[32F] With chronic lymph node swelling, body swelling, and gastrointestinal issues
Patient Description
A 32-year-old female presents with chronic swollen lymph nodes and body swelling, including lymphedema. The lymph nodes are described as hard and firm, with some being soft, and have been intermittently swollen for over a year. The swelling started in the neck, then spread to the armpits and groin, and now seems to be a persistent issue. The patient also reports difficulty passing stool, which began with diarrhea and gas in 2021 and has since progressed to a sensation of blockage in the digestive system, yellow stool, and hard-to-pass stool. The patient experiences vein swelling, chest tightness, and pain, which is described as sharp and stabbing, particularly when lying down or after muscle movements. The chest pain has been ongoing for a couple of years and is accompanied by palpitations. The patient has also experienced dizziness, headaches, and abdominal swelling. An ultrasound of the veins in the legs revealed multiple echogenic structures, likely indicating swollen lymph nodes. The patient reports that the diarrhea is greasy, smelly, and sometimes contains undigested food.
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Arora's Assessment
What might be happening
Based on the symptoms you've described, several potential diagnoses could explain your condition. Here are some possibilities:
Swollen Lymph Nodes and Body Swelling
- Lymphedema: This condition involves swelling due to a blockage in the lymphatic system. It can cause swollen lymph nodes and swelling in the soft tissues, as you've described.
- Autoimmune Conditions: Given your history of an undifferentiated autoimmune condition, it's possible that your symptoms are related to an autoimmune disorder. Conditions like lupus or rheumatoid arthritis can cause lymph node swelling and systemic inflammation.
Kidney Stones and Gout
- Kidney Stones: These can cause severe pain, nausea, and difficulty passing urine. They can also lead to secondary symptoms like swelling and discomfort.
- Gout: This condition is characterized by sudden, severe attacks of pain, redness, and tenderness in joints. It can also cause swelling and may be related to your kidney issues.
Gastrointestinal Symptoms
- Malabsorption Syndromes: Conditions like celiac disease or chronic pancreatitis can cause yellow, greasy stools and weight loss. They can also lead to nutrient deficiencies, contributing to your overall symptoms.
- Irritable Bowel Syndrome (IBS): This can cause alternating diarrhea and constipation, bloating, and abdominal discomfort.
Chest Pain and Palpitations
- Costochondritis: This is inflammation of the cartilage that connects a rib to the breastbone, causing sharp chest pain.
- Cardiac Issues: Given your symptoms of chest tightness and palpitations, it's important to rule out heart-related conditions.
What you can do
Swollen Lymph Nodes and Body Swelling
- Consult a Specialist: Given the complexity of your symptoms, seeing a specialist such as a rheumatologist or an immunologist may be beneficial.
- Compression Garments: Wearing compression garments can help manage lymphedema.
- Elevate Affected Limbs: Elevating your legs can help reduce swelling.
Kidney Stones and Gout
- Hydration: Drink plenty of water to help pass kidney stones and reduce the risk of new stones forming.
- Dietary Changes: Avoid foods high in purines (like red meat and shellfish) to manage gout.
- Pain Management: Over-the-counter pain relievers like ibuprofen can help manage pain, but consult your doctor for specific recommendations.
Gastrointestinal Symptoms
- Dietary Adjustments: A low-fat, high-fiber diet can help manage symptoms. Avoid foods that trigger your symptoms.
- Probiotics: These can help balance your gut flora and improve digestive health.
- Medical Consultation: See a gastroenterologist for a thorough evaluation and possible tests like a colonoscopy or stool analysis.
Chest Pain and Palpitations
- Monitor Symptoms: Keep a journal of your symptoms, noting what activities or foods seem to trigger them.
- Relaxation Techniques: Practices like deep breathing, meditation, or yoga can help manage stress and reduce palpitations.
- Medical Evaluation: Given the potential seriousness of chest pain, consult a cardiologist for a thorough evaluation.
What you should look out for
Given the severity and complexity of your symptoms, it's important to seek medical care as soon as possible. Reasons to seek care even more urgently include:
- Severe or worsening chest pain
- Shortness of breath or difficulty breathing
- Severe abdominal pain or persistent vomiting
- Sudden, severe swelling in any part of your body
- Fainting or severe dizziness
Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and treatment plan. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
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4 mo ago