Digestive Disorders / Gastroenterology Expert Forum
unexplained abdominal pain
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unexplained abdominal pain

hi doctor,
i am nineteen and  have been having for 2 months/(going into its 10th week) now unexplained pain in my right side of my stomach uner the rib cage.the pain came out of no where and started one day. the pain is constant and all day. when the attacks come which i never know when to expect them they come with a vengence and go through to my back not around only through.the pain can be so bad that it will cause me to fall to the floor or pull over if i am driving. sometimes they hit into the middle of my stomach and then go through the back.
I have gotten a cat scan of the abdominal and pelvic and an upper endoscopy, which they also took biopsys which came back clear, and thorough blood work and every thing thank g-d came out negative, i got a pelvic and abdominal ultra sound and they came back clean but the pain is endless and using all my energy. the docotor put me on prevacid thinking it was ulcears, but that didnt help so after aroun a month they told me to stop taking it.the doctors then put me on lefsin for stomach spasms the lefsin only help for 20ish min. along with the pain comes symptoms of naseau, car sickness which i never had before, loss of appetite and los of weight, extra saliva that i always have to spit out and not being able to anymore sleep through the night anymore.when i get an examination from the doctor he presses down in the spot where it hurts and he hits the back where the pain comes though and if he pushes to hard then i do wince or scream with pain. i do not take pills so the doctor does have a limited window of what he can give me to try. I NEVER drank or smoked a day in my life. this past week the doctor gave me a breathe test to see if i have an overgrowth of bacteria but the tests are almost certain negative just waiting for the doctor to call me and confirm. I just want the pain to go away and not to come back.
is there any advice of what this maybe? any help will be appreciated
thank you in advance
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I agree with the workup thus far, and it has been comprehensive.  

Pain in that area can be indicative of gallbladder or liver disease.  The CT scan is a reasonable initial test, but further imaging can be done with a HIDA scan with CCK stimulation.  This can evaluate the gallbladder ejection fraction.  If low, this can be a cause for the symptoms.

More specialized tests can be obtained as well if the diagnosis is elusive.  This can include a 24-hr pH study or gastric emptying scan to definitive rule out GERD and gastroparesis respectively.  

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 patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com
10 Comments
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Avatar_f_tn
by the way how long (app.) does it take for the doctor to answer?
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Avatar_f_tn
i was also tested for crohns disease and ibd and they both came out negative.
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Avatar_f_tn
thank you so much taking the time to try to figure out what is wrong with my stomach. in the near future they are going to give me the emptying stomach test and the doctor told me that when i have an attack i should get the HIDA exam done. he doesnt think it is my gaullbladder but to rule it out doesnt hurt either.
i have 2 new symptoms that are a bit alarming and i dont know if it is on top of the stomach problem or combined within. i started to vomit (only once but it scared me) and i have major nasuea with it and alot of diarea (diarrhea) i do not know if there is a bug going around that i caught or if its another bizarre symtom to add to.
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Avatar_f_tn
they ruled out gerd by putting me on prevacid for a month and the symtoms (symptoms) didnt get better. and the pain was still there and as intense as before
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Avatar_n_tn
Thank you for your post. I have almost the same thing but on the upper left, not right side, under the rib cage.The pain is dominating my life and I feel for you, so young and suffering.

I have had lots of pain since July 07 and all the 'standard GI' tests are negative. I am going to have some heart testing int he near future. I hope I get an answer soon.

Thank you also Dr. Pho for taking the time to post suggestions on line.
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Avatar_n_tn
. You might try doing research on Intestinal Dysmotility.or Digestive motility diseases...  I have had debilitating nauz for over year now and get almost pass out pain attacks that are under my left lowest rib and happens soon after eating ==  Levsin barely helps, but my hubby found me a big cup with handle I used to push on the spot that hurts while applying heating pad, doing both slows the contractions.  I normally have constipation but will swing to BigD, sometimes even within one BM sitting. I barely eat anything anymore beyond saltines, cereal, bread or dry (cooked) pasta, but managing to not loose weight as 7up and Gaterade help get the calories in. My situation has gotten so bad,  I can't work, lost most friendships, and missing special family events.  I'm a hostage to my body, so I understand how bad you feel.  But read on...

A weird thing is I had same problem 6 years ago where they did all the tests and decided it could be my gallbladder causing it even tho ultrsound didn't show stones. But got 2nd surgeon opinion who agreed it was worth a try, from whom I'm now guessing was my doc's golf buddy (the pathology showed it was healthy). Anyway, it went on for about another 2 years of all that nauz & pain. Then oddly it slowly went away on its own.  We only assumed it had to be allergic to some environmental mold we had on a place we rented, and had since moved.  Four years of occasional pain if constipated but could resolve with Collace, and normal nausea when stressed, etc.  

However, I hurt my back (2 herniatied disks during a biz trip) and soon after got into the cycle of muscle relaxers, pain relievers, and few others, and slowed down my activity, and sometimes complete bed-potato during the recovery time after the corizone injection treatments. Within 5 months, all that same nausea and side pain started up, getting worse and worse each week to where I now live in bed most days. I keep a log of every food I eat, drink, or meds I take and how i'm feeling that day... this was a helpful tool in figuring out what's going on. I wasn’t on those meds when it happened the first time, so we didn’t go in that direction immediately.  Probably just had “remission” of what I had before, so we go keep going down the test list to exclude all the other ulcer, cancer, etc., etc. problems.  In some ways, frustrating to get “normal” results.  ..

BUT in the last two tests, curious things came out of it hat I had to get my doc to focus on.... 1) During the small bowel xray with barium, Radiologist doc was fascinated that my bowels were full of stool but were stretching out so the barium could move around the stool, forcefully enough, it caused that familiar pain, and  I had to jump off table and run for bathroom (which doc thought was odd cuz barium normally gives people constipation, but I had white/gray stools/diarrhea for 2 weeks after that damn test!    

2)  Next test was the camera pill endoscopy which is where you swallow this vitamin size pill that takes pix of it's path thru the stomach and small intestines.  Of course, have to "prep" for it like a colonoscopy the day before where you get cleaned out by mega doses of Miralax over 3 hour timeframe so you're poo'ing water. . Did that, went to doc's office in morning to swallow the little camera and got hooked up with the receivers.  8 hours later went back to doc where I got unhooked, and told to watch my stool to ensure it passed.  Two days later got urgent call day from doc's assistant asking if I’ve seen it pass (no) so to immediately go to hospital for an xray as they wanted to see where the capsule was (or if  it was stuck)... apparently doc saw something of concern while looking at all those pix of my small intestine.   Xray showed it was moving into last part of my colon, but the Radiologist doc saw again "bowels were full of stool"... I thought HOW was that possible after the Prep?????   The Pill passed few days later, and all was well, BUT the key to my illness mystery came during the gross stool inspections… a LIGHTBUILB MOMENT that gave me info I know my doc wasn't looking at.... sorry to be descriptive, but in looking for the camera pill, I saw beans...I knew from my Log that I had eaten bean soup 5 days before I did the Prep and there was supposed to be nothing left in me after the prep, and remember, the Xray report showed I was “Full”.
At doc appointment, this news combined with the fact that the pill camera's 8 hour battery died before it made it’s way through to the end.  This means, my small intestine moves very slow.  And the xrays showing the stool when it shouldnt been there, or when barrioum pushed it's way around it, turns out to also be a function problem.  Not super great news in some ways and the treatment isn’t as easy as taking a med, but at least now, after years and years of all this pain and nausea, we finally are on a path to an answer.  Been reading how some docs give up and just diagnose IBS, but best advise, log everything that goes in and out of your body, note every pain, every med, it will help. . I’m on the path to take away all medications that have any risk of ‘constipation”, then doc and I will be talking about how to get enough exercises for my gut but not overdo on my back herniations, see of nutritionist who specializes in CIPO and maybe I’ll try an acupuncturist to appease my hubby’s request.  I’m just glad there is a plan, because I was at the point of giving up…. Truly, giving up as I couldn’t life the rest of my life the way I have been.   Best of luck to you, and keep researching… and start a Log. !!!
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Avatar_f_tn
hi doctor just wanted to let you know that when i had my bloods drawn they checked for liver disease so that can now be ruled out.
I am getting the HIDA scan and the stomach emptying scan next week. and will have updates of what is going on.
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Avatar_f_tn
sorry i meant to write to doctor kevin-spelling mistake
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hi, i know it's been awhile but i just wanted to add another point. i did a test today on myself to see the reaction. i have been off levsin now for a day cuz i am doing a gastric emptying scan and i can not be on any meds or the results wont come back accurate. so i had a chocolate milk this morning and that didnt affect me at all so i am not lactos intolerant. then later in the evening i did another test where i had a pizza with very little cheese but it was a bit oily and that was at 9:30 pm and at 9:54 i was doubled over in pain with another one of these attacks of mine. could this be related to the gallbladder?? after the gastric emptying scan i am getting a HIDA scan 2 days later and before i do i wanted to know if its related or is this another fact added to the already big mystery that i am going through???
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A related discussion, What to do about unexplained abdominal pain was started.
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