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Dr. Andrew Rynne

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What causes abdominal pain and back pain?

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Dr. Klerida Shehu

Gastroenterologist

Practicing since :2006

Answered : 2251 Questions

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Posted on Mon, 8 Dec 2014 in Digestion and Bowels
Question: Hello doctor,



I’m having issue with my abdominal pain and other pains for over a year now and I’d like to hear second opinion. My story is a bit long so I appreciate your patience to read it through.



I’m a 29 years old male and I started to have abdominal pain since last October, initially the pain was on the upper right abdominal region. I would describe the pain as mix between dull pain and sharp pain, from mild to moderate. The pain is mostly on my upper right abdominal region. Sometimes is on the left side of the 8th or 9th rib (soft side), or between ribs. Or sometimes it’s on the left side, occasionally on the back. The pain seems to have no pattern, not related with hungry or full of food, or fatty food. However changing posture may make me feeling better. If I lie on my right side sometimes I can feel the pain. Sometimes, when the pain happens, heavy breathing (breath in and hold the air) could make the pain worse. The pain usually goes away after 10 to 30 minutes, however could happen several times per day. Usually I don’t feel the pain in the morning, so it happens in the afternoon and evening. When I use my hand to touch my upper middle or right abdominal region, I feel tender and uncomfortable. Starting this XXXXXXX I started to feel back pain however the pain location is all over my back, from left side to right side below the shoulder blades, on the spine and sometimes close to the waist. Like I mentioned before, these days I can have pain on my upper left and middle abdomen too. The pain doesn’t impact my daily activity however it just keeps me thinking (and worrying) about it.



There is no change of appetite, no weight lost, urine and bowel movement are OK (about twice a day in the morning). Recently I had a fecal occult blood test and it was positive, so I’ll have a colonoscopy soon however my GP told me it’s highly unlikely this is related with my upper abdominal pain, and the positive was probably caused by a spilt on my anal.



I’ve been seeing my GP and specialist since last year and I’ve done a lot of tests, the blood / stool test results are attached. I also had gastroscopy which showed that I have gastritis, but no ulcer nor polyp. I had several ultrasounds over the last year, which showed that I have several gallbladder polyps which the largest is 6mm (in last year the largest was 5mm). The exact words are:



“The liver echogenicity is felt to be within normal limits. No focal hepatic masses or intrahepatic biliary dilation. Multiple gallbladder polyps are again demonstrated, largest 6mm, previously 5mm. No gallstones, gallbladder wall thickening, nor pericholecysic fluid. The common bile duct, spleen, kidneys and visualized pancreas, aorta, and IVC are unremarkable. There is a stable accessory splenule.”



My GP and specialist suggested that it’s possibly functional pain or muscle pain, I really hope this is the case however I’d like to hear second opinion. So here are my questions:



1. What’s the most likely reason of my abdominal pain and back pain?

2. Is it related with my gallbladder polyps? Since it grew 1mm over a year should I consider gallbladder removal?

3. Do you think I might have some serious diseases?



Thank you very much for reading so much words, I appreciate it.
doctor
Answered by Dr. Klerida Shehu 2 hours later
Brief Answer:
Possible vertebral spine/colon/IBS issues...

Detailed Answer:
Hi XXXX,

I have gone through your medical history carefully and can say as following:

1. From what you are reporting, the pain you are feeling in the abdomen and back are related to possible vertebral spine issues. MRI of spinal cord is recommended to exclude such vertebral issues.

2. I need to know the size of the polyps in the cholecyst. The greater the size, the more difficult for the bile to move is, the more intense the pain.

I need to have the abdominal ultrasound report to determine whether you need to remove your cholecyst or not.

Another reason could be due to issues related to large bowels. I advise to run colonoscopy to rule out/determine the right cause.

If nothing organic is found, then, IBS is the last diagnosis.

3. I do not think it is a serious disease, however, further determinative tests are highly recommended first.

Hope it helped!
Dr.Klerida
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Klerida Shehu 13 minutes later
Hello Dr. Shehu,

Thank you for your reply, I'll have colonoscopy next month so hopefully there is no serious issue.

My ultrasound reported the size of the gallbladder poloys:

“The liver echogenicity is felt to be within normal limits. No focal hepatic masses or intrahepatic biliary dilation. Multiple gallbladder polyps are again demonstrated, largest 6mm, previously 5mm. No gallstones, gallbladder wall thickening, nor pericholecysic fluid. The common bile duct, spleen, kidneys and visualized pancreas, aorta, and IVC are unremarkable. There is a stable accessory splenule.”

Also do you think this could be related with my pancreas?

Thank you.
doctor
Answered by Dr. Klerida Shehu 51 minutes later
Brief Answer:
No clue for pancreas problems....

Detailed Answer:
Hi back XXXX,

Thank you for providing additional data and test reports.
I have gone through the reports you sent me in, and I've noted that GGT was elevated, indicative for possible cholecyst problems and/or consuming alcohol.

The size of your cholecyst polyps is not indicative for serious issues. It could give problems if they would be larger than 10 mm.

However, there are some rare cases, when even small sized polyps can give cholecyst problems as you are having now.

With regards to your pancreas, I'd say, that the reports of abdominal ultrasound, the pancreas was unremarkable (within normal morphology). Furthermore, from the lab reports, no high amilase levels were noted (pancreas function test within normal range).

Vertebral spine should be further evaluated as such problems can simulate the symptoms you are currently experiencing.

I highly recommend to keep regular follow ups for the polyps in your cholecyst and see the progress (changes in size, etc.).

All the best!
Dr.Klerida
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Klerida Shehu 1 hour later
Thank you doctor. Will the gastritis (as discovered by gastroscopy) cause the pain on both right and left upper abdomen?

I took rabeprazole before I had the blood test of GGT, will rabeprazole cause GGT elevated?

I'm now having ultrasound every half year to monitor the polyps growth.

Thanks a lot.
doctor
Answered by Dr. Klerida Shehu 19 hours later
Brief Answer:
Gastritis can cause such pain...

Detailed Answer:
Hi XXXX,

Thank you for providing more medical data of yours.

1. Yes, gastritis can cause pain that is located on both right and left upper abdomen due to location of stomach and duodenum.

2. So far, the use of rabeprazole is not considered as cause to high GGT levels.

3. Happy to know that you are going to keep regular follow ups to monitor polyps growth.

All the best!
Dr.Klerida
Above answer was peer-reviewed by : Dr. Raju A.T
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