. A few weeks later, the abdominal pain had gone, and there was no more diarrhea. A subsequent liver function blood test showed that the AST/ALT levels had returned to normal.

Five months later, my bowel habits are still a bit off, although there is no pain. My stool has consistently been a light brown, and is messier-- it leaves streaks in the bowl and requires more cleanup. It is solid, but soft, with an occasional diarrhea (every 2 or 3 weeks). My urine has also been behaving the same way--I can't remember if this is normal. It is clear when I drink a lot of water, but otherwise seems to be a medium to darker yellow that doesn't always mix evenly with water.

I returned to the doctor, who ordered another stool sample to test for fecal fat - qualitative, and an additional liver function test. He also referred me to a GI doctor, who I will be seeing this week. My primary doc suggested the possibilities of Celiac or some type of malabsorption. I have no known history of either in my family.
I have maintained a stable weight for the past few months.

I will be seeing a specialist. But in the mean time, I've got myself concerned that I have pancreatic or liver cancer-although no family history of either. Would these things have been visible on the CT scan? Any other ideas about what could be going on?

[Kevin Pho, MD]

I agree with the testing done thus far.  If the symptoms continue, a colonoscopy would be the next step.  I would take biopsies of any suspicious areas of inflammation, which can also cement any diagnosis of infection.

If celiac disease is suspected, blood antibody tests can be done, and a small bowel biopsy be done.  

A negative CT scan would make liver cancer less likely.  To exclude pancreatic cancer, an MRI or endoscopic ultrasound would be considered.  

These options can be discussed with your personal physician.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd

[caoimhinn]

Quick addendum: Stool is occasionally more solid, cleaner, and browner--but contains visible mucous. When it is soft, the stool and the gas that precede it smell awful--kind of like a baby's diaper.