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Dr. Andrew Rynne

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Having abdominal pain and feeling fatigued. Not cured by medicine. What should I do?

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Dr. Grzegorz Stanko

General Surgeon

Practicing since :2008

Answered : 5770 Questions

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Posted on Wed, 26 Dec 2012 in Abdominal Pain
Question: Hi there,
I have had 24/7 abdominal pain inches above my naval. The pain has been going on for 10 days. It feels uneasy and churning. It has woken me up in the middle of the night. I had blood work done-all normal. Upper endoscopy was normal and I am still waiting on the biopsy results. I have been taking Prilosec OTC for 4 days but it has not seemed to help. My stool has been normal-no diarrhea, no blood. No nausea. The pain sometimes worsens after eating but not all the time. I feel very fatigue but I am not sure if that is a symptom or just a change in the seasons.The doctor I am seeing now stated if the endoscopy was normal that he would like to proceed with a CT scan. I want to make sure that a scan is necessary before I do one. Please let me know what you think, I would really like to feel better soon. Thank you. -XXXXXXX
doctor
Answered by Dr. Grzegorz Stanko 44 minutes later
Hello!

Thank you for the query.

Before CT simple abdominal ultrasound and urine analysis should be performed. Your symptoms may be caused by gallstones or pancreas disease. Anxiety can also cause such symptoms and related wit it IBS.
What blood tests were performed? Have you had amylase, GGTP and bilirubin level checked? Does your pain radiates to the back?

I`m looking forward to hearing from you.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 2 hours later
Thank you for answering.

I had a CBC and I believe a lipase and CMP. I forgot to add that I did have a urine analysis done and it came back normal. I do not have lower back pain. It does sound a bit like IBS however my bowel movements are normal. Is it possible to still have IBS without the change in bowel movements? He said he would like to do imaging, possibly Friday, if I do not feel better or my symptoms get worse. What are the side effects of this scan? Also, if CT comes back normal is there any other option it could be?

Thank you again,
XXXXXXX
doctor
Answered by Dr. Grzegorz Stanko 28 minutes later
Hello!

Yes, IBS is still possible even without bowel movement changes. It is strongly related to anxiety and depression. However before such diagnosis, all other possible reasons of your symptoms should be ruled out. I`m just wondering, why you did not have abdominal ultrasound performed. It is much more safer than CT as CT is based on X-rays and as it is common known, this radiation in high dosages can be a reason of cancer. And it is contraindicated in pregnancy.
However CT might be necessary if no finding in ultrasound. But it should be the second test, not the first one.
It is also possible that the CT will be negative. It is possible if you do suffer because of partial intestines obstruction due to adhesions after C-section. This disease gives bowel movements changes and nausea, however the pain can be the only reason as well. In such cases, when nothing is helping, laparoscopy might be necessary to see where the problem is.

Hope this will help. Feel free to ask further questions.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 3 days later
Hello!

My pain is still inches above my belly button. Starting yesterday I get little sharp pains underneath my right and left rib cage throughout the day. My doctor said he decided not to do an ultrasound due to my pain not being localized to one specific point. I had CT scan of my abdomen and pelvic region yesterday. The preliminary results showed nothing was wrong. I am still having a burning and churning uncomfortableness non stop. I have been taking Priolosec OTC now for 8 days and I have been directed to take it twice a day for 5 days. It has not made my symptoms better at all, if anything I feel like I am getting worse and the pain is continuing to wake me up in the middle of the night.

I asked for a copy of my test results from the blood and urine sample. My Urine Epithelial Cells were 9-20hpf. Can you explain to me what that means?

I continue to have normal bowel movements and no nausea. My doctor said he is recommending me to a GI specialist now. Let me know what you think.

Regards,
XXXXXXX
doctor
Answered by Dr. Grzegorz Stanko 15 hours later
Hello!

Were this CT with oral contrast consumption and after intestines clearing with laxatives? If not, it may be necessary to do one (so called enterolysis).Only such CT can visualize intestines passage.
Epithelial Cells in urine are very common. This cells comes from the wall of all urine tract and its present is normal. So it does not tell anything.
GI specialist is a good next step. He will probably ask you to have colonoscopy performed.
In a meantime you may ask your regular doctor to try Mebeverine treatment. It is quite helpful in IBS. You may also try Magnesium 400mg per day supplementation.
Priolosec wont give you any relief as you do not have any stomach problems.


Hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 10 days later
Hi there!

It was a CT with oral contrast consumption, but there was no clearing of my intestines. The results from the endoscopy were normal. It lasted 17 days of non stop discomfort and pain, and I still have discomfort but for the last week it is now on and off. I do not have much of an appetite. The specialist I am seeing suggested a HIDA scan and stated that is his only idea. He did not mention a colonoscopy like my previous doctor. He was very brief and did not explain what this scan could show, so if you could explain to me about the scan and if you think this is a good idea to be performed I would appreciate it.

Thank you.
doctor
Answered by Dr. Grzegorz Stanko 14 hours later
Hello!

HIDA test is nothing more than scintigraphy of the gallbladder. You will get some substance marked with the nuclear chemical element and after an hour special camera (gamma camera) will scan your body looking for this nuclear element. With this test the function of the gallbladder will be checked.
But like I have written before, when you were asking me about CT,"before CT simple abdominal ultrasound should be performed. Your symptoms may be caused by gallstones or pancreas disease".
You need to know that most of the gallstones are invisible for CT. And all of them are visible for ultrasound. Ultrasound is much easier and safer than any other test so I would insist to have it done before HIDA test.

Hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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