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Gastroenterology (Expert Forum)
Nausea and Upper 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.
Nausea and Upper abdominal pain
by Ordway, Apr 20, 2005 12:00AM
For 4 months I have been experiencing the following symptoms:
1. Nausea - especially bad after sleeping several hours and waking up feeling very nauseous.
2. Upper abdominal pain
3. 35 pounds of weight lost
4. increasing anxiety, depression, and OCD
After receiving an EGD, the doctor found slight inflammation around the flap(?), limited Barretts syndrom (syndrome), and a hiatal hernia.
I have had ph24 test, a CAT scan, and a test where they investigated the muscles in the esophogus as I swallowed, a right quadrant ultrasound which included the gallbladder. All tests came back normal.
My G.I. doctor has had me on the various medications:
alprazolam 1mg twice daily
chlord/clidi 2.5mg 6 times daily
vicodin - usually 3 times a day for the pain (15mg) daily
Prilosec - 1 tablet daily
I have tried these medications various ways and in larger and smaller quantities by doctors orders but the symptoms remain. My G.I. doctor has no alternative solutions which I feel is hard to believe.
For one week I have been seeing a oriental medical doctor who has changed my diet and is providing acupuncture and oriental herbal medicine. The O.M.D. is concerned that I'm over medicated and am doing damage to my digestive system so we have been able to decrease the medications somewhat. I have had slight improvement overall with this technique. However, I am still miserable about 50% of the time.
THE BIG PUZZLE to me is that I can feel pretty good for one hour or so and the next hour I can feel very nauseous and an increasing pain in the upper abdominal region. I am especially nauseous and uncomfortable right after waking up from a longer duration sleep at night. After naps when I wake I don't feel as bad as I do when I wake up in the morning.
Please answer my BIG PUZZLE question and also what should be my next move?
Thank you so much, Alvin
1. Nausea - especially bad after sleeping several hours and waking up feeling very nauseous.
2. Upper abdominal pain
3. 35 pounds of weight lost
4. increasing anxiety, depression, and OCD
After receiving an EGD, the doctor found slight inflammation around the flap(?), limited Barretts syndrom (syndrome), and a hiatal hernia.
I have had ph24 test, a CAT scan, and a test where they investigated the muscles in the esophogus as I swallowed, a right quadrant ultrasound which included the gallbladder. All tests came back normal.
My G.I. doctor has had me on the various medications:
alprazolam 1mg twice daily
chlord/clidi 2.5mg 6 times daily
vicodin - usually 3 times a day for the pain (15mg) daily
Prilosec - 1 tablet daily
I have tried these medications various ways and in larger and smaller quantities by doctors orders but the symptoms remain. My G.I. doctor has no alternative solutions which I feel is hard to believe.
For one week I have been seeing a oriental medical doctor who has changed my diet and is providing acupuncture and oriental herbal medicine. The O.M.D. is concerned that I'm over medicated and am doing damage to my digestive system so we have been able to decrease the medications somewhat. I have had slight improvement overall with this technique. However, I am still miserable about 50% of the time.
THE BIG PUZZLE to me is that I can feel pretty good for one hour or so and the next hour I can feel very nauseous and an increasing pain in the upper abdominal region. I am especially nauseous and uncomfortable right after waking up from a longer duration sleep at night. After naps when I wake I don't feel as bad as I do when I wake up in the morning.
Please answer my BIG PUZZLE question and also what should be my next move?
Thank you so much, Alvin
Doctor's Answer
by Kevin Pho, MD, Apr 24, 2005 12:00AM
, Apr 24, 2005 12:00AM
You have had a pretty comprehensive GI evaluation already. Most of the more common diseases have been ruled out with the tests you have had.
One thing that can be considered would be a gastric emptying scan. This looks for a condition known as gastroparesis and may lead to the symptoms you described.
Another option would be to take another look at the gallbladder. A HIDA scan with CCK stimulation can look at the gallbladder ejection fraction. If the ejection fraction is low, the symptoms like nausea, vomiting and gallbladder pain, may all be caused by this.
These options can be discussed with your personal physician or in conjunction with a GI evaluation.
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.
Medical Weblog:
kevinmd_b
One thing that can be considered would be a gastric emptying scan. This looks for a condition known as gastroparesis and may lead to the symptoms you described.
Another option would be to take another look at the gallbladder. A HIDA scan with CCK stimulation can look at the gallbladder ejection fraction. If the ejection fraction is low, the symptoms like nausea, vomiting and gallbladder pain, may all be caused by this.
These options can be discussed with your personal physician or in conjunction with a GI evaluation.
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.
Medical Weblog:
kevinmd_b
