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Dr. Andrew Rynne

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What causes upper abdominal pain, constipation, appetite loss and stress?

Answered by
Dr. Ramesh Kumar


Practicing since :1986

Answered : 1940 Questions

Posted on Fri, 25 May 2018 in Digestion and Bowels
Question: upper abdominal pain that lasts for almost 2 weeks. Abdominal ultrasound came back normal. Constipation; lost appetite, stressed out; indigestion.

I am worried about having pancreatic cancer. My doctor won't order MRI. I have mh blood drawn today and painfully (both physically and psychologically) waiting for the results

Question is: if pancreatic cancer causes pain, will it show up on abdominal ultrasound?
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Modt likely its due to constipation.

Detailed Answer:
Hello my dear patient,
Thanks for choosing HealthcareMagic for your query,
Have seen your details and i appreciate your concerns.

Abdominal ultrasound is not a very good test to diagnose aur detect pancreatic cancer and usually misses it(especially in initial stages).
Usually a CT scan should be done if we are looking specifically for pancreatic cancer.Plain ultrasound abdomen is not very accurate in diagnosis of pancreatic cancer.At least endoscopic ultrasound should be done if a CT is not suggested.

Pancreatic or any other cancer can cause pain in body however this cancer often tends to cause symptoms such as weight loss, jaundice dark urine, light stool color, itching, nausea, vomiting,back pain, and enlarged lymph nodes in the neck,These symptoms are usually much more common then upper abdominal pain in patients presenting with pancreatic cancer.

Though not asked yet i feel that constipation is the cause of your problem.Constipation causes food to stagnate and ferment which causes inflammation in that area of gut causing pain.
I think you should start a laxative and see if pain responds to it.

Hope i was helpful,
Feel free to follow up my dear,
Above answer was peer-reviewed by : Dr. Nagamani Ng
Follow up: Dr. Ramesh Kumar 54 minutes later
Let me sum up my symptoms in a more systematic way. Two weeks ago, I started having the upper abdominal pain. The first 2 days, I have diarrhea. Since then, I don't have the urge for bowel movements as usual. The pain usually happens around 6pm, but it could happen any time of the day. I don't feel hungry due to indigestion. My doctor did not think I have PC and therefore won't subscribe an MRI I requested. He said ultrasound is already overkill. He seems to rely only on the blood test (full chemistry plus the CA-19 test). He thinks I have acid reflux and prescribed Pepcid. A second doctor thinks it was IBS and gave me Bentyl (for the pain) and Collace for constipation.

Do you think I should have an MRI done? (I don't want CT due to radiation). If yes, should it be MRI with contrast?

One more question: is Endoscopic Ultrasound more or less expensive than MRI/CT?
Answered by Dr. Ramesh Kumar 9 hours later
Brief Answer:
I don’t feel that all these tests are required with such a small history.

Detailed Answer:
Hello again dear,
I dont feel that you need to have a MRI or CT scan rather a stool microscopic test should be done to see infection in stool.
Your symptoms are just 14 days old and i don’t think we need to jump on IBS etc rather it can be Gastroenteritis which means inflammation of gut wall of intestines as a result of infection by virus or bacteria or protozoa.
I would suggest you to go for few tests

Stool test under microscope
Complete blood count
Total and differential leucocyte count.

If stool test is positive for bacterial or protozoal infection.Start taking Zithromax(Azithromycin 500 mg once daily) and secnidazole 1 gram daily for 5 days.
Along with it take Fybrogel husk,It will increase the bulk of your stools.
We should follow the protocol of investigations and i don’t feel that a MRI or CT or Endoscopic USG is required right now.

Above answer was peer-reviewed by : Dr. Raju A.T
Follow up: Dr. Ramesh Kumar 5 hours later
thank you so much for detailed answers/suggestions which really help me a great deal. Please do not get offended as I am asking you lots of questions because my anxiety of pancreatic cancer is torturing me.

1. Since pancreatic cancer is usually detected when its too late, why don't doctors (or the protocol) go in the opposite direction by ordering Endoscopic Ultrasound/MRI/CT first to rule out then go for viral/bacterial infection tests?

2. If my pain is caused by infection, should I have fever as well?

3. Does infection/inflamation cause constant pain or just a few hours a day?

Thank you again for your kind responses.
Answered by Dr. Ramesh Kumar 10 hours later
Brief Answer:
Follow up answer.

Detailed Answer:
3)Infection /inflammation is usually associated with constant pain.As there is swelling in that area so when ever there would be a wave of moment in intestine or gut there would be pain.
So most of the times its constant.

2)Its not necessary that every patient with infection always have fever.Fever can be a sign of infection however its never necessary that its there in every patient.

3)Ruing out infection would take a day.You just need to submit a stool specimen and you have the reports in few hours with you.As per protocol is concerned i can very well appreciate that you are haunted by pancreatic cancer thought but if you are in place of doctors apart from pancreatic cancer there are number of pathologies in gut which can present with same symptoms.
Therefore order of assessment of patient is common thing first.
Feel free to follow up its a pleasure to help you.
Above answer was peer-reviewed by : Dr. Kampana

The User accepted the expert's answer

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