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Cause of intense abdominal pain in a teen - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Abdominal Pain
Answered by

General & Family Physician
Practicing since : 2008
Answered : 3620 Questions
User :   Hi
Doctor :   Hi
Doctor :   I am Dr. XXX
User :   I have a son who is sick for 4 months now
Doctor :   Ok
Doctor :   Please explain in detail
Doctor :   When it started and how it started, medicines taken and doctors seen
User :   Abdominal pain, when we ended up in ER first time his blood level was fine and they thought he had acid reflux
User :   they put him on prevacid and prebiotics but when we ended up couple week later in ER they found elevated level of lipase but not much over 500
User :   he was submitted in hospital on liquid diet then low fat
User :   they ran all test
User :   endoscopy, colonoscopy, ct scan, sweating test, mri
User :   ultrasound
User :   everything was negative
User :   in meantime he lost 20lbs and has problem eating, since he can not digest properly, burping, hearthburn
User :   second time he was submitted again for his lipase level little over 800
Doctor :   Where is the pain exactly? is it progressing now? , how did he describe it and when does it occure and the frequency. All these help me
User :   but after all consultation and since his lipase were going down he was relaesed with no diangnose with suggestion to see psichiatris since they think that this could be on mental side causing him constant pain that does not react on pain killer and they said he can eat anything since they are concerned about his weigh lost and being able to gain
User :   pain is mostly around belly button, sometimes goes little up sometimes little down
User :   its seems to be worse when he eats or not eat at all empty stomach
User :   for some reason it is worse in evening
User :   could he has higher lever of lipase for some other reason than pancreatitis, since they said it's not pancreatitis and he is not on low fat diet
Doctor :   What is his age?
User :   16
User :   they think is puberty
User :   causing him to have all these issue
User :   he is taking only achipex for acid 20mg daily
User :   nothing else
Doctor :   How many doses per day and what time?
User :   once in the morning, he was on prevacid until last week but my family doctor switched since prevacid was not helping a lot and let me mention he has been before this on prevacid for 3 months 30mg
User :   I am scared why his lipase level is elevated
User :   they said its nothing
User :   but he has obvious some problem since he can not eat anything
User :   every food is bothering him
Doctor :   Lipase level is elevated in other problems also
User :   like what?
User :   please tell me
Doctor :   Peptic ulcer can be one in yoru son's case
User :   he had endoscopy
User :   negative
Doctor :   When was that?
User :   just two weeks ago
Doctor :   Any family history of abdominal conditions like Crohns or Ulcerative colitis
User :   no, he has colonoscopy also
User :   he had all tests
User :   negative
User :   it does not show any organic issue
Doctor :   Is serum amylase done?
User :   yes that was only little elevated
User :   i think it was 147 something like that
User :   at one point it was normal
Doctor :   I can think only about nonpancreatic abdominal pain
User :   what is that?
Doctor :   A serum lipase level > 3 times normal has a better diagnostic accuracy than serum amylase in differentiating nonpancreatic abdominal pain from acute pancreatitis.
User :   can you explain
Doctor :   Just give me a minute
User :   but is not 3 times level anyway
Doctor :   Non pancreatic abdominal pain include Peptic ulcer, partial obstruction of the gut, Crohn's
User :   but they would see that in colonoscopy right?
Doctor :   yes, it is a puzzle for me too
Doctor :   Did you see an experienced Endoscopist
Doctor :   who would not miss
User :   if he has higher level lipase can I give me papaya enzyms?
User :   this was pediatric GI
User :   she performs a lot of these I dont think this can be missed
User :   can they missed that?
Doctor :   Not really
Doctor :   I am still clueless
User :   how about enzyms supplements
User :   can I give him papaya enzyms if he has high level lipase
Doctor :   Yes
Doctor :   That is not a problem I believe
Doctor :   Was it objected by his treating Gastro
User :   so if he has higher level of lipase does that mean he needs enzyms or he had a lot?
Doctor :   What was his opinion after all the tests?
User :   I did not ask
User :   They are clueless
Doctor :   I think you can ask a Pediatric Gastroenterologist here for her opinion
User :   how can I get her
Doctor :   WWW.WWWW.WW
User :   like email or?
Doctor :   They are not available on chat by certainly by email
User :   thanks
Doctor :   You will get response in 48 hours
Doctor :   to 72 hours
User :   Thanks
Doctor :   Meanwhile I shall check myself
Doctor :   and send you an email
Doctor :   YYYY@YYYY
User :   thanks
Doctor :   Please confirm
User :   it YYYY@YYYY
Doctor :   Ok noted
Doctor :   I am sorry my chat with you could not help you much
Doctor :   However an experienced Pediatric Gastro should be able to give some inputs
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