Re: Severe abdominal pain

Posted By HFHSM.D.-rf on May 12, 1998 at 13:16:17:

In Reply to: Severe abdominal pain posted by Giz on May 10, 1998 at 07:01:42:






    I will try to make this brief as possible.   The first year
of life nothing but hiccups.   Then food was introduced.
Followed by constant constipation, abdominal and chest complaints.
By 3 1/2 extensive dental.   Night vomiting for no apparent reason.
The vomiting was sporadic.  Followed more dental.  Later complaints
of sore throat, constant swallowing, complaints of mucous in throat.
Night vomiting continued and became more and more frequent.   Then started waking with
severe pain about an inch above naval, followed by vomiting and
constipation to diarrhea.  For several years others made note of
my appearance, (pale with dark circles enveloping eyes).  Finally
an endoscopy and was told  GERD (grade 2 esophagitis),  gastritis,
irritable bowel.   Was put on Reglan and told to drink excessive amounts of Maalox.
No results.   Condition continued constant ER visits and hospitalizations.
Suffered from failure to thrive.   New physician prescibed Prevacid and my condition
improved.  Also by now was taking Maalox/Donnatol.  Another endoscopy was ran and
found mild esophagitis and gastritis.   Cisapride was prescribed.  This also helped me.  I continued
improving.  But could always feel the spot above my naval.   Several months passed and
started waking up at night with severe pain.   To describe:   Pain is about an inch above my naval,
is always in the same spot,  about the size of a half dollar.   I immediately have diarrhea,  and if left untreated
start vomiting.  Also my hands become skeletal,  once they drew up in a fist and I couldn't get them to straighten out.
Several times during these events my knees and legs are in severe pain.  Sometimes in ER
they are able to stop these attacks and sometimes several methods are applied before the severe pain stops.
For example:  Phenergan suppositories,  Maalox/Donnatol,  Phenergan in I.V.'s,  finally pain subsided when given Inapsin.
Once several attempts were made and Toradol was given before severe pain would stop.  For 8 months this continued.  I became
lethargic.   Would get sick upon any exertion.  Started having muscle pain as if someone was inside tearing at my muscles, and started
experiencing joint pains.  Blood tests have been told show elevated white count, elevated sugar, and dehydration.   Several months ago
stayed on bland diet and worked up to foods which I found through trial and error dont' bother me.   These foods include:  All grains,
fruits, and vegetables, lean meats.  I continue to improve gaining weight, strength and color.  Have discontinued several prescription drugs
prescribed to me.  But continue to take Prevacid, Cisapride and tums, and sleep with head elevated.  Forgot to mention have severe gas also.
Recently new tests were ran.   Forgot the name but one test they drew blood, removed white cells from red, to check for Crohns Disease.
Also Ultra Sound and blood tests.  These revealed nothing.  At this point they believe I have Reflux, but wonder whether anything else
could be wrong.   I still feel pain in spot, nothing severe.  Have woke with pain and diarrhea, but pain subsided and was able to resume sleep.
I am experiencing more pain with joints (mainly in knees) and have woke to find can't walk and knees won't straighten out, till up for awhile.
I have pain in my back on the sides and have painfull urination and sometimes can't urinate.  No tests have been ran for joint complaints.
They did run urine speciman and I was told nothing was wrong.  Wanted to describe the pain in spot above naval during attacks.   It feels like
something is tearing at my skin to get out, and cannot tolerate anything touching my abdomen when this happens. I take Tylenol for the joint and muscle pain, because I
want to be active.  And I continue to stay in a good frame of mind.
I know you cannot attempt a diagnoses.  But was wondering if you have suggestion of tests that might lead to finding the reason for my symptoms.
Sometimes I feel that I am too young for anyone to take me seriously.
Thank You.

______


Dear Giz,
I read your letter with great interest.  When I see a patient with a complex history like yours, I usually do not think of organic gastrointestinal illness as the primary cause of the problem. Some of your symptoms could be indications of Crohn's Disease.  Exclusion of this diagnosis usually requires gastrointestinal barium x-rays and/or colonoscopy.  Another consideration, although unlikely, is malabsorption with mineral deficiencies as the cause of the muscle pains.  Food allergies may be contributing to your symptoms but it is difficult to prove this diagnosis.  In view of your multiple symptoms, I would wonder about one of the collagen vascular ( autoimmune) disorders causing your symptoms.  You do not provide your age or other medical history, information that could direct workup in this direction.
Your letter does illustrate an important feature of reflux disease.  Acid reflux is a chronic problem.  Symptoms may be present for years, although the severity can fluctuate. Medical treatment can be lifetime.  Surgery can improve symptoms and eliminate the need for medication.  If surgery is considered, an esophageal motility study should be done pre-operatively to exclude any esophageal motility problems that could cause problems in the postoperative period.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
HFHSM.D.-rf
*keywords:: abdominal pain, esophageal reflux, malabsorption, Crohn's disease, food allergy