Jejunal Ulcer, Fatty Liver? and difficulty eating

[Darktowerdream 421]

I know this is not really going to get answers but maybe someone might have some insight. I have lifelong chronic illness and disability. A challenge is being sensitive to medications and side effects and having allergic reactions (my list of antibiotics I am allergic to is growing) It started with Umbilical area pain that radiated upward to the right shoulder blade area like spasms. Admittedly I am also dealing with diverticulitis issues, bleeding and pain I'm not sure the source as well as Interstitial cystitis. My gastric bypass surgery inadvertently revealed a form of neurological dysphagia I have difficulty drinking thin liquids. landing in hospital with aspiration pneumonia a day after I got home, I found out that was why. started before surgery but I didnt know why I was having difficulty drinking Water. normally i could chug it no issues.

For a while I had trouble with eating which turned out to be stricture. I had history of ulcers prior to my gastric bypass surgery. and they found it afterward as well. I had dilations. and eating got a bit easier I just had to be careful what types of foods I ate. But then some weeks back it got really bad I found myself feeling sick just taking nibbles of my lunch. I always meal plan daily and prepare Portion Control sizes so I know how much calories and Protein I am getting and what my portion is so its never too much for my pouch. But Id get partway through nibbling slowly and at times depending what Im eating Id just have to stop. and then feel the need to throw up but cant at times heaving but only a thick mucus comes up.

I saw my general practitioner and had a CT scan and bloodwork. I also made some appointments. She told me to see my Bariatric surgeon. I had to wait until just recently to have a Endoscopy. I am just frustrated. because the CT scan showed Hepatic Steatosis. My one liver level is high it was not high when I was losing weight. Only when it was stable already. I did not have fatty liver prior to surgery. But they want to assume I did and that no one told me. But that's something they check for because its a co-morbidity! Also my gallbladder was checked at the time it had to be removed due to chronic inflammation. People have gastric bypass to get rid of fatty liver ... I have only read of maybe a rare case of liver disease post surgery.

Anyway. back in June I had a enteroscopy to check the remnant portion of stomach and dilation. no mention of ulcer then. I have trouble with proton pump inhibitors not working and they just seem to deplete my Vitamin levels too much. plus trigger my Migraines. Ive had ulcers go away without the PPI and gotten ulcers while on them so they just dont seem effective. Then there is carafate. one side effect is Constipation and with diverticulitis I cant afford that especially since the CT also showed inflammation and narrowing of my colon ... and I am trying to get Iron and even the supposed non constipating kind in my whole foods based Multivitamin is throwing my system off.

so I had the Endoscopy this month and it showed Jejunal ulcer so the doctor just prescribes proton pump inhibitor and carafate (my insurance decided to not pay for carafate) but what other options are there besides these? and what could be causing the ulcers if Im not taking motrin or similar meds even though I do need them. Ulcer at the junction between the pouch and small intestine can happen in the first months post op and common treatment is PPI and carafate but not nearly two years out. Hard to believe April will be two years ... my gut keeps telling me its issue with my remnant stomach. perhaps even with the staples used. but I dont know how to get answers. I have seen when these things dont work doctors do a surgical revision of some kind. my surgeon is great but yet he seems to address it as it too simply and its not that simple anymore.

Also I cant figure out the fatty liver aka hepatic statosis and the high ALT (liver enzymes) they assumed it was high before but no not really. Also I had blood transfusions in June and the levels went down due to the transfusion but then went back up again. so one would assume if it had to do with the weight loss the levels would have stayed down.

I cant sort out what move to take next. I kind of sat on this post a while and didnt post it. I still hesitate. I know its probably not something anyone can answer. I am just getting frustrated. I am also retaining Fluid in my abdomen along with a lot of pain.

[njlimmer 344]

I’m sorry I don’t have any insight for you, but I wanted to send you a virtual hug. I hope you find some answers soon!

[GreenTealael 25,484]

11 hours ago, Darktowerdream said:

so I had the Endoscopy this month and it showed Jejunal ulcer so the doctor just prescribes proton pump inhibitor and carafate (my insurance decided to not pay for carafate) but what other options are there besides these? and what could be causing the ulcers if Im not taking motrin or similar meds even though I do need them. Ulcer at the junction between the pouch and small intestine can happen in the first months post op and common treatment is PPI and carafate but not nearly two years out. Hard to believe April will be two years ... my gut keeps telling me its issue with my remnant stomach. perhaps even with the staples used. but I dont know how to get answers. I have seen when these things dont work doctors do a surgical revision of some kind. my surgeon is great but yet he seems to address it as it too simply and its not that simple anymore.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737339/

you can read the whole article if you want but skip to the section on marginal ulceration if your short on time

[Deb9386 110]

22 hours ago, Darktowerdream said:

I am just frustrated. because the CT scan showed Hepatic Steatosis. My one liver level is high it was not high when I was losing weight. Only when it was stable already. I did not have fatty liver prior to surgery. But they want to assume I did and that no one told me. But that's something they check for because its a co-morbidity! Also my gallbladder was checked at the time it had to be removed due to chronic inflammation. People have gastric bypass to get rid of fatty liver ... I have only read of maybe a rare case of liver disease post surgery.

I'm sorry that you have so much to deal with - it sounds miserable, and sending you virtual hugs.

I hadn't heard of liver issues being caused by bariatric surgery, like you I'd been told that a fatty liver would be helped by the surgery. But looking at this article here it seems to be a potential outcome from the surgery, and some of the symptoms you mention (pain, nausea) are listed as known signs & symptoms in the article.

https://sites.kowsarpub.com/hepatmon/articles/86078.html

If your bariatric consultant isn't really taking on board what you're saying about this could you ask for a consultation with a hepatic consultant or find another bariatric consultant, preferably one who is very experienced (as they might have more knowledge of this area) and who would be prepared to consult with hepatologists about your care?

Good luck.