Question: Hello Dr Narasi,
About 7 months ago I started to get some strange loud noises from my abdomen. There was no real pattern except after I eat something my stomach would growl very loudly. I found this unusual as I'd not had this ever before This went on for approximately 1 month; then all of a sudden the noise stopped. Almost immediately thereafter I started experiencing some random but continuous abdominal cramps. They are felt in general to be in the upper part of the abdomen specifically concentrated in the area under my ribs on both side and somtimes a little lower, All above my belly button and around my sternum and the pain is continuous throughout the day easing off a little when I lay down or stand up. Again, never had anything like this before and their is no particular pattern or trigger except that they seem to be least painful in the morning and get progressively worse throughout the day . In addition to the abdominal cramps I have also been experiencing back pain, under the bottom of my rib cage in the back radiating up under the right shoulder blade. This is a dull annoying ache rather than a sharp shooting pain and feels deep to the point where I cant massage it out. I have had these symptoms now for approximately 6 months. In addition I noticed some very strange lumps and bumps on my abdomen under my skin. On both sides of my rib cage the fat under the skin feels lumpy almost like clusters of lymph nodes but more fatty and web like. I have NOT experienced any unusual weight loss, night sweats or any change in bowel habits. The only other symptom I have felt is a little more tiredness than usual in the daytime. Just after I stared experiencing the abdominal pain 6 months ago I had an ultra sound and blood work. The blood test showed high liver enzymes and the abdominal ultra sound showed a fatty liver, slightly pronounced kidneys but nothing else remarkable. I was told to improve my diet and dramatically cut down on alcohol both of which I have done and to follow up again in a few months. 6 months later the pain seems to have go progressively got worse, the fat on my abdomen under my skin has become even more uneven and the cramp in my abdomen seems to be more consistent and frequent and slightly more painful. I went to see my GP last week to follow up and he prescribed me with 1 month of proton pump inhibitors, ordered some new blood tests to included Amalayse and has also ordered an abdominal CT. Depending on the result of that Blood test and the CT he said that he may refer me to a gastro enterologist. I have been taking the PPIs now for apprx 1 week and they have made no difference to the pain or cramps. Dr Narasi my question is, as a specialists Gastroenterologist given what I am presenting with would you order a CT and will that accurately show any problems with the Pancreas, Liver, Kidneys or Stomach? I appreciate that I am awaiting the results of the latest blood test but I'd like to ask what your thoughts are on the above and the course of action you would suggest as a specialist. Is a CT the best next course of action or would a repeat ultrasound be as effective. I understand that Ultrasounds can only see part of the Pancreas. Are their any less invasive or safer tests that would give a better picture of what might be going on and is their anything else that you might check so we can get to the bottom of the problem. Could this be a bacterial infection perhaps and if so would you recommend testing? Sorry for all the questions but would very much appreciate a specialists opinion as I'm very concerned and would appreciate a specialists view on this, especially whether their is a clinical justification for a CT over other tests at this point.

Hello Dr Chandrakant,

Thank-you for your answer. Prior to the onset of the initial symptoms 6 months ago I underwent an upper GI endoscopy (about 8 months ago in total) to check for GERD related problems and the findings were unremarkable. This was done before the abdominal symptoms I am describing started and therefore I believe this is unrelated to an upper GI issue . One thing that did occur to me was that I have been quite over weight and wonder if this could be a possible cause of an obstruction. The reason I am suggesting this is because when I stand or lay down I do not seem to have the symptoms. I have also (as part of a recent fitness initiative) been keeping a record of how big my abdomen is. Even when it distends it dosnt get significantly larger but feel noticeably harder. In your opinion does the above support your suggestion of a subacute intestinal obstruction and if so will a CT scan reliably show this? Thank-you for your help.