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What Causes Pain In Upper Left Abdominal Quadrant?
Question: Hi. I'm having pain in my upper left abdominal quadrant. Near my flank and close to my waist. I feel paroxysms of pain like something is cramping and fibrillating. My pancreatic enzymes were high but the pain is where the end of the tail would be not so much the head. My stools are flat like ribbon and very short, about 1 inch long. They are not dry. They are very mushy actually yet I sometimes feel obstipated. It doesn't feel like they are coming out so tiny but that is how they look in the toilet. (sorry, this is unpleasant) This may be non-related but I'm also experiencing headaches and pain in my spine close to my waist which radiates out to my flanks, mostly the left one. Large doses of ibuprofen or aspirin don't help much. A very interesting symptom is my skin. It is abnormally sensitive to the touch, very hard to explain. It kind of feels like I'm lightly running my fingers over a rug burn. Both this sensation and the pain move around a bit but stay in the upper left quadrant. Thanks for your consideration.
Brief Answer:
Possibility of Chronic Pancreatitis
Detailed Answer:
Hi
Welcome to Healthcare-Magic
Greetings of the Day
Dear Ms
Lets analyze your symptoms
Pain in the abdomen in left quadrant along with elevated Pancreatic enzyme and mushy stool , suggest the possibility of Acute on Chronic Pancreatitis. Lets consider the reasons for suspecting this as diagnosis
1. History of chronic alcohol intake
2. Elevated Pancreatic enzyme: In chronic Pancreatitis there is mild elevation in Enzymes like Lipase and amylase. Significant elevation is likely to be due Acute inflammation on already inflammed Pancreas
3. Mushy stools especially if they are sticky and float in lavatory pan, suggest the possibility of Steatorrhoea ( Excess fat in stools). There is state of malabsorption due to deficiency of digestive Pancreatic enzymes.
( I would suggest you to get stool examination for confirmation of your diagnosis)
Also there could be contribution from gastritis and colitis for causing the pain.
The pain in present near the spine and radiating to flanks could be due to
1. Chronic Pancreatitis
2. Ureteric colic
The Hypersensitivity of the skin especially in the area of glove and stockings(hands and legs) could be possibly be due to Peripheral Neuropathy. Past alcohol intake and diet deficient in Vitamin B6 ( Pyridoxine) and Vitamin B12( Cyanocobalamine) predisposis to Neuropathy. Taking Multivitamin supplements will definitely be beneficial.
Next question that could come to your mind is How to proceed further?
Its important to establish a diagnosis. I would suggest you to consult your Physician and get these investigation done
1. Complete blood Count
2. Liver Function test
3. Ultrasound of abdomen
4. Stool examination: Microscopy, occult blood, reducing substance, fat
5. Serum Vitamin B12 level
In the meantime I would suggest you the following which may provide the much needed relief
1. Complete and absolute abstinence from alcohol
2. Consume plenty of water: 2 to 3 liter a day
3. High fiber diet
4. Avoid fat in diet
5. Avoid spices/excessive oil
6. Capsule Pantoprozole once a day
7. Multivitamin supplement
In case you need any further assistance, will be glad to assist you.
Take Care
Best Regards
Dr Deepak Kishore
MBBS,MS,MCH
Consultant Surgeon
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much for your speedy response. I have had a CT scan. It did not pick up inflammation of the pancreas but I don't know how likely it is that it could be missed. I do have some fatty liver damage from past alchohol abuse. I am not losing weight so malabsorption seems unlikely to me. I tend to gain weight if I'm not careful to watch my caloric intake. I eat way too many fatty foods but am struggling to cut back. (sorry, I know I'm not a doctor but I still want to educate myself regarding my own health)
I know that pancreatitis seems the likely culprit due to my past history of alchoholism. What is it that prevents pancreatic enzymes from being able to move into my intestines? Are they digesting my pancreas?
I want to come back to the question about the flat stools. They don't float by the way. Why are my stools so flat? And why are they only an inch long? There are a hundred tiny pieces in the toilet when I am finished. Could this be indicative of some sort of partial intestinal blockage? And could this drive up pancreatic enzyme levels?
I also am sure you are suspecting peripheral neuropathy due to my diabetes. Tests show I have extremely good sensation in my feet, better than most people.
The skin sensation I was referring to is only on my abdomen, never my hands or legs. It is directly above where I am experiencing pain and discomfort. I told you the pain only occurs in the upper left quadrant. I was wrong. Occasionally, like this morning, it hurts across my belly (my intestinal area). I am having that same odd skin sensation over my belly now. I do not notice it unless I lightly run my fingers over my skin. It hurts. Not intensely but it hurts, like running your fingers across a scrape. My greatest area of tenderness is on my left side, my literal side, my flank. Gently pressing there, close to the bottom of my ribs is always painful and very sensitive. But what would be so tender there besides bone or muscle?
I'm sorry this is presenting so abnormally. Could all of these symptoms be caused by pancreatitis? I know my pancreas is troubled. I sometimes feel a stab of pain there. And the cessation of eating will slowly bring relief. Most of my pain is very close to my spleen and my descending colon. It is also always in my back, close to my left flank near my waist. Oh, and there is a large lump there by my spleen that comes and goes. I can feel it. My doctor could not feel it but thought she could see it. It goes away when my symptoms abate.
So stools, lump, skin sensation. If you have any ideas what might be causing these, I'm grateful for any input. The CT scan didn't pick up anything other than the fatty liver. And what blocks enzymes from leaving the pancreas and entering the small intestine.
Thanks much. Have a great day. XXXXXXX
Brief Answer:
To consider Herpetic Neuralgia
Detailed Answer:
Greetings
Thanks for detailed description
Chronic Pancreatitis is basically a slow inflammation of the Pancreas, literally causing slow destruction of Pancreas(Its like a smouldering fire slowly engulfing the surrounding). Its due to direct toxic effect of alcohol on Pancreatic tissue. As you must be aware pancreas has Exocrine part(synthesis digestive juices and enzymes) and endocrine part( Releases Insulin and glucagon). Alcohol could affect both the cells. Normally Lipase and amylase are produced inside the cells and secreted in inactive state in duodenum and get activated in small intestine after coming in contact with acidic food. These enzymes are not present in blood. Destruction of cells may cause their release in circulation causing elevated Pancreatic enzyme level.
When majority of pancreas is destructed it causes reduction in digestive enzymes and and may cause fat malabsorption. Weight loss may not be significant. In majority of case Chronic Pancreatitis is asymptomatic and may not present with symptoms. Endocrine insufficiency in form of Diabetis Mellitus may be initil presenting symptoms.
Sometimes Pancreatitis can be missed by Plain CT scan. It will require Contrast CT scan or Magnetic Resonance Cholangiopancreatogram (MRCP).
In view of History of Alcohol intake, pain in abdomen and stool disturbance, and elevated Pancreatic enzymes especially Serum Lipase and Serum Amylase Pancreatitis needs to be ruled out.
Coming to exaggerated touch sensation or pain like sensation while touching which is referred as Hyperaesthesia . Normal touch sensation is perceived as pain. If this Pain is located on one side like in your case where its found in left flank and hypochondriac region possibility of Shingles (Herpes Zoster) needs to be considered . It may or may not be accompanied by rash. Differential diagnosis of Shingles should be considered especially when there is no signs of inflammation. Its known as Herpetic Neuralgia which affects one dermatome and usually involves one side.
I have no Idea why your stools are ribbon like. Getting stool examination done as previously advised may guide us further. Its unlikely to be intestinal Obstruction( Subacute), as the pain usually is colicky and mainly located in Umbilical region and also there tends to be some amount of distension and vomiting.
I hope I have clarified your doubts, do get back to me for any further query.
Wishing you a happy and healthy life.
Take Care
Regards
Deepak
Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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