Severe Abdominal Pain

I'm 37 yrs. old and for the past month I have been having sporadic abdominal pain that is almost unbearable at times. It started one evening with severe bloating, nausea, and vomiting.  After the first emergency room visit, the doctor prescribed Prevacid.  It got worse a few days later and I was prescribed Reglan, Levsin, and Nexium.  I have now had an Ultra-sound, Endoscopy, and Colonoscopy and other than a hiatal hernia that was discovered, everything else looked normal.  However, my white blood cell count was a bit elevated.  I'm still taking the Nexium and the acid reflux is better; however, the severe abdominal cramps are still there; I also feel pain in the middle of my back and my right shoulder.  I'm always fatigued and I have no appetite.  I've been constipated for the entire period. I belch constantly and it hurts right below my breast plate.  Can I rule out things like appendicitis, kidney desease, or gallbladder desease?  Can all of this be caused by the hiatal hernia? Could it be a bad viral infection?  I have not been prescribed any antibiotics.

[Kevin Pho, MD]

Appendicitis needs a CT scan to evaluate.  Kidney disease would also be seen during the CT scan, and can be evaluated with a blood creatinine level.  Gallbladder disease is first evaluated with an ultrasound, and if normal, then a HIDA scan.  The biliary tree of the gallbladder is evaluated with an MRCP or ERCP.

If the endoscopies are negative, the next test to consider would be an abdominal CT scan.

If all the tests are negative, irritable bowel syndrome can then be considered and treated (i.e. increasing fiber in the diet as well as antispasmodic agents).

These options can be discussed with your personal physician.

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.
Medical Weblog:
kevinmd_b

[ratbag]

The pain going through to your back is a classic symptom of gallstones.

[dd2482]

I had your same symptoms.  It was discovered through an upper GI that I had a hiatel hernia and an ulcer.  Apparently the ulcer caused scaring which closed my pylorus, thus causing the vomiting.  I was having severe abdominal pain, nausea, and vomiting.  It went on for almost five months while the doctor was conducting tests.  Once he found the problem, he opened my pylorus and I have not vomited since.  I am still taking the Protonix.  It is the same type of medicine that you are taking. I thought for sure that my hiatel hernia was causing all of the problems.  However, I was wrong.  It's kind of strange.  I was constipated severely the entire time that this was going on.  Your should see a gastrologist and ask for an upper GI.  Anytime you have vomiting, they always say that it is associated with the digestive tract, which is the upper portion. (Even when it feels like your entire stomach is killing you.)  Hope this helps.

[yoshi]

how do you solve your constipation problem??

[momspub]

I have had a stomach problem for the passed year and a half.  I have a lot naseau and burning.  I have it every day and it is worse if I eat anything spicy or fatty.  The doctor put me on protonix and it has helped some.  I have had a dull ache in my right upper quadrant for almost two weeks.  Last Tuesday the dull ache went to severe pain.  I went to the ER and they did an ultrasound and Ct Scan.  I didn't have an appendicitis or gallstones.  All of my bloodwork came back fine.  I was miserable all week.  I also had a slight fever of 100 with lots of cold chills.  I continued to go to the doctor because I as a mom of three don't have time to be this sick.  I needed him to find out what this was.  I also couldn't eat.  As soon as I would eat the pain would come back more severe.  Finally this last Monday he had a HIDA scan done (I have not got the results back yet, but the tech said my gallbladder was doing what it should be doing).  I have felt so bad I wanted them to find something so they could take care of it.  The pain has went back to just a dull pain and I'm back to doing my day-to-day things.  I'm a 36 year old female with diabetes and was just diagnosed with gastroporesis (sp) about two months ago.  My diabetes has been in good control.  My A1C has always been 7 or under.  The doctor was shocked when she found I had gastroporesis because of my good control.  She did the test just to rule it out.  Do you have any suggestions of what other tests should be done? My doctor seems a little done with me, but I want to find out what this pain is.  Can you have a diseased gallbladder without stones that won't show up on a HIDA scan?  Thanks for any information you may offer me.

[momspub]

I have had a stomach problem for the passed year and a half.  I have a lot naseau and burning.  I have it every day and it is worse if I eat anything spicy or fatty.  The doctor put me on protonix and it has helped some.  I have had a dull ache in my right upper quadrant for almost two weeks.  Last Tuesday the dull ache went to severe pain.  I went to the ER and they did an ultrasound and Ct Scan.  I didn't have an appendicitis or gallstones.  All of my bloodwork came back fine.  I was miserable all week.  I also had a slight fever of 100 with lots of cold chills.  I continued to go to the doctor because I as a mom of three don't have time to be this sick.  I needed him to find out what this was.  I also couldn't eat.  As soon as I would eat the pain would come back more severe.  Finally this last Monday he had a HIDA scan done (I have not got the results back yet, but the tech said my gallbladder was doing what it should be doing).  I have felt so bad I wanted them to find something so they could take care of it.  The pain has went back to just a dull pain and I'm back to doing my day-to-day things.  I'm a 36 year old female with diabetes and was just diagnosed with gastroporesis (sp) about two months ago.  My diabetes has been in good control.  My A1C has always been 7 or under.  The doctor was shocked when she found I had gastroporesis because of my good control.  She did the test just to rule it out.  Do you have any suggestions of what other tests should be done? My doctor seems a little done with me, but I want to find out what this pain is.  Can you have a diseased gallbladder without stones that won't show up on a HIDA scan?  Thanks for any information you may offer me.  Just realized I typed all this in the wrong place.  I need to post a question - oops!

[yoshi]

if you want doc to answer your question,you have to start a new post.

[dd2482]

The doctor prescribed a liquid medicine called "Lactulose" three times a day.  It will help, trust me.