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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes upper left abdominal pain below ribs?

Answered by
Dr.
Dr. Muhammad Hanif

General & Family Physician

Practicing since :2009

Answered : 2369 Questions

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Posted on Mon, 6 Jun 2016 in Digestion and Bowels
Question: My husband is having pain in the upper left abdomen just below his ribs, he has been running a low grade fever for over a month. 1 day after blood tests from our GP he was in a motorcycle,auto accident where he flew off his bike, bounced off the roof of a car and landed on the asphalt 3/3/16. He was taken to emergency and released mid day. Amazingly he had no severe symptoms, broken bones, just a couple cuts and bruises and very sore. He had MRIs and Cat scans of all the potential injury areas, head, knee, right hand. He has had gout his whole life and the trauma caused him to get it in his left foot and knee agravating the pain, making walking without crutches almost impossible. He has seen a specialist for the knee who drained fluid and injected cortizone this week. He also started a blood pressure medicine in march due to high blood pressure flagged at the dentist. 200/90 a little over a month ago. I took him to emergency because it was a Friday night and he took a blood pressure medication. the GP started him on a blood pressure med that started severe diarrhea which has yet to stop. He switched 2 weeks later to Amlodipiine 10 mg but has had a low grade fever and severe diarrhia , cramping and blood in stools and urine showed up on the blood tests. He had been diagnosed with Crohn's and or ulcerative colitus after a heart attack in 2005 in which they gave him a stent. He had a nervous breakdown in 2013, probably due to all the medications he was taking for the Crohns including pentasa, humira, hydrocodone and ambien because he couldn't sleep. He attempted suicide with an overdose of ambient and they flushed him in the ambulance and hospital with charcoal. After that incident he got off all meds except indomethacin for gout for 3 years and had no crohns symptoms. He is 66 years old on monday and had no history of Crohns in his younger years. The GP sent him for a prostrate biopsy with ciproflaxin taken for 3 days which aggravated all the GI symptoms even more and gave him a steroid pack which temporarily helped the knee and just prescribed cholestyramine 4g, and antibiotics which he stopped this week because he now has acid reflux at night and pain in his upper left abdomen. My guess from researching is his body is toxic due to all these medications and that either the blood pressure medicines or the indomethacin is inflaming his intestines. In the back of my mind I am worried maybe they missed an internal injury to his spleen or pancreas? Not sure what Dr. to send him to next, heart doctor for questions about the blood pressure medications or a gastroenterologist for the stomache symptoms.
thank you, we do not seem to have access to really caring and thorough Drs here in Las Vegas NV, it is very frustrating. I have the blood test results I could send also. The biopsy came out negative for Cancer- his prostrate level was only 6.
doctor
Answered by Dr. Muhammad Hanif 6 hours later
Brief Answer:
Best next step is to go for a Gastroenterologist consultation !!!

Detailed Answer:
I welcome you here at HCM and giving the due regards to your consultation I have carefully gone through your husband's case. I feel proud to answer the query you raised here about the next best step to take in all of these circumstances.

No, this isn't a case in which they can miss an internal hemorrhage due to injury to spleen and pancreas. They must have done and you have elaborated all the diagnostics needed when your husband was in the ER. If there had been an internal bleed or milder injury, they never had discharged him from the ER without addressing the issue. Actually in case of road traffic accidents, after establishing the vital signs of patient, we first of all go for internal bleeds from such vital organs.

His prostrate seems to be OK according to the details given. It is better he got tested as this is mandatory at this age for every male. Nice to hear his biopsy showed no cancer as PSA levels above 4 ng/mL usually need a biopsy.

His knee has been treated very well and after the steroid injection it will stay pain free for some more time. He should take the gout medications according to prescription as this is needed for his other painful joints.

He seems to be having an ulcer of the upper gastrointestinal tract. Mostly it is in the area of stomach and duodenum and is named as the Peptic Ulcer Disease. In such a situation, it is highly recommended to go for a thorough evaluation by a Gastroenterologist as he is the personnel to treat such issues successfully. He will go for a thorough physical examination and will run a battery of tests on your husband including the Esophagogastroduodenoscopy that simply is the test in which we see the inner tract by passing a camera inside the stomach. This will show up all the issues related to his digestive system. Management goes accordingly.
He will also go for a stomach screening test for h.pylori bacterial infection that is curable through medications if present.
Blood pressure medications are needed to be carried on as prescribed and on the next visit to his GP (PCP) his medications can be reviewed according to the latest scenario.

Please feel free to contact me anytime for further assistance. For future reference my dirrect link is: www.tinyurl.com/drhanifmd

Regards!
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Muhammad Hanif 3 hours later
Thank you, it takes weeks to get appointments here especially if you are a new patient. do you have any advice about the diarrhea, can he take over the counter meds for that or will it just aggravate the situation? I am not sure our insurance will cover the camera procedure are there alternative ways to diagnose?
doctor
Answered by Dr. Muhammad Hanif 2 hours later
Brief Answer:
Diarrhea is medication induced caused mostly by the antibiotics!!!

Detailed Answer:
Welcome back and thanks for putting up a follow up query here at my health portal HCM. Your trust in our services make us do even better for the patients.

Yes, on the basis of physical examination and clinical evaluation based on other than camera assisted diagnostic tests, his Physician can reach to a diagnosis I guess. So, it is good to at least have an office visit of a GI Doctor.

Yes, for diarrhea, one important point is medications have caused much of his diarrhea and associated symptoms. Stopping antibiotics and taking IMODIUM MULTI SYMPTOM RELIEF chewable mint flavored tablets (2 tablets right now and then 1 tablet after every loose stool--not to exceed 4 tablets in 24 hours). Plus:
Take Oral Rehydration Solution like PEDIALYTE to replenish fluid and electrolytes that deplete due to diarrhea and are a major cause for weakness and a lot more symptoms including cramps in muscles. Plus:
CITRUCEL DIETARY FIBER SUPPLEMENT is to be taken for better relief.

He should try once if his insurance covers all the GI Physician diagnostics. Don't assume if they will cover or not. Sometimes, it goes through and they cover even the unexpected ones.

Please feel free to ask for any future health concerns by clicking my direct link tinyurl.com/drhanifmd
If satisfied here, please don't forget to click on Close the discussion and add your valuable feedback too. Prays for the best times ahead for your family.

Regards!
Dr. Hanif
Above answer was peer-reviewed by : Dr. Prasad
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