Three weeks ago I started having mild abdominal pains. It is a dull pain under my lower right rib, and sometimes I also feel it on my lower left rib. The pain kind of dissapears when I am very bussy/stressed out, and it comes back when I am resting. The pain is everytime more frequent, and there are days when lasts all day.
I still eat normally, and food doesn't change what I feel. My weight has not changed at all. I have NOT turned yellow.
I am a 32 year old hispanic man,non-smoker, not drinker,no family history of cancer, no surgeries, 5.5 height, 175 pounds. Last year I was diagnosed positive on H.pylori and mild gastritis. I was treated with antibiotics and prilozec. 2 weeks ago I did an upper endoscopy and they confirmed that my gastritis is gone and that I NO LONGER have H.pylori.
3 months ago I had a slightly elevated Ca19-9 (41 U/mL, the test is normal if less than 37 U/mL. I took the test just for the heck of it). Since then, I have repeated the test 5 times, and 3 of them where elevated, and 2 of them were normal (and they happen to be normal after I take vacations away from the USA and away from my girlfriend). Last week I was tested POSITIVE on mononucleosis.
I already did abdominal CT scans (everything normal), abdomen ultrasound (everything normal, no stones found), a colonoscopy (resulted normal), barium enema (shows no alterations), blood tests for pancreas and liver functions (all good), HIV(negative) and Hepathitis (negative) .
Question: Is it posible that my abdominal pain is related to mononucleosis? Is it posible that is also related to my elevated CA 19-9 (and that is why it is elevated when I am close to my girlfriend, who gave me mono, and it is normal when I am away from her?) Can this be related to stress? Do I still need to be worried about some kind of cancer (even though my doctor already told me not to worry about)? Is there any other test that I should take regarding my abdominal pain? Thanks a lot for your advise.
I agree with the workup thus far, and it has been comprehensive.
The negative imaging studies would make a mass in the liver, or gallbladder disease less likely. That being said, I would also test for hepatitis and other causes that can inflame the liver and lead to discomfort.
Mononucleosis can be associated with splenic rupture, but this presents more with left-sided pain, and would have been seen on the CT scan.
The CA 19-9 marker can be raised in cases of pancreatic cancer, but by itself, cannot diagnose the disease. If this is suspected, further pancreatic imaging can be done with an MRI or endoscopic ultrasound. I cannot explain why this level is fluctuating in your case.
Stress can exacerbate irritable bowel syndrome, and can be considered if the additional tests remain negative.
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 Pho, M.D.
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