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Upper Abdominal pain
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Upper Abdominal pain

My daughter is suffering from abdominal pain for about 7 months.  Case history is given below.
Name of patient: Devashri Chakravorty
Age: 17
Address: C/o Dr.D.Chakravorty, CSB, Satyam Complex, Link Road, Bilaspur, Chattisgarh 795001

Histry of ailment
1st week June 2007 – High temperature about 102ºF, bodyache, infected tonsil with loose motion. Neighbour doctor diagnosed as heat fever and treatment of antibiotics, pain relivers, oral rehydration started.
2nd week June 2007- Mild feverish but she developed severe upper abdominal pain. Consulted medicine specialist. Blood test revealed infection.  Doctor prescribed antibiotics and other medicines.
3rd Week June 2007 – Abdominal pain persists, blood in stool. Pains occur mostly at night about 2-3 hours after last meal. Pain comes just bellow the middle of the rib cage which spreads to both sides. She rubs her upper abdomen vigorously. Later crushing pain at the back, shoulders, arms even legs. Pain lasts for about 2 hours. Gradually she looses appetite and moves with much effort due to bodyache which lasts the whole day. Blood tests (routine and amylase) repeated, stool and urin tested which are reported to be normal. Ultrasonography carried out which is normal. Doctor prescribed medicines and pain killers
4th Week June 2007 – Pain becomes more severe which occurs about 2 times a day (the pattern is same as above). She is in considerable discomfort after the bouts of pain. Abomen bloated even after very soft food. Breathlessness during pain. Consultation with gastro-enterologist at Apollo Hospital Bilaspur started.
1st Week of July 2007 - Doctor carried out endoscopy and finds gastric antral erosion. Medicines prescribed for 15 days. Soft food suggested. Pain killer continues as and when pain occurred.
3rd Week July 2007 – Not much improvement. Daily episodes of pain, bloated abdomen and discompfort continued. She is cionsiderably week due to frequent pain and discomfort. Barium x-ray revealed delay in in emptying of stomach due to narrowing of the pylorous. Doctor changed some medicines and advised less use of pain killers.
4th week July 2007 – Pain is more. Mostly at night. Pain starts just bellow the middle of the rib cage which spreads to both sides. Wracking pain radiates to all parts. She rubs her upper abdomen vigorously. Difficulty in breathing, head reeling. She is not able to tolerate even very soft food. There is constipation and occasional blood in stool. Apollo Hospital Bilaspur refers to CMC, Vellore.
30th July to 6th August 2007 – Variety of investigations at CMC, Vellore. Diagnosis is biliary sludge and biliary colic. Medicines (Nexpro for two months and Ursodiol for 6 months) prescribed. Returned to Bilaspur. Gastro-enterologist of Apollo Hospital Bilaspur, adds Motiza and Epitril.
Along with allopathic drugs Mag Phos and Nat sulph also were given for some time.  
Present condition: Pain occurs at least once a day either at night or early morning though the duration is about 30-40 minutes.  After some time she goes in to trance and there is jerky convulsion (conversion?). Sprinkling water helps to gain consciousness. Abdominal bloating and discomfort occurs specially at night. Often she looses balance due to reeling. She has fallen a few times. There is burping (as many as 50 times) as she sips water.
Use of pain killers reduced to once in about 3 days.

The local doctor thinks pains  mostly at night  is not a gastric problem. He referred her to a Psychiatrist. The psychiatrist  prescribed one Epitril tablet  at night. But there is no improvement. Please inform is it a gastric problem or what line of consultation should be obtained.
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There are no docs on this board so if you are seeking a medical opinion, you need to repost on one of the doctor-moderated boards.

However, the presence of biliary sludge can cause a number of symptoms similar to those your daughter is going through. If the sludge has been released into the common bile duct, irritation can be felt throughout the biliary system and spasms can result. Biliary spasms can result in crushing chest pain that can radiate throughout the chest. The varying release in bile can result in both constipation and diarrhea.

The pain from biliary spasms can 'floor' a grown man and have him begging for relief.

If the sphincter of Oddi is irritated and spasming, the use of narcotic pain meds can result in increases in ductal pressures and in increasing levels of pain. Pain meds - if the condition is due to biliary issues - need to be carefully chosen.

If a HIDA scan with CCK injection has not been done it might be considered.

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