Question: MY 34 YEAR OLD STEP DAUGHTER'S CT SCAN FOR RECENT, UNREMITTING EPIGASTRIC PAIN (10 DAYS NOW) REVEALED PELVIC CONGESTIVE SYNDROME, A RENAL LESION CONSISTENT WITH A CORTICAL CYST AND POSTERIOR GASTRIC FUNDUS DIVERTICULUM. SHE'S BEING TREATED FOR GERD, HAS BARRETT'S ESOPHAGITIS, A HIATAL HERNIA AND IS POST LAPAROSCOPIC CHOLYCYSTECTOMY AND APPENDECTOMY. SHE HAD TUBAL LIGATION AND "A NERVE CLIPPED" IN HER STOMACH AFTER THE BIRTH OF HER THIRD CHILD 5 YEARS AGO. SHE DESCRIBES THE PAIN AS BEING CONSTANT, WITH ADDITIONAL SHARP, SEARING "STABS" PERIODICALLY. IT IS ONLY RELIEVED SOMEWHAT BY DOUBLING OVER. IT'S LOCATED IN UPPER STOMACH AREA, MID LINE TO THE RIGHT, JUST BELOW HER RIBS, WITH PAIN FELT IN HER BACK IN THE SAME LOCATION. VICODIN PROVIDES NO RELIEF. SHE'S TAKING ZOFRAN WHICH IS CONTROLLING THE INITIAL NAUSEA AND VOMITING. SHE'S UNABLE TO EAT MUCH. THE SURGEON SAID THE LOCATION OF PAIN IS NOT CONSISTENT WITH PCS BEING THE CAUSE. SHE'S A HOUSEWIFE WITH 3 CHILDREN (UNREMARKABLE VAGINAL DELIVERY THOUGH ALL WERE 10# BABIES) AND HAS HAD RECURRING BOUTS OF ACUTE PAIN FOR APPROXIMATELY 10 YEARS. THIS RECENT BOUT IS THE WORST AND LONGEST LASTING. THE CURRENT TX TENDS TO BE TO GIVE HER MORE MEDS FOR GERD (PPI NOT HELPING), PAIN MEDS, ANTI DEPRESSANTS AND SEND HER HOME. NO ONE HAS DISCUSSED THE GASTRIC DIVERTICULUM WHICH WAS PRESENT ON A PREVIOUS CT AS WELL (AS WERE THE OTHERS-PCS AND RENAL LESION WHICH ALSO HAVEN'T BEEN DISCUSSED). HER SX ARE CONSISTENT WITH THIS AS A POSSIBLE CAUSE FOR HER PAIN. THOUGH HER AGE IS NOT WITHIN "TYPICAL" PRESENTATION, AND BECAUSE IT'S RARE, I'M ASKING WHOM SHE SHOULD SEE FOR A DEFINITIVE DIAGNOSIS. SHE'S SUFFERING, ISN'T NEUROTIC AND IS DESPERATE FOR HELP AT THIS POINT. I'M AN RN AND RELUCTANT TO GO WITH HER TO THE DOCTOR AS OFTEN IT CAN WORK AGAINST A PATIENT. WHAT SAY YOU GOOD DOCTOR? I THANK YOU SO VERY MUCH FOR YOUR TIME.

I NEED TO AMEND SOME OF THE INFORMATION: PER CONVERSATION JUST NOW WITH HER SHE STATES THIS PAIN BEGAN RIGHT AFTER HER APPENDIX AND GALL BLADDER WERE REMOVED 5 YEARS AGO (RATHER THAN 10 YEARS AS I EARLIER STATED). ALSO, IT WASN'T A "NERVE" THAT WAS "CLIPPED" IN HER STOMACH, SHE SAID SHE HAD THE "SPHINCTER VOTIA" (SIC) IN HER STOMACH CUT. I'M UNFAMILIAR WITH THIS, AM SURE YOU WILL KNOW WHAT THIS IS. THANK YOU AGAIN.

THANK YOU FOR YOUR THOUGHTFUL RESPONSE DR. MITTAL.

IF SHE IS EXPERIENCING POST SURGICAL NEURALGIA, OR NERVE COMPRESSION IN HER BACK, WOULD HER PAIN BE EPISODIC AS IT CURRENTLY IS, OR WOULD IT BE CHRONIC?

THANK YOU AGAIN.

AGAIN, THANK YOU. YOUR REVIEW HAS BEEN QUITE HELPFUL.

I HAVE ONE LAST QUESTION. SHE HAD THE SPHINCTER OF ODDI CUT (?). HER PANCREATIC AND LIVER ENZYMES WERE NORMAL. IS THERE ANY POSSIBILITY THIS EPISODIC PAIN COULD ALSO BE DUE TO COMMON BILE DUCT SPASM SINCE SHE'S POST CHOLYCYSTECTOMY? I WOULD THINK NOT DUE TO THE LONG DURATION OF TIME THE PAIN HAS LASTED, BUT WANT TO COVER AS MUCH AS POSSIBLE WITH YOU BEFORE SHE GOES TO THE DOCTOR. I JUST RETURNED FROM THE GROCERY STORE WITH HER. SHE WALKS VERY SLOWLY, BENT FORWARD AND HAS GRUNTING PAIN. SHE SAID SHE HAD TAKEN THE VICODIN GIVEN HER AT THE EMERGENCY ROOM AND OBVIOUSLY IT WASN'T ADDRESSING THE PAIN. SHE AGAIN INDICATED HER RIGHT UPPER ABDOMINAL AREA MIDLINE AND TO THE RIGHT AS THE AREA IN WHICH SHE'S HURTING.

I THANK YOU SO MUCH FOR YOUR TIME AND EXPERTISE. I WILL GIVE THIS INFORMATION TO HER TO REVIEW WITH HER DOCTOR.