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What Causes Abdominal Pain?
Question: I have been on this site for several months and have been very satisfied, but I continue to look for answers. In December of 2013 I started to have abdominal pain, at the time of my annual physical. My GP reported all my blood work was normal and nothing was out of range, but he felt I needed to get a upper GI and ultrasoumd. They came back normal, so he suggested I see a gastreologist. The GI said I needed an endoscopy. I was diagnosed with mild gastritis, but no bacteria. Therefore the GI suggested a ct scan, MRI and MRCP. The MRI found 2 small 1 cm IPMN side branch lesions. All other tests were normal, these tests were done at the end of January 2014. I met with a pancreatic specialist and she wants to monitor these lesions in 6 months. The MRI showed no other abnormalities and she did not believe my symtoms were related to these lesions. Also no inflammation. Also during this time I started to get back pain, mainly in the thoracic region, but neck and lower lumbar as well. I then had a HIDA scan that also showed a normal liver and gallbladder. In fact, the gallbladder had excellent contraction and ejection fraction of 86%. I then saw an orthopedic specialist. I also had back X rays that showed degenerative discs. But this doctor feels my pain is muscle related and now I am seeing a PT. My pain comes and goes, but I seem to have a knawing pain in my upper right quadrant, right near the gall bladder. Could this pain be related to my gall bladder or liver, even if all these tests show everything normal? I have been on zocor for many years, and I am a moderate beer drinker. I have seen a dietician, and now use several supplements to help with the gastritis. Not sure how these things work. I also plan to do yoga. I am very stressed and maybe that is causing some of the pain, but this pain is real and I want it to stop. Please advise.
Brief Answer:
Acid peptic disease Could be cause
Detailed Answer:
Hi
Welcome to Healthcare-Magic
Greetings of the day
Dear Sir
I do understand the pain you must be undergoing.
Let analyse them. As you have right upper quadrant pain (right hypochondriac region). This pain is unlikely to be due to gallbladder and Liver due to following reasons
1. No anatomical abnormality picked up on Ultrasound, MRCP and CT scan: It rules out gall stone which is most commonest cause of pain due to gallbladder. As you mentioned you consume beer in moderation, prolonged consumption of which can cause alcoholic Liver disease, earliest manifestation of which is fatty Liver. Fatty liver can normally be picked up by ultrasound and MRCP. As these tests are normal it almost rules out Liver as the culprit
2. Functional test normal: Some individual have pain due to gall bladder even in absence of stone due to hypo-contractile (less) or acontractile (no contraction) gall bladder . As your HIDA scan is normal it almost rules out gall bladder as the culprit
3. Biochemical test normal: As you mentioned blood work up was done and nothing was out of range, I assume that battery of test would have also included Liver function test like SGOT, SGPT ALKALINE PHOSPHATASE. Normal level of which almost rules out liver disease.
So from this it goes that Liver and gall bladder are not culprit
When you mentioned that gastritis was diagnosed and no bacteria, I assume Upper gastrointestinal endoscopy was done. I also assume you meant no Helicobacter Pylori infection (which was ruled out during Endoscopy).
The most likely cause for your right upper quadrant pain is due to acid peptic disease, especially possibility of Duodenal Ulcer has to be considered. It's the other common cause for right upper quadrant pain.
I would suggest you the following which will definitely help
1. Regular intake of meals: Consuming small quantity frequent meals will be beneficial
2. Consume plenty of water: 2 to 3 liter a day
3. Absolute abstinence from alcohol in any form
4. Avoid carbonated/caffeinated beverages
5. Tablet Pantoprozole along with Domperidone will provide much needed relief
6. Empirical treatment for Helicobacter Pylori eradication will definitely help: It's my personal experience, many individuals with negative test for bacteria have responded to it
7. High fiber diet
8. Avoid Oily and spicy food
. Avoid stress
These will definitely be helpful.
Coming to issue with your back. Many of the individual beyond 6 years of age may have degenerate disc changes. It's due to constant wear and tear. It can be associated with muscle spasm which can be cause of pain. Some contribution can be from Zocor. Zocor is a statin group of lipid lowering agent and one of the common side effect is muscular pain.
I hope it helped
In case you require any further assistance, will be glad to assist you.
Take care
Best Regards
Dr Deepak Kishore
MBBS, MS, MCH
Consultant Surgeon
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr XXXXXXX your assessment of my condition appears to have merit and your explanation is very precise. I thought a peptic ulcer could be found on an upper GI, and at least during an endoscopy. I had both exams and neither indicated an existing ulcer, only the Gastritis. I can seem to locate the pain in the upper right quadrant, and it is in the same place most of the time, which appears consistant with an ulcer. Although, I also get discomfort in my entire abdominal area, but never too severe. Also, do you recommend not to continue on Nexium and sulcrafate if we determine this is an ulcer and I should switch to the Protonix and the Motilium?
Brief Answer:
Gastritis can also produce similar symptoms
Detailed Answer:
Hi
Greetings
Gastritis can also produce right hypochondriac pain. Also it more likely appears to be Duodenal ulcer.
Nexium is Esmoprozole(its a Proton pump inhibitor and suppresses hydrochloric acid synthesis), Sucralfate is an Ulcer protective agent. Its not advisable to take both of them at same time of day, Proton pump inhibitors are preferably taken early morning on empty stomach. Protonix is Pantoprozole which is also Proton pump inhibitor. Either you can take Nexium(more preferred) or Protonix.
Motilium is Domperidone which increases motility of stomach and hastens gastric emptying and may prevent gastro-oesophageal reflux. It can also be beneficial in symptomatic treatment.
If the symptoms persists, I would suggest H Pylori erradication kit for 10-14 days.
Do write to me directly if you need any further assistance.
Take Care
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Do you prefer Nexium over Protonix? Also, as I said in my initial summary, I have back pain, and I am having treatment with a PT. I have had discussion with another doctor on this site and he feels in addition to gastritis, I could have mild pancreatis. None of my exams indicate any inflammation, but he says mild pancreatis would not show on an image scan. I do get instant upper back discomfort if I have one beer. My back pain appears to move around a lot and that is why the orthopedic doctor feels it is muscular, I have degeneratIve disc disease, but he feels that is not causing this pain. My wife has the same kind of discomfort in the upper back and her nutritionist/ chiropractor,says it is related to the stomach. I seem to get more confused as time goes by. I have seen my GP, 3 times, a gastroenterologist, a pancreatic specialist, 3 doctors that work for a local medical express, and a orthopedic specialist, all in 3 months. Your explanation is very helpful.
XXXX
Brief Answer:
Unlikely to be Pancreatitis
Detailed Answer:
Hi
Greetings
Alcohol is known to induce Pancreatitis and usually Pancreatitis associated with alcohol intake is chronic Pancreatitis which will definitely be associated with changes in ultrasound .Even if it's acute episode of Pancreatitis which occurs after binge intake of alcohol it should have shown up on MRCP/Ultrasound/Ct scan or there should be some elevation in enzyme especially while you are experiencing pain. Modern practice of medicine is evidence based, when there is no evidence of any pathology either by Radiology or Biochemical investigation it would not be appropriate to nail down Pancreas as the culprit. During an attack of pain , if the radiology work up like Ultrasound and Pancreatic function like Serum Lipase and Amylase are normal it almost rules out Pancreatitis as cause of symptoms.
I prefer Nexium.
As previously advised complete abstinence from alcohol in any form will provide much needed relief.
I agree with the opinion of your Orthopedician. Disc degeneration is quite common at age of 67. The symptom could likely be due to muscular spasm.
Do get back to me if you need any further assistance, will be glad to assist you.
Take care
Best Regards
Dr Deepak
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr XXXXXXX how do I get an H Pylori erradication kit, and are there any consequences in application, because I have gastritis not caused by H Pylori? And, does this mean using antibiotics? Is it also likely to speed up the healing?
XXXX
Brief Answer:
Its combination of Pantoprozole and antibiotic
Detailed Answer:
Hi
Dear Sir,
Long ter solution can only be provided if you could abstain from alcohol completely.
H Pylori kit contains Following which needs to be taken
1. Proton Pump Inhibitor\
2. Amoxicillin( Antibiotic)
3. Metronidazole( Antibiotic)
Commercial kits are available under the brand name of HP Kit, Ulcikit( Depending on the country of your residence). In many cases of H pylori negative gastritis , it has helped. It also promotes early healing of ulcer if present. There are no major side effects with these, 1 kit/day for 10 days is usually recommended.
Wishing you happy and healthy life.
Take Care
Best Regards
Deepak
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr XXXXXXX One more question on the pancreas. A friend of mine has several attacks of panceatitis each month, She had her gall bladder removed years ago and her pain, which is very severe, seems to be located where I am having discomfort, in the right upper quadrant.I also have pain in other areas of the stomach, she does not. Her back pain is always in the same place near the mid back where I have some, but mine is mostly in the upper back. My pain is no where near her's, and my MRI and MRCP, plus blood test show no inflammation. But, I did think that pancreatitis pain was usually in the upper abdomin in the center and not on the right side. She is not sure if it is acute or chronic pancreatitis. I am wanting to rule out my symptoms that could be associated with pancreas disease. Please advise.
Brief Answer:
Pancreatitis has been ruled out
Detailed Answer:
Greetings
Presence of gall stones is one of the cause for Pancreatitis. Her gall bladder would have been removed as that was the causative agent for her Pancreatitis. Irrespective of presence of Pancreatitis, presence of symptomatic Gall stone warrants Surgical intervention.
Every individual is unique, complaints and location of pain is also variable. Pancreatic pain may occur in epigastric (midline) , right hypochondriac , left hypochondriac or even back.
Till date you have done all the necessary investigation to rule out Pancreas as the culprit.
Diagnosis of Pancreatitis requires following
1. Radialogical: MRI is most sensitive and specific
2. Biochemical: Raised enzyme like Serum Lipase and Amylase.
I assume you have got both these set of investigation already done and they are normal.
Acute Pancreatitis is one in which pain is for less than 4 weeks duration.
Do get back to me if you need any further assistance.
Take care
Best Regards
Dr Deepak Kishore
Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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