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Gastroenterology (Expert Forum)
Chronic right abdominal pain
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Chronic right abdominal pain
by phineas, Oct 18, 2006 12:00AM
I am a 37-year-old male and have been experiencing chronic right abdominal pain for approximately 2.5 months. The pain is constant, but varies in intensity (2-8/10). The pain "moves" from the lower right quadrant to the upper right quadrant (right below the rib cage) and is often localized around what I would suspect is the hepatic flexure. Sometimes the pain radiates to my right shoulder blade and/or around my right flank. There appears to be no relationship between the pain and eating. There is no nausea or vomiting, no change in appetite, no unexplained weight loss, and no weakness/increased fatigue. I am a runner but I had to stop because I found that the pounding sometimes made the pain worse.
There has also been a change in bowel habits over this time period, characterized predominantly by constipation, and on a few occasions, diarrhea. I have also noted blood in my stool a few times (either bright red or darker red). Currently (the last few weeks), I have been dealing with constipation and thin stools. Sometimes the stool has a side that is completely flat.
In terms of medical investigations conducted since the pain started, I've had two abdominal ulstrasounds (gall bladder involvement was suspected given the back pain) and an abodominal CT with contrast. All results were negative in terms of explaining the pain. A "prominent bowel loop" in the right lower quadrant was noted on one of the US studies. The small and large intestines were characterized as WNL on the CT study. All bloodwork to date (including liver function tests and lipase value) have been normal.
Regarding my medical history, I have been diagnosed with GERD and IBS. I am currently prescribed Pariet (20mg) and Zantac (150 mg at bedtime). Approximately 26 months ago, I was assessed by a gastroenterologist (for left abdominal pain) and I had a colonoscopy and an upper GI and small bowel series. All results were negative, aside from evidence of internal hemorrhoids. This is when i was diagnosed with IBS. There is no family history of colon cancer.
Given this information, here are my questions:
1) What are the most likely candidates re: differential diagnosis?
2) Is it reasonable to suspect colon cancer given the results of my consult with the gastroenterologist two years ago? I realize the neither US or CT are very sensitive for the purposes of diagnosing colon cancer.
3) What further investigations would you recommend? I have been referred to a gastroenterologist but I won't be seen until at least February 2007. I am not willing to wait that long and I'm considering going to a private clinic (I live in Canada). Would a repeat colonoscopy be indicated? I realize that the standard wait is 10 years after an initial negative scope, but would that apply in my situation?
Thank you in advance for considering my case.
There has also been a change in bowel habits over this time period, characterized predominantly by constipation, and on a few occasions, diarrhea. I have also noted blood in my stool a few times (either bright red or darker red). Currently (the last few weeks), I have been dealing with constipation and thin stools. Sometimes the stool has a side that is completely flat.
In terms of medical investigations conducted since the pain started, I've had two abdominal ulstrasounds (gall bladder involvement was suspected given the back pain) and an abodominal CT with contrast. All results were negative in terms of explaining the pain. A "prominent bowel loop" in the right lower quadrant was noted on one of the US studies. The small and large intestines were characterized as WNL on the CT study. All bloodwork to date (including liver function tests and lipase value) have been normal.
Regarding my medical history, I have been diagnosed with GERD and IBS. I am currently prescribed Pariet (20mg) and Zantac (150 mg at bedtime). Approximately 26 months ago, I was assessed by a gastroenterologist (for left abdominal pain) and I had a colonoscopy and an upper GI and small bowel series. All results were negative, aside from evidence of internal hemorrhoids. This is when i was diagnosed with IBS. There is no family history of colon cancer.
Given this information, here are my questions:
1) What are the most likely candidates re: differential diagnosis?
2) Is it reasonable to suspect colon cancer given the results of my consult with the gastroenterologist two years ago? I realize the neither US or CT are very sensitive for the purposes of diagnosing colon cancer.
3) What further investigations would you recommend? I have been referred to a gastroenterologist but I won't be seen until at least February 2007. I am not willing to wait that long and I'm considering going to a private clinic (I live in Canada). Would a repeat colonoscopy be indicated? I realize that the standard wait is 10 years after an initial negative scope, but would that apply in my situation?
Thank you in advance for considering my case.
Doctor's Answer
by Kevin Pho, MD, Oct 19, 2006 12:00AM
, Oct 19, 2006 12:00AM
To answer your questions:
1) The ultrasound and CT scan can rule out many of the major disorders. Other possible causes can include inflammatory bowel disease (i.e. Crohn's disease), irritable bowel syndrome, or continued gallbladder disease. Things like decreased gallbladder ejection fraction and Sphincter of Oddi dysfunction would not be seen on the ultrasound or CT.
2) Colon cancer is possible. A colonoscopy can be considered if this is suspected.
3) I would consider the colonoscopy as well as further evaluation of the gallbladder. A HIDA scan with CCK stimulation can evaluate the gallbladder ejection fraction. A small-bowel follow-through can be considered to evaluate for Crohn's disease.
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_
1) The ultrasound and CT scan can rule out many of the major disorders. Other possible causes can include inflammatory bowel disease (i.e. Crohn's disease), irritable bowel syndrome, or continued gallbladder disease. Things like decreased gallbladder ejection fraction and Sphincter of Oddi dysfunction would not be seen on the ultrasound or CT.
2) Colon cancer is possible. A colonoscopy can be considered if this is suspected.
3) I would consider the colonoscopy as well as further evaluation of the gallbladder. A HIDA scan with CCK stimulation can evaluate the gallbladder ejection fraction. A small-bowel follow-through can be considered to evaluate for Crohn's disease.
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_
Hida scan, abdominal ultrasound and as well as cat scan revealed nothing so far. I recently changed doctors. The new one is out to get to the root of the problems.
Small bowel studies revealead changes in the jejunum compatible with Celiac disease. I almost fell of the chair when I heard that. The IBD serology (which is a bloodtest), done at Prometheus Lab, predicted Crohn's and inflammatory bowel disease, and ruled out ulcerative colitis.
Next test coming up is a blood test at Prometheus for Celiac, as well as a colonoscopy/endoscopy with biopsy sampling.
He also wrote a script for a bunch of stool studies, everything from fecal fat, stool culture, ova and parasites, occult bloob,
C defficile, and fecal Leucocytes.
Oh and another test, CEA, I don't know yet what that is.
Even though I don't have a firm diagnosis of Celiac yet, I stopped eating for several days anything with gluten. Don't know yet if it helps. Still can't believe all what's going on.
Ina