Abdominal Pain/Loss of weight-appetite

[vjj65]

Here are my symptoms since August of this year and continuing to present:  Pain under right rib cage spreading to back (not always and not incapacitating), fatigue, a feeling of general malaise, complete loss of appetite, loss of weight (26 pounds in 2 and half months), on and off diarrhea and constipation, bloating, burping, terrible indigestion, itchy skin, and a feeling in my upper throat of tightness and that it could swell shut (this is now constant).  Lately the pain has been going to my upper abdomen and left side as well.  Sometimes I feel bone pain in my ribs and back.  Day by day I want to eat less and less.  I feel there is a terrible problem in my digestive system.  The good news is that as of late my bowel movements have been more “normal.”  My GP says this is “somatization disorder.”  While I know this is very real, I believe there is something very  wrong in my digestive system.  These are the tests I have had: 2 Sonograms, Abdominal/Pelvic CT Scan, Hida Scan, MRCP, Endoscopy, Colonoscopy, Lung X-ray, EBT scan of lungs, Small Bowl series, an unbelievable amount of blood tests.

No sign of GERD or other diseases.  Everything normal except slightly elevated hemoglobin and hematacrit counts, as well as an enlarged spleen.  Everything else was perfectly normal.  This prompted a visit to the hematologist and I am currently being tested to see if this is Polycethemia Vera might be an issue.  I recently had a bone marrow biopsy which I am waiting for the results.

My MD and GI doctor assure me that if it is Polycethemia Vera, that has nothing to do with the digestive problems I am having.  While I will not discount stress, I am very scared there is a problem.  I have been seeing a psychiatrist, am on paxil, clonozapam, neurontin, and repardal (sp), and aciphex.  While I believe my doctors have been diligent in trying to help me in ordering the tests, I cannot believe this is stress.  If someone could just feel for 5 minutes what I am feeling, I think they would agree it is not stress.  I don’t know what to do now though.  My GI says he does not want to do an ERCP because he said the only thing I can possibly get out of it is pancreatitus (pancreatitis).  

Can you think of anything else that can be done?  I asked about laproscopic exploratory surgery and my GI doctor emphatically said it was a bad idea.  I am thankful I have good insurance that allows these tests (and that they have been negative), but I want a diagnosis and to get myself well.  
1) Could the CT scan have missed something in the pancreas?  
2) Would the MRCP have identified cancer of the pancreas?  Can anti-anxiety drugs really cure this problem?
3) Could a pancreatic tumor grow that rapidly that it would start hurting on both sides?  (Again, pain is intense only at times and not that often but seems to be getting worse).
I am worried about the pancreas and liver due to lack of appetite and weight loss and itching.  Could this still be a gallbladder issue?

[Kevin Pho, MD]

To answer your questions:
1) There has been a comprehensive evaluation of the GI tract.  If you are concerned about the pancreas, an MRI (seperate from an MRCP) or an endoscopic ultrasound can be considered to further evaluate this.

2) MRCP evaluates the biliary ducts.  An MRI of the pancreas can provide more clarity.  Anti-anxiety medications will help if anxiety is causing your symptoms.

3) It is possible for a pancreatic tumor to cause such pain.  However, if that was the case, it would have to be large enough such that a CT scan would be able to pick it up.  

4) With the itching, you can consider something like primary biliary sclerosis or sclerosing cholangitis.  If this is considered, you can consider a liver biopsy or ERCP for further evaluation.

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.
http://www.straightfromthedoc.com

[worry1]

A hida scan would rule out gallbladder problems for sure!!!The only way to really now if you have a liver problem is a biopy done..I have been trying to get my gi to do one on me but they will not do one if your lft keep coming back normal..But if you read on symtoms of axiety there is a big list of them its pretty crazy on how the mind can do things to your body the mind gut theory..

[ricktrent]

A related discussion, has his issue been resolved? was started.

[Serafym]

A related discussion, loss of appetite + common GERD symptoms was started.