Abdominal Distension and Weight Loss: Gastrointestinal Concerns

Abdominal bloating, feeling more full in the morning upon waking than before going to bed (sensation of abdominal distension)?

Six months ago, my weight began to gradually decrease, and it has dropped from 50 kg to 40 kg (height 153 cm).
Blood tests show liver enzymes over 70.
I have experienced muscle wasting in my upper body, and despite consuming adequate protein daily (boiled eggs, meat, soy products), my weight has not improved.
I suspect there may be gastrointestinal issues, as I often feel extremely full after eating (even with a high protein intake).
One to two hours after meals, I still feel very full, and I feel even more full when I wake up at night or in the morning, with a sensation of something foreign in my abdomen.
My bowel movements occur every two days.
I would like to know which organ might be affected or if this could be stress-related.
Do you have any suggestions for improvement? Thank you, doctor.

Miss Yan, 10~19 year old female. Ask Date: 2022/04/05

Dr. Chen Shidian reply Gastroenterology and Hepatology

Please seek medical treatment.

Reply Date: 2022/04/05

More Info

The symptoms you are experiencing, including significant weight loss, abdominal distension, and changes in bowel habits, are concerning and warrant a thorough evaluation by a healthcare professional. Given your reported weight loss from 50 kg to 40 kg over the past six months, alongside elevated liver enzymes (with a liver function test showing levels above 70), it is crucial to consider several potential underlying gastrointestinal issues.

Firstly, the significant weight loss and muscle wasting you describe could be indicative of malabsorption syndromes, where the body is unable to absorb nutrients effectively from the food consumed. This could be due to conditions such as celiac disease, Crohn's disease, or chronic pancreatitis, which can all lead to nutrient deficiencies and subsequent weight loss despite adequate dietary intake. The fact that you are consuming sufficient protein but still losing weight suggests that there may be an issue with how your body is processing and utilizing these nutrients.

The sensation of fullness after meals, particularly if it persists for hours or even into the next day, could suggest delayed gastric emptying, also known as gastroparesis. This condition can cause feelings of bloating and discomfort, as food remains in the stomach longer than normal. Gastroparesis can be caused by various factors, including diabetes, certain medications, or even stress and anxiety, which can affect gastrointestinal motility.

Your bowel habits, with bowel movements occurring every two days, could also be a sign of constipation, which can contribute to abdominal discomfort and distension. It is essential to evaluate your diet further, as a high-protein diet may sometimes lack sufficient fiber, leading to constipation. Incorporating more fruits, vegetables, and whole grains into your diet can help alleviate this issue.

Additionally, the elevated liver enzymes could indicate liver dysfunction, which can be caused by a variety of factors, including fatty liver disease, hepatitis, or alcohol-related liver disease. It is essential to follow up with your healthcare provider regarding these liver function tests, as they may require further investigation, including imaging studies or a liver biopsy, depending on the clinical context.

Stress and psychological factors can also play a significant role in gastrointestinal health. Conditions such as irritable bowel syndrome (IBS) can manifest with symptoms like bloating, changes in bowel habits, and abdominal discomfort, often exacerbated by stress. If you suspect that stress may be contributing to your symptoms, consider discussing this with your healthcare provider, who may recommend stress management techniques or therapy.

In terms of management, it is crucial to address both dietary and lifestyle factors. Here are some recommendations:
1. Dietary Adjustments: Ensure a balanced diet rich in fiber, including fruits, vegetables, and whole grains, to promote regular bowel movements. Consider consulting a registered dietitian for personalized dietary advice.

2. Hydration: Ensure you are drinking enough fluids, as dehydration can exacerbate constipation.

3. Regular Physical Activity: Engaging in regular exercise can help stimulate bowel function and improve overall gastrointestinal health.

4. Stress Management: Incorporate stress-reducing techniques such as mindfulness, yoga, or counseling to help manage any psychological factors that may be impacting your gastrointestinal symptoms.

5. Follow-up Care: Regular follow-up with your healthcare provider is essential to monitor your symptoms and liver function. They may recommend further testing or referrals to specialists, such as a gastroenterologist or a nutritionist.

In conclusion, your symptoms suggest a complex interplay of gastrointestinal issues that require comprehensive evaluation and management. It is crucial to work closely with your healthcare provider to identify the underlying causes and develop an appropriate treatment plan tailored to your needs.

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