Gastrointestinal Disorders Online Doctors Consultation — page 5

**Outpatient Consultation – General Medicine / Patient Name:** [ Roshan] **Age/Sex:** 19 / Female **Date:** 12-04-2025 **Chronic Illnesses:** Diabetes Mellitus (Type not specified) # **Presenting Complaints:** 1. Pain in right side of abdomen 2. Severe constipation 3. Nausea and occasional vomiting 4. Fatigue/tiredness throughout the day 5. Elevated blood sugar levels 6. Raised liver enzymes: - SGPT (ALT): 96.8 IU/L - SGOT (AST): 58 IU/L # **Provisional Diagnosis:** - **Fatty Liver (NAFLD)** – suggested by elevated SGPT/SGOT, common in diabetics - **Diabetic Gastroparesis** – causing bloating, nausea, and constipation - **Functional Constipation / Possible IBS-C** - **Hyperglycemia-induced fatigue and abdominal discomfort** ### **Suggested Investigations:** 1. Liver Function Test (LFT – repeat with GGT, ALP, Bilirubin) 2. HbA1c (to assess sugar control over 3 months) 3. Fasting and Postprandial Blood Sugar 4. Abdominal Ultrasound (for fatty liver, gallbladder, pancreas) 5. Thyroid Profile (T3, T4, TSH – hypothyroidism can worsen constipation) 6. Serum Electrolytes (to rule out imbalances causing fatigue) ### **Treatment & Management:** **1. For Constipation:** - Tab. *Lactulose* 10–15 mL at bedtime for 5–7 days - Tab. *Isabgol husk* (2 tsp) with warm water after dinner - Drink 8–10 glasses of water daily - Include fiber-rich foods: oats, papaya, soaked chia seeds, green leafy veggies - Walk for 15–20 minutes after meals **2. For Nausea/Vomiting:** - Tab. *Ondansetron 4 mg* SOS (as needed) before food - Small frequent meals, avoid oily/spicy food **3. For High SGPT/SGOT (Possible Fatty Liver):** - Tab. *Udiliv 150* – 1 tab twice daily (consult physician before starting) - Avoid fatty, fried food - Avoid self-medication (painkillers like paracetamol in excess can worsen liver) **4. For Tiredness & Blood Sugar Control:** - Recheck sugar readings and medication compliance - If on insulin/oral drugs – dosage adjustment may be needed - Include light protein in diet (boiled egg, lentils, paneer) ### **Lifestyle Advice:** 1. Walk for 30 minutes daily 2. Avoid sugar, sweetened drinks, white bread, and junk food 3. Take meals on time, no meal skipping 4. Practice deep breathing or light yoga for stress and fatigue 5. Sleep 7–8 hours daily ### **When to See a Doctor Urgently:** - Severe abdominal pain - Vomiting persists more than 1–2 days - Yellow eyes/skin (jaundice signs) - Blood in stool or dark-colored stools --- ### **Follow-Up:** - Review with reports in 7–10 days - Continue lifestyle changes and hydration Dr Shayeque Reza MD 9800280276.

Thanks for sharing, Rohit. I am here to help you with all my efforts. I understand it can be frustrating to deal with persistent symptoms, especially when initial medications don’t offer relief. Based on your symptoms and diagnosis of Irritable Bowel Syndrome (IBS), here’s a structured clinical-style summary with next steps and suggestions. Follow-Up Clinical Note – Suspected IBS with Incomplete Relief Patient Name: Rohit Age/Sex: 25 / M Chronic Illnesses: Hypothyroidism Date: 12-04-2025 Chief Complaints: Persistent pain in upper left and lower left abdomen Diarrhea in the morning, followed by constipation in the evening Worsening pain with physical activity (e.g., running) No significant relief despite 5 days of: Tab Clistar-RT (antispasmodic/prokinetic) Tab Esopase 40 mg (proton pump inhibitor) Likely Diagnosis: Irritable Bowel Syndrome – Mixed Type (IBS-M) (Note: Functional gut disorder often linked with stress, food sensitivities, gut motility changes.) Points to Consider: IBS symptoms can take 2–4 weeks to respond to medication, lifestyle, and diet changes. Left-sided abdominal pain, especially worsening on exertion, may also involve: Gas entrapment in the colon/splenic flexure Mild colitis (even with normal reports) Functional bloating Hypothyroidism can slow gut motility, worsening IBS symptoms. Stress, irregular meals, sleep changes, or specific food triggers can contribute. Recommendations / Next Steps: Investigations (if not already done): Stool routine & occult blood CRP/ESR (inflammatory markers) Lactose intolerance and gluten sensitivity test Colonoscopy (if symptoms persist >4–6 weeks without relief) Diet & Lifestyle: Follow low-FODMAP diet for 3–4 weeks (removes fermentable carbs that trigger IBS) Avoid: dairy, artificial sweeteners, onions, garlic, legumes, and spicy food Eat small, frequent meals; avoid large gaps Stay hydrated with 2–3L water daily Gentle exercise or yoga, not intense running right now Consider CBT or stress-relief techniques – IBS strongly linked with brain-gut axis When to Revisit: If no improvement in 10–14 days If weight loss, blood in stool, fever, or fatigue develops You need proper treatment plan for this. Dr Shayeque Reza MD 9800280276

Patient Name: Rishant Age/Sex: [Not Provided] Date: [Insert Date] Chief Complaints: Chronic bloating and excessive gas Choking sensation (especially during severe gas episodes) Throat irritation Noisy and watery sounds from the stomach Recurrent feeling of fullness and stomach discomfort History of Present Illness: Patient reports suffering from bloating and gas for several years. In the past year, symptoms worsened significantly, leading to choking-like sensation. An endoscopy was performed, and the patient was diagnosed with erosive gastritis. Since then, the patient has been on multiple medications, with partial or temporary relief. Currently, the patient still experiences: Persistent throat irritation Stomach bloating and gas Choking sensation Stomach producing noisy and watery sounds Previous Investigations: Upper GI Endoscopy: Erosive Gastritis (as per patient report) Assessment: Chronic Erosive Gastritis Likely GERD (Gastroesophageal Reflux Disease) contributing to throat symptoms Possible Functional Dyspepsia / IBS Rule out H. pylori infection, food intolerances, or SIBO (Small Intestinal Bacterial Overgrowth) Further Workup (if not already done): H. pylori stool antigen or urea breath test Abdominal ultrasound Complete blood count, LFTs Lactose/fructose intolerance tests if suspected Please mention the medication you are taking. Dr Shayeque Reza MD 9800280276 Follow up soon

As you mentioned you had erosive gastritis last year, my honest opinion is you should go for Endoscopic evaluation along with some piece of food pipe taken for pathological examination and also H Pylori disease. Meanwhile Take Capsule Esokem D 1 capsule empty stomach Syrup Pantop MPS 2 tsp three times a day Syrup Sucral O 2 tsp three times a day

Patient Name: Abdul Soleh Age: 25 years Sex: Male Date: 13/04/2025 Chief Complaints: Chronic right-sided abdominal pain (since 2019) Pain increases after eating a full meal Occasional constipation Difficulty releasing gas and urine; requires effort History of suspected peptic ulcer (no appendix) Provisional Diagnosis: Functional Dyspepsia with Suspected Peptic Ulcer Disease Constipation-Predominant IBS Possible Pelvic Floor Dysfunction Investigations (if not done recently): Abdominal Ultrasound H. pylori test (stool antigen or breath test) Colonoscopy (if symptoms persist or worsen) Pelvic floor function tests (if urinary/gas difficulty continues) * Follow up with these reports for your treatment plan* Dr Shayeque Reza MD 9800280276

Hi Faizan, Thanks for sharing your concerns. Your symptoms—chest pain when lying on the left side, bloating, reduced appetite, loose stools, weight loss, and fatigue—suggest an issue likely related to your digestive system, such as gastritis, acid reflux, IBS, or a possible infection or malabsorption. The weight loss and weakness are especially important and should not be ignored. What you can do next: Please visit a physician or gastroenterologist soon. They may suggest: - Blood tests (CBC, iron, B12, etc.) - Stool test - Abdominal ultrasound - ECG or chest X-ray to rule out cardiac causes - Possibly an endoscopy In the meantime: - Eat light, small, frequent meals - Avoid spicy or greasy foods - Drink enough fluids and ORS if needed - Avoid lying down right after eating These symptoms can also affect your mental peace, so don’t hesitate to seek emotional support too. Early diagnosis will help you feel better faster. Take care, Dr. Aman Shaba Consultant Neuropsychiatrist 7992489808

Investigations: 1) Stool test (routine + occult blood + ova/cyst) 2) Blood tests (CBC, CRP, ESR – to rule out infection/inflammation) 3) Celiac screen (anti-tTG antibodies) if chronic pain, bloating, poor weight gain 4) X-ray abdomen – To check for fecal loading if constipation is severe

Any outside food history?? Are you a vegan ?? Do u consume non veg?? History of fever?? Plz tell history gajal.. mean time use tab metrogyl 400mg 10 1-1-1 tab pantop dsr 40mg 5 1-0-0 Tab ondonsetron 4mg 1-1-1 Tab naproxen Domperidone 500mg 10 1-0-1 Sporolac shashet (dissolve powder in water drink it early morning empty stomach) Syrup mucaine gel 10ml TID 15 mins before food

Hii neha.. previously bhi aapko aisey huwa kya?? Kitney din sey aisey horaha hai apko?? Plz tell history of illness correctly...& above mentioned symptoms for u may be becz of food allergies due to pesticides being used in vegetables which u mentioned .. no worries take daily aristozyme syrup 15ml before food tab syrup mucaine gel 15ml before food three times a day.. pantop dsr 40mg empty stomach early morng for period of 10 days.. drink pleanty of oral foods eat more fibere food curd rice and change lifestyle modification..

Change ur diet add more liquids soups porridges .. drink more water ... of severe u can use tab metoclopramide once daily night before sleep along with 20ml syrup cremaffin at night times