Upper Left Quadrent Abdominal pain, Lump

Male, age 40.  5'10", 190lbs.  No past surgery or serious illness. Symptoms began 3 months ago. Bowel movement mixed color (brown mixed with unusually light brown/tan). Sense of pressure under middle of ribs, mild nausea no vomiting. Fatigue/Flu-like feeling, no fever. Pain persists for 2-3 weeks.  BM's continue to be light in color, mucousy, strange shape, texture.
Fatigue/Flu-like feeling retreats. Pain moves to mostly right side radiating to back.
After a week or 2, pain moves to mostly left side, radiating to back. 3 weeks ago that left/right pain subsides, and a swelling/bump appears below lower left rib.  Also, pain between ribs after eating, fading after a period of hours to vague feeling of "weight" in the area.  Throughout the entire experience, point pain is present in joints and other locations. Knees, Armpits, Pectoral area. Under right jaw (small lump) Right armpit-radiating to right bicep/deltoid-sore/numb.  These pains come & go,disappearing from one area to move to the next. Lump under jaw disappeared after a week.

Stool returns to normal brown, still mixed as far as consitancy.  No mucous recently.  Lately I have also noticed almost daily stiffness on both flanks...below ribs/down to pelvis.  Finally, I notice that I get a substantial reflux after eating... burps easily bring stomach contents into mouth.  Lots of gas rumbling in gut. Feeling of a "lump" in throat as well. I take Atenolol for high BP & Nexium as needed for reflux. Nexium does resolve the lump and reflux, but not other pains in upper abdomen. 1 recent bout of extreme dizziness lasting 1min.

CBC 4/12/06-Normal (Routine bp/cholesterol checkup, prior to symptoms.)
CBC 7/10/06-Normal
Upper GI/Barium,Gallbladder Ultrasound-Normal
Stool test for parasites,& Blood test for Hepatitis A/B/C-Negative

CT Scan with & w/o contrast-Negative except for scattered diverticula.
Home test for stool blood-negative. Urine test, Giardia & C Diff, Normal.
Blood Culture tests-no growth. HSV IGM-Negative
Epstein-Barr virus VCA IGM AB - 1.19 (Antibody detected)
CMV IGM Antibody-0.24 (Negative)
Amylase-40,Lipase-19 (Normal)

It seems I've been through a bout with EBV, and that seems to explain some of the point pain and fatigue. I still don't understand what's causing all the abdominal stress I've been going through.  Stools are a better color now but overall not what I consider normal.  The lump below my left rib came up a few weeks after my CT scan. I've since gone for a Spleen ultrasound (they also scanned the lump) Waiting for results.What puzzles me is the variable nature of my symptoms as well as the point pain. What are the gastrointestinal illnesses that can present like this? Could this be Gastritis? Crohns? The pain gets worse after eating and moderate physical activity,lawn mowing, etc. Does the negative CT rule out pancreatic cancer? What other tests should I push for?  What organs may be involved given the location of the "bump"?

[Kevin Pho, MD]

To answer your questions:
1) Many possible causes.  Can include various causes of dyspepsia (GERD, ulcers, inflammation), inflammatory bowel disease, malabsorption, celiac disease, irritable bowel syndrome etc.

2) Atypically, you want to exclude heart causes with its relation to exertion.  A stress test can be considered.

3) Pancreatic cancer can be seen on CT scan.  If suspected, endoscopic ultrasound or MRI are more sensitive tests.

4) I would consider an upper endoscopy to more thoroughly look at the upper GI tract as well as a colonoscopy to evaluat ethe lower GI tract.  A blood test for celiac disease can be considered.  

5) Regarding the bump - the spleen or soft tissue masses can be felt on physical exam.

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.
kevinmd_

[Active8]

Update: I had a followup with my GI today.  Spleen ultrasound showed an organ at the upper end of normal size range.  No unusual masses.  Given my post-meal pain of late, the doctor recommended an endoscopy, and I agreed.  The test is scheduled for 2 weeks from today...I'll post an update here if the thread is still open at that time.  Thanks for the input, Doctor Kevin...

[Active8]

Update 2: Endoscopy showed indications of Barrett's.  Biopsys were taken and now I await the results of those.

I doubt Barretts is the core cause of my symptoms... too many other things going on.  Barretts doesn't explain the lump below my left rib, the abnormal stools or the other aches and pains.  I suspect a colonoscopy is next.

[georgie439]

Just wanted you to know I have very similiar symptoms, actually all that you have except I can not feel a lump!!  I was also worried about cancer but I did have the cat scan, the mrcp and the EUS which is the endoscopic ultrasound, they look at the pancrea thru the stomach, like an internal sonogram.  
I also had the blood work and the endoscope. I have to go for the colonoscopy and then if that doesn't show anything I will look into that new tiny camera that looks at your small intestines.  Good luck, Please post if you get answers...georgie

[cocolici]

i'm 27 yr old female, and my problems started about 3 months ago. Innitialy I had lower abdominal pain(dull), and sometimes a burning sensation. I had an ultrasound, which did not reveal anything abnormal( like ovarian cysts, or kidney stones). no urinary infection either. After eating sushi one night (about a month later), i had severe diarrhea accompanied by severe abdominal cramps. I noticed blood in my stool. The next day i went to the ER, where they did some blood tests and took stool samples. Nothing abnormal. I was having cramps every day since then, diarrheea on and off, felt nauseated and vomited. I started loosing weight( from 110 to 102 lbs), i lost my apetite. I saw a GE twice, he presumed i had an infection or IBS. He didn't prescribe any treatment. Shortly after, i began having lower back and flank pain, especially in the left side. Also joint pain. Over the last month i had unusually loud rumbling in my intestines and stomach(sometimes even in the left side flank/back). Sounds like boiling and bubbling. I've kept a strict diet all along(gluten and lactose free, a lot of rice, baked potatoes, fish and white meat, vitamins). Still, the symptoms haven't gone away. I had a 2nd ultrasound done, and made sure nothing was wrong with my liver, kidneys, gallbladder. Recently my stomach started to ache too, i have acid reflux, and intestinal/stomach rumbling kicks in minutes after eating. I had been diagnosed with duodenal gastritis 3 yrs ago(barium), which stopped bothering me soon after. For a while my stools were constantly yellowish but now dark green. No traces of blood lately. I've been tested for parasites, bacteria, H Pylori, etc, everything came back negative. I'm scheduled for a colonoscopy 1.5 months from now. I'm mostly concerned about the left side pain, and constantly upset intestines/stomach. One other problem is being unable to pass gas despite the cramps.

[Seija]

Another case here with upper left quadrent abdominal pain. Iam a 40 year old female. My problems started 2 years ago after being in Africa for 2 years. While in Africa I had had some typical stomach problems related to that part of the world - most of them food related, but no pain and not consistent. What I have had for the last 2 years is dull ache and feeling of fullness or heaviness in this one specific part after meals and a lumb (that I felt especially in the mornings while still laying down - if I pressed it it moved and disappeared). I went to a specialist (at that time I was in Sweden) and I had CT scan done of pancreas, spleen, liver, gallbladder, kidneys and nothing abnormal was found. I also had gastroscopic examination done and everything looked normal except some minor redness. All blood tests were normal and stool sample (one of many) again showed nothing abnormal.
Year after the test I found a live parasite in my stool (round worm - ascariasis - adult size). I got Vermox medication for that. The lump disappeared after the treatment. I have done colon hydrotherapy later to cleanse my colon. There was indication of candida overgrowth in my colon (often go parallel with parasites) Now two years from the first symptoms I still have problems in the same spot in my stomach and fullness after meals and sometimes ache. Also, perhaps once or twice a month when bending forward I get this very painful cramp in this area and this spot gets extremely hard and painful for a minute or so.  I have not done colonoscopi but now I am planning on doing new round with specialist since these symptoms do not seem to leave me. There is also possibility that in my case the parasites have not left me yet, their eggs or themselves seldom show in tests. I had at least 6 tests done and none of them showed that I had parasites which I obviously did since it takes some time for the worms to get adult size... Let me now if there is anything new in your case.

[healtheworldrn]

I am 39 y/o female that has been experiencing left flank pain for two weeks. UA results that was done was negative. I was treated with three days of Bactrim and given Lotab 5mg Q 4hours for pain. I went to ER five days ago for increased pain. ER performed KUB, IVP, UA, CBC, BMP, and CT, all that came back normal. I was given percoct 5mg, 1-2 Q 4hours for pain. I am still experiencing the left flank pain that seems to intensify prior to going to void. I was advised by ER Dr. to f/u with urologist. This pain is sharp at times with a burning sensation. I have not had a fever, but experienced nausea and elevated B/P with the pain. Please help!

[tweety1962]

A related discussion, hard lump inside center to lower left rib was started.

[farhatkayani]

A related discussion, Upper left side pain just below ribs, occassionally sharp pain between ribs for a few minutes was started.