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What causes abdominal pain?

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Posted on Mon, 28 Jul 2014
Question: I continue to have abdominal pain and have been on this site for many months. My history is evident. I have more abdominal pain after weight lifting. I have always suspected some inflammation of the pancreas. Although, in the last months I have had all the imaging exams and numerous blood panel tests. Nothing indicates pancreatitis and a pancreatic specialist, after reviewing all the reports also feels no pancreatitis. But I think I could have spincter of Oddi dysfunction and this cause the pancreas to inflame. Something is wrong and I am not healing.. I don't drink anymore, but never drank that much. My exercise routine was very rigorous and I know I did something to cause this on going abdominal pain. I have mild gastritis, but I really believe the pancreas is causing some of this pain. I have lost 3 pounds since January and have no oily stool. I do have a weak appetitie. When I lift weights the pain is worse. please advise.
doctor
Answered by Dr. T Chandrakant (5 hours later)
Brief Answer:
MRI of the thoracic spine

Detailed Answer:
Hi.
Thanks for your query.

Noted and re-read the history.

The pain is at a fixed area it seems.
It is increased after weight lifting.
All the investigations done till now related to this problem are negative.
Sphincter of Oddi dysfunction will always be picked up by the tests. So no question about this unless the investigations are abnormal. So out of question.
Pancreatitis will never be increased by weight lifting.

Gastrtis pain is typically burning sensation and increases with stress. It is usually increased on food.

As you have done all relevant tests and are negative, I would advise for a few more tests which may help ::
*MRI of the whole spine particular attention to the thoracic vertebral area. Disc and such problems causing compression can mimic the symptoms you have and your saying that the pain increases on weight lifting leads more to this diagnosis.
* Angiography of the abdominal aorta and the arteries supplying the GI system to see for stenosis/ blockage.

Let this be diagnosed or be ruled out.
Consultation of the Neurologist or Neurosurgeon can help in this regards, better to have a second opinion.


Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. T Chandrakant (5 hours later)
Dr Chandrakant, what imaging exam is used to determine spincter of Oddi dysfunction? It is my understanding a manometry test would be needed.
doctor
Answered by Dr. T Chandrakant (5 hours later)
Brief Answer:
Yes, indeed !

Detailed Answer:
Yes, very true !
Sphincter of Oddi manometry can be done and involves passing a catheter into the bile and/or pancreatic duct during ERCP ( Endoscopic Retrograde Cholangiopancreatography ) to measure the pressure of the biliary and/or pancreatic sphincter. It is considered the gold standard diagnostic test for Sphincter of Oddi Dysfunction.


Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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Follow up: Dr. T Chandrakant (6 hours later)
Dr Chandrakant, my symptoms appear to biliary and that is why I feel the Spincter of Oddi could be the problem. I have not had ERCP, but I did have a MRCP, which did not show any stones. I also have had many liver blood exams and they are always normal, which I understand if not normal, could be a sign that the pressure in the biliary could be effected. I have had upper right quadrant pain for 6 months, that comes and go. I also had a HIDA scan, that was very good, so I know that pain is not related to the Gall bladder. I have seen many doctors, three GI's and a pancreas specialist and nobody mentioned the Spincter of Oddi. If this is related, and I think it is, what would you prescribe to treat?Also, what could cause Spincter of Oddi to dysfunction? Could it be the weight lifting or excessive exercise I discussed in my query?
doctor
Answered by Dr. T Chandrakant (4 hours later)
Brief Answer:
Go for ERCP

Detailed Answer:
Thanks for your feedback and an understanding you have.

Since the MRI and all other investigations are within normal range, this can be a type III SOD- Sphincter of Oddi Dysfunction.

The medical management is by giving anti-spasmodic medicines only,

ERCP can be employed for diagnostic (including manometry if available )as well as therapeutic. You have to discuss this with your Gastroenterologist.
Since the MRCP and other investigations are negative, ERCP can help in diagnosis > the direct visualization of the Sphincter is possible, also to see if there is scarring / edema and fibrosis of it. A small cut in the sphincter called sphincterotomy may hep as a treatment too.

Medical treatment is to take the anti-spsmodic tablets.

The causes of SOD are not really understood. There can be a fibrosis over this sphincter mechanism, or the sphincter has become less pliable.

Weight lifting or exercises can not cause this.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. T Chandrakant (2 days later)
Dr Chandrakant, my real concern is pancreatitis. I have had all the imaging tests, except ERCP or EUS. I had all the lab work. All is normal except I have two small 1cm side branch lesions in the pancreas. I have a scheduled MRI in January to check for stability. I have seen many doctors and no one feels these cysts are causing my pain. I understand mild pancreatitis may not be seen on imaging. I have this recurring pain in my upper right quadrant and tingling in my hands and feet on occasion. I have lost about 3 pounds in 6 months, no oily stool. I do get, what appears to be gas pain in my upper back when I eat amd drink sometimes. I do have Gastritis, but I think I think I have pancreatitis or something wrong in my biliary.
.
doctor
Answered by Dr. T Chandrakant (41 minutes later)
Brief Answer:
Follow-up ultrasonography & Upper GI Endoscopy

Detailed Answer:
Yes, surely your concerns are noteworthy.

As a rule, no simple cysts of the size of 1 cm in any part of the body cause pain. They can cause pain only if complicated by sudden increase in size, infection or bleeding (and twisting in case of ovarian simple cysts).This may be the reason your Doctors are not feeling these simple cysts to be a cause of pain.

Mild pancreatitis will definitely cause pain, but still it will be characteristic of a pancreatic pain only. Severe, in the mid-upper abdomen or back, starts or increases after few hours of food, not immediately on food.

Pancreatic enzyme supplements, when taken with the food can lessen or relieve pain ( one diagnostic and therapeutic simple test).

These can be easily followed-up regularly on a simple ultrasonography- we have to just see the size and contents.

Let us suppose, this is causing pain, it will be felt in the center of abdomen or in the back, exactly where they are situated.

The pain can be due to gastritis, comes on eating or drinking almost immediately, not relieved easily, increases with stress or certain foods and beverages, can appear to be gas pain in upper back as you have rightly explained.

Tingling in hands and feet, and mild weight loss can be due to chronicity of the problem. Gas pain in the upper upper back can be due to gastro-esophagitis as it is enhanced by eating and drinking.

There has to be an evidence-based investigation to prove pancreatitis. You may also go for upper GI Endoscopy.

I hope this helps you further to understand the problem.


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. T Chandrakant (3 hours later)
Dr Chandrakant, thanks for clear explanation. I did have an abdominal ultrasound and upper GI endoscopy 5 months ago. My symptoms were the same then as they are now. I did have an upper GI barium last month. These exams with the exception of Gastritis, were normal. I never have severe pain, but it seems, the ache is most of the day, although slight, and especially in the morning before breakfast, then it does seem to be less or even go away for a period of time. Are you referring to a EUS regarding ultrasonography? Also are you referring to the tingling as association with gastritis or pancreatitis? And is it true that MRI, MRCP, and Ct scan, which I had,could miss mild pancreatitis?Also,I have had a lot of stress, mainly because of this ordeal. I have been trying anxiety medication. I am having a hard time with all this?
doctor
Answered by Dr. T Chandrakant (7 hours later)
Brief Answer:
stress > gastritis

Detailed Answer:
Sorry for the late ( you know how is the Surgeon's life).

You had USG, Endo, Ba and all came to normal except for GASTRITIS.
The main reason of gastritis is always the stress and the symptoms related to the ones you have explained.
You have a pain mainly before breakfast and then goes away.It is never severe.

EUS is a very good investigation in the hands of an expert. and will help us to rule out any problem and the condition of the 2 simple cysts that were detected. Please get these too done if you have the facility.

Tingling is mostly due to stress, and is usually non-specific.

MRI, MRCP, CT, USG, Clinical Judgement of so many Doctors, blood tests can not miss even mild pancreatitis. I hope your blood sugar levels are also normal.

Stress is the mother of many many diseases = (dis-ease). It has to be under control at any time at any cost, I would say. You live only once, then why to have anything which causes stress? Go out , change the atmosphere, habits, hobbies, lifestyle- Say NO- a strict no to anything which you know increases your stress.
Is there any history of pancreas related disease or disorder or deaths in your near and dear ones?

I again hope this helps you a lot.


Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. T Chandrakant (4 hours later)
Thank you, I had every blood test under the sun, and most were recent. My glucose is normal and I do not know of any family member or any relatives who had any pancreas issues. The only blood test result that was abnormal was a vitamin D deficiency. I am taking supplements to correct that. I live in XXXXXXX we have little sun.
doctor
Answered by Dr. T Chandrakant (2 hours later)
Brief Answer:
Therapeutic dose of Vitamin A and D.

Detailed Answer:
Nice to know your glucose is normal, the question was pertaining to pancreatitis. Normal glucose again supports against pancreatitis.

Yes, a proper supplement of Vitamin D and A helps healing the mucosal lining of the stomach (gastritis). Take the therapeutic dose in consultation with your Doctor.


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. T Chandrakant (47 hours later)
One of your questions was where is my pain situated. I have had upper right quadrant pain off and on for 6 months. Some mid to upoer abdominal pain and my back pain seems to more upper back, but moves around. I met with a pancreatic specialist twice in the past 5 months. We discussed my small lesions in the pancreas and as you suggested that it is unlikely they are causing any symptoms. I insisted on another appointment in late March and asked about pancreatitis. She said she never gave it a thought, but never gave me a physical. She just read all the imaging reports. She also insisted pancreas pain would be mainly in the mid back and not the upper back. When I explained the RUQ pain, she said she did not know what was causing it. I did read vitamin D defiencey could be a link to pancreas problems. This pancreas thing is making me a basket case.
doctor
Answered by Dr. T Chandrakant (23 minutes later)
Brief Answer:
Consider costo-chondritis.

Detailed Answer:
Hi,

Thanks for your feedback again.

It is very true that the pancreatic pain is always referred to the part of the back where it is situated, not in the upper back.

Upper back pains are usually due to stress and muscle spasm ( I do not mean to connect to your case).

RUQ Pain :: Just a thought. Please do a simple test at home. Palpate and put a pressure on the lower ribs. See whether it elicits the similar pain. If yes , this can be a case of costo-chondritis. It can have varied associated symptoms , least understood and easily missed by many. ( you had noted that the pain increases on lifting weight and may be exercises ans such activities which expands the chest more than normal and also increases with stress)

Vitamin D deficiency is not well documented to be connected to pancreatic problems.

If there was an acute pancratitis, then only chronic will develop.
By definition: Chronic is where there is permanent damage. And is easily picked by any imaging tests.

regards,




Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. T Chandrakant (3 days later)
Dr Chandrakant, I definitely Have pain when I press on my lower rib in the URQ. That pain is not on the ULQ. It appears it comes and goes, but it seems most of the time the pain is below that area. Is that called referred pain if in fact the lower rib is a possible source of pain. I have not had the constant abdominal pain since I stopped with weight lifting and I did not awaken with abdominal pain this morning for the first time in a long time, but I think my anxiety still exists.
doctor
Answered by Dr. T Chandrakant (36 minutes later)
Brief Answer:
Costo-chondritis to be thought of

Detailed Answer:
Thanks for your feedback.
Costo-chondritis is more probable, the nerves pass from the under-border of the ribs , thereby whenever there is inflammation of this area, the nerves might be transmitting the pain to the area where you feel it.

Costo-chondritis: the exact reason is not known, it does increase with stress. Tapering doses of steroids like Deflazacort is the best diagnostic and therapeutic trial. This means if the pain goes away, this is diagnostic of costo-chondritis and therapeutic as you get a relief. We Do advise additional anti-inflammatory medicines, Doxycyclin and multivitamins, application of local rubrafacient liniments ( which make the area warm and increase blood circulation, reduces the pain and improves the healing)
You may please discuss with your Doctor and take a course if you believe.
It is good that you do not have diabetes. Deflazacort can be safely given.

Well the anxiety would obviously not go till you get relief ( and get a diagnosis ).
Relax: it helps in early recovery.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Dr. T Chandrakant

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What causes abdominal pain?

Brief Answer: MRI of the thoracic spine Detailed Answer: Hi. Thanks for your query. Noted and re-read the history. The pain is at a fixed area it seems. It is increased after weight lifting. All the investigations done till now related to this problem are negative. Sphincter of Oddi dysfunction will always be picked up by the tests. So no question about this unless the investigations are abnormal. So out of question. Pancreatitis will never be increased by weight lifting. Gastrtis pain is typically burning sensation and increases with stress. It is usually increased on food. As you have done all relevant tests and are negative, I would advise for a few more tests which may help :: *MRI of the whole spine particular attention to the thoracic vertebral area. Disc and such problems causing compression can mimic the symptoms you have and your saying that the pain increases on weight lifting leads more to this diagnosis. * Angiography of the abdominal aorta and the arteries supplying the GI system to see for stenosis/ blockage. Let this be diagnosed or be ruled out. Consultation of the Neurologist or Neurosurgeon can help in this regards, better to have a second opinion.