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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Abdominal Pain And A Shooting Pain Below Belly Bottom?

Hi, I m a 29 year old female. I began having mild aching pain in my right lower abdomen one week ago today. The pain grew in intensity, and soon it was a shooting pain that started in the lower right quadrant and went to just below my belly button. The pain is intermittent, and sometimes goes away for up to an hour. The pain initially felt digestive but then began to get worse with certain movement- including moving my right leg or turning on my left side. It is more painful when pressure is applied but not necessarily on rebound. The pain started on Tuesday and grew in intensity to the point that I scheduled an urgent DR appointment on Thursday. The doctor felt that it was appendicitis- although that it was not acute appendicitis. She ordered an urgent CT scan but said they might not get me in for a few days. She told me if the pain got worse or I broke out in a fever. The pain worsened and I ended up in the ER the next day. They ran a CT scan (I believe with contrast) and it came back unremarkable. Same for an ultrasound. Blood tests came back normal except for slightly elevated lymphocytes. Urine tests were also normal. Slight fever at 99.5 (which is high for me since I usually run cold at 97.3). I went back for a follow up the next day to a different DR and he shrugged it off and maintained the tests didn t show anything and that it was probably a virus. The pain is worse today, one week later. It hurts to touch anywhere near the area. The pain is continuing to shoot through my abdomen- NSAIDS do a little but not much. They gave me tylenol 3 and that just makes me sleepy but still in pain. I ve read other similar stories and many people ended up having appendicitis but it was chronic instead of acute and didn t show up on CT scans either- it was only found and their pain resolved after surgery. Other past symptoms: - IBS like symptoms (including a couple bouts of bloody diarrhea- these were explained away by my DR at the time as being due to constipation before the diarrhea causing tears inside the intestine or colon) - GERD and possibly Bile reflux as well - rapid heart rate - a previous long period with a low grade fever (around 99.5-100.0 for approximately 1-1/2 months). - A familial history of Mitochondrial Disease on the MtDNA- I m at 75% affected cells but only show minor symptoms. Any insight would be helpful.
Mon, 21 Jul 2014
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Psychiatrist 's  Response
HI THANKS FOR POSTING YOUR QUERY ON HEALTHCARE MAGIC.
GOING BY YOUR CLINICAL AND LAB HISTORY IT SEEMS "METABOLIC CAUSE" AS THE PRIME ORIGIN OF PAIN.THIS CONCLUSION IS AS A RESULT OF SIGNIFICANT PAST MEDICAL HISTORY LIKE.IRRITABLE BOWEL SYNDROME,GASTRO ESOPHAGEAL REFLUX DISEASE ,MITOCHONDRIAL INHERITANCE .THE LIKELY CAUSE OF YOUR SYMPTOMS COULD BE "ACUTE INTERMITTENT PORPHYRIA"GET YOURSELF TESTED FOR BLOOD AND URINE PORPHYRINS.I SUGGEST YOU REPEAT AN ULTRASOUND SCAN ABDOMEN TO RULE OUT CAUSES LIKE GALL STONES .UPPER GI ENDOSCOPY CAN HELP TO RULE OUT PEPTIC ULCER AS A CAUSE OF PAIN.ERCP-ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATICOGRAPHY" CAN HELP TO VISUALISE BILE ACID REFLUX.MEANWHILE I PRESCRIBE TAN PANTOP 40mg,INJ KETOROLAC TO TIDE OVER YOUR CRISES.CONSULT AN EXPERT GASTROENTEROLOGIST IN YOUR CASE TO HELP YOU FURTHER.A GENETICIST CONSULTATION IS ALSO VERY HELPFUL.
THANK YOU.
TAKE CARE.
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What Causes Abdominal Pain And A Shooting Pain Below Belly Bottom?

HI THANKS FOR POSTING YOUR QUERY ON HEALTHCARE MAGIC. GOING BY YOUR CLINICAL AND LAB HISTORY IT SEEMS METABOLIC CAUSE AS THE PRIME ORIGIN OF PAIN.THIS CONCLUSION IS AS A RESULT OF SIGNIFICANT PAST MEDICAL HISTORY LIKE.IRRITABLE BOWEL SYNDROME,GASTRO ESOPHAGEAL REFLUX DISEASE ,MITOCHONDRIAL INHERITANCE .THE LIKELY CAUSE OF YOUR SYMPTOMS COULD BE ACUTE INTERMITTENT PORPHYRIA GET YOURSELF TESTED FOR BLOOD AND URINE PORPHYRINS.I SUGGEST YOU REPEAT AN ULTRASOUND SCAN ABDOMEN TO RULE OUT CAUSES LIKE GALL STONES .UPPER GI ENDOSCOPY CAN HELP TO RULE OUT PEPTIC ULCER AS A CAUSE OF PAIN.ERCP-ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATICOGRAPHY CAN HELP TO VISUALISE BILE ACID REFLUX.MEANWHILE I PRESCRIBE TAN PANTOP 40mg,INJ KETOROLAC TO TIDE OVER YOUR CRISES.CONSULT AN EXPERT GASTROENTEROLOGIST IN YOUR CASE TO HELP YOU FURTHER.A GENETICIST CONSULTATION IS ALSO VERY HELPFUL. THANK YOU. TAKE CARE.