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Why do I have abdominal pain and fatigue?

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Internal Medicine Specialist
Practicing since : 2007
Answered : 362 Questions
Female, 49 years old. 11/29/10 went to doctor with symptoms of appendicitis. Blood work showed WBC 18.6%, Neutrophils 86.4%, Lymphocytes 8.2% Neutrophil Absolute 16.1%. Results of a CAT scan showed that the appendix had begun to “harden.” At this point I made the choice to treat with an antibiotic—blood work on 12/1/10 showed all levels within normal range. The test for pancreatitis was negative.
1/3/11 following doctor’s direction, went straight to the ER with symptoms of appendicitis. CAT scan and blood work showed everything to be within normal ranges. The ER doctors said if I had come to the ER on 11/29 he would have removed my appendix.
The CAT scan done on 11/29/10 showed a small kidney stone in my left kidney and a small cyst on my right ovary.
Pap smear on 7/8/11 resulted with a diagnosis of ASCUS. I feel like a train wreck—haven’t felt like myself since the beginning of November 2010. Very tired, low energy, and have constant “feeling” on my right side level with my bellybutton. This feeling is about a 1 or 2 on the pain scale most of the time, but occasionally gets to a 3 or 4. Every time I bend over I feel like I have been pinched on this spot.
I appreciate your input. While I feel my family physician, who I will see in two days, has been a good care giver. I feel that I need to say more than “I just know something isn’t right.”
Posted Sat, 28 Apr 2012 in Abdominal Pain
Answered by Dr. Kiran Kumar 55 minutes later

Thanks for posting your query.

You have two issues.

1. PAP Smear - suggestive of ASCUS
An ASCUS pap smear result is considered to be mildly abnormal. This is the most common type of abnormal Pap smear. ASCUS stands for Atypical Cells of Undetermined Significance, and basically means there were mild cellular changes and the the cause in unknown. The first step in managing an ASCUS Pap smear is to repeat the Pap test. Many times a slight infection or cervical inflammation may causes a Pap to come back as ASCUS. The Pap may be repeated immediately or within 4-6 months. A course of antibiotics might be required.

2. Pain Abdomen - Right side
Your initial presentation was suggestive of appendicitis. however, subsequent CAT scan have been normal. This suggest some other etiology for your pain abdomen. Appendicitis can some times resolve only to come later after few months. So watch out for severe painif it recur, it can still be appendicitis.

However, the constant ache which you have is likely due to other causes. CAT scan did not reveal anything which can be attributed to your pain. Some patients can have muscular pain over abdomen which can present like this. Others some times have involvement of the large bowel (Ascending Colon) which can cause pain in this reion. If your symptoms persist, consider getting an endscopy to evaluate the GI tract.

Hope this answers your query. Please get back if you need any further information

Thanks and Regards

Dr Kiran
Above answer was peer-reviewed by
Follow-up: Why do I have abdominal pain and fatigue? 28 minutes later
Is it possible that these issues could all be related? After two rounds of antibiotics since 11/2010, which prior to this I hadn't had antibiotics since 1994, I would have hoped I would not be feeling poorly.

When you say if my symptoms persist how long should I wait to see if these symptoms will resolve themselves?
Answered by Dr. Kiran Kumar 5 hours later

Its not possible for your pain abdomen and your PAP Smear abnormality to be related. The PAP smear abnormality will in almost all patients be asymptomatic.

You definitely need evaluation for your pain abdomen. Its not a urgency. However, is a necessity. So, you can consider evaluation if you do not feel fine a week or two weeks time.

Mean while consider taking some medications such as Proton Pump Inhibitors (Pantoprazole) and Antispasmodics (Buscopan).

Hope this answers your query.

Take care

Dr Kiran
Above answer was peer-reviewed by
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