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What Causes Pain In Lower Abdomen And Nausea After Eating Food?

Posted on Mon, 31 Aug 2015

Question: For about a month, the patient has occasionally mild to moderate pain in the right lower abdomen, Has vomiting tendency after eating, feels overloaded after intaking half or one third of the normal amount of food which she used to take before, thus cannot eat much and gets low pressure, feels dizzy. had to put on saline few times....Moreover, for one and a half month, while standing up suddenly from sitting position,or rising stairs quickly feels something bulky lump of mass pushing inside the belly with slight pain. Pregnancy test done recently is negative.

PATIENT DETAILS
Gender : female
Age-28
Weight-42kg
Height-5’2”
Country : XXXXXXX
Status : married and has a 1 year old boy
Creatinine-0.9 mg/dl
Urea- 29mg/dl
Generally has low pressure,
Menstruation cycle normal for the last 4 months (April –Jul 2015)
She does not smoke or drink

TEST RESULTS

1> 25July15 -USG report :
Bulky Uterus(size-109x38x54mm)
Endometrium is normal
Left Hydronephroureter
Dilated Renal Calyces(left)
Dilated ureter(left)
Right Kidney-10.9cm
Left Kidney-10.8cm
Right ovary-21.5x25.4 mm Left ovary-24.1x29.8

2> 8July15- CTKUB Scan with contrast
Gross Hydronephrosis
Possible obstruction at PUJ
both kidney shows normal excretion of contrast

3> 6Aug15- DTPA test

Right kidney appears to be functioning normally; there is no e./o. renal outlet-obstruction on
this side.
The left kidney appears to have overall good function; slower renal drainage is noted on this
side (outlet-obstruction is not conspicuous).

PREVIOUS HISTORY
4March2014- Cesarean Delivery

11Sep2014- MTP(6 weeks of pregnancy)

14Oct2014 - Excessive Bleeding (2-4 L
Diagnosis-incomplete abortion on 11 sep
DE operation done again on14 Oct

22Oct 2014- USG Report
Endometrial Hypertrophy
Endometrial Thickness-14.4mm
Uterus Size-100x61x46 mm
Right Ovary-27x24 mm
Left Ovary-31x26 mm

24 Feb2015- USG Report
Bulky Uterus in Anteverted Position
Mild Left Sided Hydronephrosis
Bilateral Polycystic Ovaries
Endometrial Thickness-6mm
Uterus Size-88x51x40mm
Right Ovary-26x32x36 mm
Left Ovary-26x31x43 mm

MEDICINES TAKEN
30 oct14 onwards for 20 days
Tab modus(10mg)-1 tab twice daily x20 days
oval g-1 tab daily x20 days
16Nov14 onwards for 18 days
Loette-1tab daily x18 days
From 12 Dec14 –Jan15
Tab Oval G-1tab dailyx20 days
Tab Primolut N 1tab daily x20 days
From Feb2015-July15
no medicine
menstruation cycle normal with normal bleeding

Please let us know the possible reason for her condition and what should be done for cure.

Answered by Dr. Manisha Jain (30 minutes later)

Brief Answer:
Chronic pelvic infection

Detailed Answer:
Hello sur, thanks for trusting health care magic.
It seems like post cesarean adhesive band formation causing mild to moderate obstruction of ureter as well as intestines.
This clinical picture is typical of adhesive bands and thus needs to be evaluated jn that direction.
Discuss its possibility with your doctor.
Another possibility is of mild grade pelvic infection after abortion and thus causing chronic lower abdominal pain and all other symptoms.
For infection most common treatment is Doxycycline and metronidazole treatment for at least 14 days along with anti inflammatory drugs for same time.
Try this simple treatment first and discuss with your doctor and in case you have any other questions please feel free to ask.
Regards
Dr Manisha

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Manisha Jain (2 days later)

What tests should be done to confirm that there is either adhesive
band formation or mild grade pelvic infection
?
Also, what specialist should be seen to confirm
either ?
Please provide the details of dosage for each medicine (
Doxycycline and metronidazole as well as anti inflammatory
drugs) including how many times times to be taken in a day, in what dosage, before/after meals. Also, provide name of the anti-inflammatory drugs. The patient has low pressure 50-90. In that case, is it safe to take these drugs ?

Answered by Dr. Manisha Jain (14 hours later)

Brief Answer:
Treat pelvic infection first

Detailed Answer:
Adhesion bands are a diagnosis of exclusion.
So patient is first treated for pelvic infection and in case symptoms don't subside even after full course of antibiotics then only adhesion bands can be suspected.
Bands can only be diagnosed on CT scan and that too by a good experienced radiologist.
Antibiotics are prescription drugs so will be available only on prescription and are given twice a day with meals for at least 14 days for complete cure so visit a gynecologist for examination and prescription.
Low blood pressure is not a problem but still ask her to keep her fluid and salt intake on higher side and avoid hot and humid climate.
Anti inflammatory drugs include diclofenac and ibuprofen and if given along with antibiotics ensure better cure.
All the best.

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Above answer was peer-reviewed by : Dr. Neel Kudchadkar