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Gastroenterology (Expert Forum)
In desperate need of an answer... seems I am always diagnosed with nothing!
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
In desperate need of an answer... seems I am always diagnosed with nothing!
by Pat767, Dec 13, 2005 12:00AM
I've been having pains for the past 3 years and it was only until 2 years ago that I started consulting doctors.
I am a 26 year old male, 140 lbs, 5'9.
Symptoms:
Extreme discomfort (I could call it pain) in the lower right quadrant. When I feel this pain, and I push hard (down) where it hurts, there is like air/liquid moving around at that place and causes sounds. If I push down move my hand back and forth on it, I can almost play a tune because of the sound. At the same time as I am pushing, I feel other discomforts throughout the colon. Sometimes, the same type of pain is felt on the lower left side. This discomfort can easily last up to an hour. What could this be?
Another strange thing is that once every few months, and God do I hate those episodes, I get a cramp in the lower abdomen. It can be left, center or right side. It's maybe 2 inches below the navel. This cramp is so bad I need to bed over and stay like that for a couple of hours. I lie down on my side (on the couch) until it passes. At that point you can see my lower abdominal muscles are contracted and won't uncontract until the cramp passes.
Other fact: I am extremely gassy, I would say more than the average person. I am aware that the human body generates a lot of gas, more than one would imagine, but this is terrible. At times, it is extremely foul smelling too.
Also, recently I noticed pain (only when I push down)on my right side. The position is roughly 2 inches right of my belly button and maybe half an inch down. Would this be in the small bowel? Sometimes I notice this pain even without pushing down on it.
Another recent fact: stabbing pain maybe 1/2 inch below left bottom rib. I teld to hold my breath for a second or two and it goes away. Happens once every 2-3 weeks only.
Tests done:
Barium meal, 2 years ago: negative
Barium enema, 2 years ago: negative
Complete blood series: negative
Lactose / sugar intolerance: negative
Endoscopy of the stomach + biopsy: negative
X-Rays and Ultrasound: Negative, except for noticing I have an slightly enlarged spleen. Appendicitis ruled out.
DIAGNOSIS: IBS (although I'm not sure that is the case).
I rarely get diahrrea (once every 2 months) and am not that constipated.
Treated with Dicetel : doesn't help.
Recently, since i am now living in Mexico temporarily, I consulted a Mexican doctor. After touching my abdomen for a few minutes: his diagnosis: colonitis... gave me some antibiotics (Trimetoprime 80mg with Sulfametoxazol 400mg) along with Buscopan. No change since taking the antibiotics, but I think the Buscopan helps at times, yet I am unsure if it's really helping.
Any thoughts, as I am desperate.
Could there be any change since the barium enema? How long are the results for the BE good for? Would it be necessary to get a colonoscopy? I am really afraid of leaving this alone and eventually end up with a deadly disease. Don't want cancer. Is this really IBS?
Thanks
Patrick
I am a 26 year old male, 140 lbs, 5'9.
Symptoms:
Extreme discomfort (I could call it pain) in the lower right quadrant. When I feel this pain, and I push hard (down) where it hurts, there is like air/liquid moving around at that place and causes sounds. If I push down move my hand back and forth on it, I can almost play a tune because of the sound. At the same time as I am pushing, I feel other discomforts throughout the colon. Sometimes, the same type of pain is felt on the lower left side. This discomfort can easily last up to an hour. What could this be?
Another strange thing is that once every few months, and God do I hate those episodes, I get a cramp in the lower abdomen. It can be left, center or right side. It's maybe 2 inches below the navel. This cramp is so bad I need to bed over and stay like that for a couple of hours. I lie down on my side (on the couch) until it passes. At that point you can see my lower abdominal muscles are contracted and won't uncontract until the cramp passes.
Other fact: I am extremely gassy, I would say more than the average person. I am aware that the human body generates a lot of gas, more than one would imagine, but this is terrible. At times, it is extremely foul smelling too.
Also, recently I noticed pain (only when I push down)on my right side. The position is roughly 2 inches right of my belly button and maybe half an inch down. Would this be in the small bowel? Sometimes I notice this pain even without pushing down on it.
Another recent fact: stabbing pain maybe 1/2 inch below left bottom rib. I teld to hold my breath for a second or two and it goes away. Happens once every 2-3 weeks only.
Tests done:
Barium meal, 2 years ago: negative
Barium enema, 2 years ago: negative
Complete blood series: negative
Lactose / sugar intolerance: negative
Endoscopy of the stomach + biopsy: negative
X-Rays and Ultrasound: Negative, except for noticing I have an slightly enlarged spleen. Appendicitis ruled out.
DIAGNOSIS: IBS (although I'm not sure that is the case).
I rarely get diahrrea (once every 2 months) and am not that constipated.
Treated with Dicetel : doesn't help.
Recently, since i am now living in Mexico temporarily, I consulted a Mexican doctor. After touching my abdomen for a few minutes: his diagnosis: colonitis... gave me some antibiotics (Trimetoprime 80mg with Sulfametoxazol 400mg) along with Buscopan. No change since taking the antibiotics, but I think the Buscopan helps at times, yet I am unsure if it's really helping.
Any thoughts, as I am desperate.
Could there be any change since the barium enema? How long are the results for the BE good for? Would it be necessary to get a colonoscopy? I am really afraid of leaving this alone and eventually end up with a deadly disease. Don't want cancer. Is this really IBS?
Thanks
Patrick
Doctor's Answer
by Kevin Pho, MD, Dec 13, 2005 12:00AM
, Dec 13, 2005 12:00AM
I would consider an endoscopy at this point. Right lower quadrant pain can be caused by IBS, inflammatory bowel disease (more likely Crohn's disease) as well as appendicitis. You state that appendicitis has been ruled out.
A colonoscopy would be a good idea. Endoscopy is generally more comprehensive than a barium study. You can also consider imaging the terminal small bowel (sometimes not seen well on upper endoscopy) with a capsule endoscopy or small-bowel follow-through.
These options can be discussed with your gastroenterologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
A colonoscopy would be a good idea. Endoscopy is generally more comprehensive than a barium study. You can also consider imaging the terminal small bowel (sometimes not seen well on upper endoscopy) with a capsule endoscopy or small-bowel follow-through.
These options can be discussed with your gastroenterologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
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They would sometimes be mild - I would dismiss these as gas pains.
Every once in a while, though, they would become crippling. These would typically last for one or two days. Each time this happened, I would go to the ER and be diagnosed with any number of minor GI maladies (gastritis, colitis, gas pains, constipation, a stomach bug... even a pulled abdominal muscle!).
Each time, I would be given the requisite prescription for a stool softener, painkiller, or antibiotic and sent on my merry way.
Well after two years of this (during which time I went through maybe 6 or 7 of these severe episodes) I went to a different ER - one of the best in my area.
They performed a CT scan and immediately diagnosed my problem as appendicitis. My appendix was removed a short time later, and I haven't had any pains since!
The surgeon who removed my appendix said that it was "chronically inflamed." He said that while most cases of appendicitis come on acutely, there are a few that fester chronically the way mine did... He said it was rare, but he'd seen it a few other times...
I suggest you ask for a CT scan with this in mind!
You might also consider the Prometheus First Step (IBD) test.